FAST scale

Functional Assessment Staging Scale (FAST scale) is a tool that is widely recognized as a method of evaluating the progression of dementia. Dementia is a condition that is identified by a progressive decline of cognitive function that impacts an individual’s thinking, memory, judgment, language, comprehension, calculations, learning capacity, as well as orientation to person, place, time, and/or situation. In this blog article, we will be discussing dementia, the FAST tool, administration, scoring, documentation, interventions, and its implications.

It is important to understand that dementia in itself is not a specific disease but a group of symptoms with underlying conditions. Some of the most common types of dementia include Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia. 

With the progression of dementia, an individual can experience a range of decline in their functional abilities which can impact an individual’s ability to perform tasks independently. These tasks include instrumental activity of daily living tasks (IADLs) such as cooking, cleaning, and managing finances, as well as activities of daily living tasks (ADLs) including eating, bathing, dressing, and toileting. 

The different stages of dementia are as follows:

Early-Stage Dementia:

• Individual may still live independently

• May require minimal assistance for IADLs

• Mild cognitive impairment: Example: Forgetfulness

Middle-Stage Dementia:

• Individual is moderately impacted specifically with their behavior and personality such as mood swings

• Difficulty with executive functioning, problem-solving, memory, and decision making

• Basic self-care needs may be done independently, however, more complex ADLs and IADLs such as organization, financial management, and planning may require some assistance

• May require caregiver assistance

Late-Stage Dementia:

• Severe cognitive impairment impacting communication, reasoning, and memory

• Dependence for IADLs and may require significant assistance for basic ADLs

• May exhibit loss of physical abilities such as incontinence and mobility

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What is the FAST scale?

The Functional Assessment Staging Scale (FAST scale) is an assessment used to evaluate the progression of dementia, specifically that of Alzheimer's Disease. It was developed by Dr. Barry Reisberg in 1982, in order to define and level all forms of dementia. Reisberg and his colleagues were able to create the scale by closely examining functional abilities and behavioral changes as Alzheimer’s disease progressed. They highlighted key areas of functioning that were impacted specifically memory, self-care, and communication. Based on these key areas, the team created stages and with increased research, the FAST scale became highly valid and reliable.

The FAST scale is a significantly valuable tool in occupational therapy that provides a comprehensive evaluation and assessment of an individual’s functional abilities and functional decline over time. It is a standardized assessment tool that allows consistency and clear communication among healthcare professionals and caregivers. 

The FAST scale provides insight into individuals with dementia and assists with the plan of care process by understanding where the individual is on the scale, which can help caregivers and professionals understand and anticipate what type of support the individual requires currently as well as for the future. 

Furthermore, the FAST tool allows for appropriate intervention methods and support for the individual. A comprehensive and early diagnosis of dementia can assist with managing symptoms as well as improve over quality of life for the individual. 

Administration and scoring of the FAST Scale

The FAST scale is important for assessing functional decline and focuses on functional ability levels vs symptoms and provides a framework for the progression of dementia, specifically Alzheimer’s disease. Administrating the FAST scale includes a comprehensive approach through detailed observations and interviews. 

Observation includes the therapist observing the individual’s ability to perform various functional abilities, behavior through interactions, and discussions over time. In addition, to gain more valuable insight, interviews are carried out with family members, or caregivers related to the individual’s ability to perform and navigate ADLs and IADLs. It is crucial that the therapist document specific, relevant, and key data points regarding the individual’s abilities, behaviors, and functional decline. 

The tool categorizes individuals into 7 different stages based on cognitive function and functional abilities.

FAST scale 7 stages of dementia

Stage 1: Normal Functioning

• No cognitive decline

Stage 2: Normal Aging - Age-related memory impairments

• Age-related forgetfulness

Stage 3: Early Stage - Mild Cognitive Decline

• Forgetting names or recent events
• Functional abilities are still intact

Stage 4: Mild Dementia - Early stage Alzheimer’s

• Difficulty with IADL tasks such as cooking, cleaning, finances, and/or travel
• More significant cognitive deficits-decreased problem-solving skills, attention, and memory
• Functional cognitive decline is apparent

Stage 5: Moderate dementia - Mid-stage Alzheimer’s

• Requires assistance with ADLs
• Difficulty with orientation to time or place
• Moderately severe cognitive decline
• Can no longer live independently

Stage 6: Moderately severe dementia - Late-stage Alzheimer’s:

• Requires 24/7 supervision or assistance
  • Requires assistance for dressing
  • Requires assistance for bathing
  • Requires assistance with toileting 
  • Urinary incontinence
  • Fecal incontinence

Stage 7: Severe dementia - Very-late Stage Alzheimer’s:

• Limited ability to speak, ~1-5 words a day
• Loss of intelligible vocabulary 
• Loss of mobility/cannot walk
• Requires assistance to sit up independently
• Inability to smile
• Inability to hold up head independently 

Interpretations and implications

Interpreting the FAST Scale scores involves understanding the level of severity of functional decline and the impact it has on an individual’s function in daily life. However, as the FAST Scale highlights functional abilities, it is important to note that it may not encompass all areas of cognitive decline, nor do individuals progress at the same rate. 

Healthcare professionals, family members, and caregivers use the FAST Scale to help plan and guide interventions, communicate among other professionals, and address patient needs and future needs. Furthermore, medical professionals may also use the FAST tool to indicate whether the individual will need hospice care. While the first 2 stages are indicative for normal age-related cognitive decline in elderly adults, for individuals who are in stage 7 or very late stage Alzheimer’s, it is indicative of a life expectancy of 6 months or less.

Documentation, goals, interventions and treatment plans

Based on the results of the FAST, it is crucial to document, set realistic goals, measure progress, and plan interventions accordingly. Documenting involves a comprehensive evaluation and assessment with a detailed history, cognitive abilities, and social support. 

It is important to remember that goals are client-specific and based on their current stage. For clients with Alzheimer’s, it is crucial to set realistic goals based on the SMART system. 

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A vital aspect of the FAST scale is to integrate the scores into an intervention plan. Intervention methods are specific to stimulate cognition, address ADLs, behavioral management, and address safety issues. Some examples of goal areas and intervention methods can be found below. Furthermore, periodic communication with healthcare professionals and reassessment is important.

Education

With each stage of dementia, it is crucial to provide caregivers and family members with the appropriate level of education, resources, appropriate expectations, and planning for the future, based on the individual’s needs. 

Education and resources can include: 

• What Alzheimer’s is
• Community resources
• Respite care
• Support groups 
• Counseling services
• Financial and legal guidance 
• Coordinating care
• Home modifications 
• Behavioral management
• End-of-life-planning

Overall, the FAST scale is a comprehensive tool that is widely utilized by healthcare professionals for individuals with Alzheimer’s disease. The FAST scale is a crucial tool in the evaluation, planning, and tracking progress for the progression of dementia.