Referral for individuals who are suffering with late-stage dementia ought to weigh factors such as Functional Assessment Staging guidelines, experienced clinical judgement, and feedback from family members and patients.
Patients are considered to be in the terminal phase of Alzheimer’s disease if they meet this criteria: One plus either two or three must to be present:
- Stage seven on the FAST (Functional Assessment Staging) Scale – A, B and C criteria are critical signs of end-stage Alzheimer’s disease.
Other criteria lend more support to terminal status:
- Incapable of holding head up
- Incapability of smiling
- Incapability of sitting up independently
- All intelligible vocabulary is lost
- Non-ambulatory (incapability of ambulating and bearing weight)
- Unable to communicate meaningfully (1 – 5 words per day)
- Existence of co-morbid disease that is distinct from the terminal illness impacts functional impairment. The combined impact of Alzheimer’s and co-morbid conditions ought to support a prognosis of six months or less.
- Neurological Disease
- Renal Failure
- Liver Disease
- Patients must have had 1 of the below secondary conditions within the last year:
- Aspiration pneumonia
- Unable to maintain enough calorie and fluid intake shown by either of these: Serum albumin < 2.5 gm/dl OR 10 percent weight loss during the prior 6 months
- Fever that is recurrent after antibiotics
- Multiple decubitus ulcers, stage 3 to 4
- Pyelonephritis or additional UTI
- Intractable or recurrent infections, like pneumonia or additional URI
What is the Eligibility Criteria for Cancer Patients?
Patients are considered to be within the terminal phase of cancer and qualified for hospice care if they meet this criteria:
Factors one and two have to be present; and either factor three or four has to be present. Consider all factors that affect a patient’s prognosis.
- Palliative Performance Scale <= 70 percent
- Dependence for 2 or more ADLs (activities of daily living).
- Pathology report uncovers evidence of metastases or malignancy.
- Progression from earlier phase of disease to metastatic disease with either:
- Patient declines more disease directed therapy, or
- Continuous decline in spite of therapy