Alzheimer’s and Dementia

When to Call Palliative Care

Fast Scale Stage 6*

  • Difficulty dressing

  • Serious difficulties with bathing

  • Inability to toilet properly without help

  • Urinary incontinence

  • Fecal incontinence

When to Call Hospice Care

Fast Scale Stage 7a*

  • Severely limited speech, just a handful of words a day

  • Little to no intelligible speech

  • Unable to walk

  • Unable to sit up without help

  • Unable to smile

  • Unable to hold head up without help

Referral Guidelines

Disease Related Complications such as:

  • Aspiration pneumonia

  • Pyelonephritis or upper urinary tract infection

  • Septicemia

  • Decubitus ulcers, multiple, stage 3-4

  • Fever recurrent after antibiotics

  • Difficulty swallowing or refusal to eat

  • If receiving artificial nutritional support (NG or G-tube, TPN), patient must be exhibiting continued weight loss despite the feedings

  • Protein calorie malnutrition:

  • Weight loss over 11% or BMI<18 or Albumin <3.1

Plus either:

OR Significant Comorbidity such as:

  • Heart Failure

  • Advanced Cancer

  • COPD

If the patient does not meet above guidelines but is still thought to be appropriate for hospice (e.g., has comorbidities, recent rapid decline), please call for an assessment.

*SOURCES:

  • Sclan, S. G., & Reisberg, B. (1992). Functional Assessment Staging (FAST) in Alzheimer’s disease: Reliability, validity, and ordinality. International Psychogeriatrics, 1992 (4), Supplement 1:55-69.

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*SOURCES:

  • Sclan, S. G., & Reisberg, B. (1992). Functional Assessment Staging (FAST) in Alzheimer’s disease: Reliability, validity, and ordinality. International Psychogeriatrics, 1992 (4), Supplement 1:55-69.