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Decline in Function Scales

Functional Assessment Staging (FAST) scale:
Assesses the decline of patients with Alzheimer’s disease.

FAST Scale Stage Characteristics
1... normal adult No functional decline.
2... normal older adult Personal awareness of some functional decline.
3... early Alzheimer’s disease Noticeable deficits in demanding job situations.
4... mild Alzheimer’s Requires assistance in complicated tasks such as handling finances, planning parties, etc.
5... moderate Alzheimer’s Requires assistance in choosing proper attire.
6... moderately severe Alzheimer’s Requires assistance dressing, bathing, and toileting. Experiences urinary and fecal incontinence.
7... severe Alzheimer’s Speech ability declines to about a half-dozen intelligible words. Progressive loss of abilities to walk, sit up, smile, and hold head up.

Developed by NYU Medical Center’s Aging and Dementia Research Center,
Barry Reisberg, MD

Karnofsky Performance Status

Description of Function Activities/Needs Index
Normal, no complaints, no evidence of disease 100%
Able to carry on normal activity, minor signs of symptoms of disease 90%
Normal activity with effort, some signs of symptoms of disease 80%
Cares for self, unable to carry on normal activity or to do active work 70%
Requires occasional assistance but is able to care for most of own needs 60%
Requires considerable assistance and frequent medical care 50%

<50% = Hospice Referral

Disabled, requires special care and assistance 40%
Severely disabled, hospitalization indicated although death not imminent 30%
Very sick, hospitalization necessary, active supportive treatment necessary 20%
Moribund, fatal processes progressing rapidly 10%
Dead 0%

The Karnofsky Performance Status Scale is one objective means of documenting a patient’s clinical decline. Most patients with a Karnofsky scale of less than 50% are eligible for hospice care.

Palliative Performance Scale

Activity & Evidence of Disease Ambulation PPS Level
Normal activity & work
No evidence of disease
Full 100%
Normal activity & work
Some evidence of disease
Full 90%
Normal activity with effort
Some evidence of disease
Full 80%
Unable to do normal job/work
Significant disease
Reduced 70%
Unable to do hobby/housework
Significant disease
Reduced 60%
Unable to do any work
Extensive disease
Mainly sit/lie 50%
Unable to do most activity
Extensive disease
Mainly in bed 40%
Unable to do any activity
Extensive disease
Reduced oral intake
Totally bed bound 30%
Unable to do any activity
Extensive disease
Minimal oral intake
Totally bed bound 20%
Unable to do any activity
Extensive disease
Mouth Care Only
Totally bed bound 10%

This is an abbreviated version of the Palliative Performance Scale (PPSv2) version 2, modified for use in this guide only.
Copyright © 2001 Victoria Hospice Society.

Blank scaling forms are available from Hospice of Marion County Community Liaisons by calling (352) 873-7400.