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A Common Language for Dementia using the Senior GEMS

Updated: Apr 30

In the article: "DEMENTIA - Keep Responses Positive" published in the Fall 2023 issue of GO Christian Magazine I called for a standard language for dementia.

Below is a chart I created that correlates the Senior GEMS with other popular Rating Scales including the Global Deterioration Scale (GDS), the Alzheimer's Association, the Allen Cognitive Scale, FAST Stages, MDS and Developmental Age Comparisons.

When the Caregiver Team uses a common language, communication is possible.

The Senior GEMS is the only staging mechanism that provides strategies to use and strategies to avoid at each level of dementia.

*MCI = Mild Cognitive Impairment

The FAST Scale

The Dementia FAST Scale, a tool used by healthcare professionals, helps determine when someone with Dementia might be eligible for hospice care. This tool is not well known to caregivers, but it provides insight into where the disease path leads. I believe it is a very valuable tool to help caregivers understand the progress of the disease

It considers a person’s functional abilities: Functional Assessment Staging Test (FAST): This scale ranges from 1 to 7.

  • FAST Stage 1: Normal functioning, no difficulty.

  • FAST Stage 2: Normal functioning, slight difficulty with complex tasks.

  • FAST Stage 3: Independent in basic self-care but requires help with complex tasks.

  • FAST Stage 4: Supervision needed for basic self-care.

  • FAST Stage 5: Assistance needed for most activities.

  • FAST Stage 6: Assistance needed for all activities, and communication becomes limited.

  • 6a. Improperly putting on clothes without assistance or prompting (e.g., may put street clothes on overnight clothes, or put shoes on wrong feet, or have difficulty buttoning clothing) occasionally or more frequently over the past weeks. 

  • 6b. Unable to bathe properly (e.g., difficulty adjusting bathwater temp.) occasionally or more frequently over the past weeks. 

  • 6c. Inability to handle mechanics of toileting (e.g., forgets to flush the toilet, does not wipe properly or properly dispose of toilet tissue) occasionally or more frequently over the past weeks. 

  • 6d. Urinary incontinence occasionally or more frequently over the past weeks. 

  • 6e. Fecal incontinence occasionally or more frequently over the past weeks. 

  • FAST Stage 7: Total assistance needed, including eating and walking.

  • 7a. Ability to speak limited to approximately a half-dozen intelligible different words or fewer in the course of an average day or in the course of an intensive interview. 

  • 7b. Speech ability is limited to the use of a single intelligible word in an average day or in the course of an intensive interview (the person may repeat the word over and over). 

  • 7c. Ambulatory ability is lost (cannot walk without personal assistance). 

  • 7d. Cannot sit up without assistance. 

  • 7e. Loss of ability to smile. 

  • 7f. Loss of ability to hold head up independently.

The FAST Scale helps determine when a person with Dementia may need hospice care, which focuses on providing comfort and support for both the individual and their family during the advanced stages of the disease. To be eligible for hospice with the main diagnosis of Dementia, someone with Dementia must score a 7a or above. 


The 7-stage model delves deeper into the dementia journey, allowing us to understand the gradual changes that occur. Each stage represents a different challenge:

  1. No Cognitive Decline: This is the starting point, where there’s no noticeable decline in memory or thinking.

  2. Very Mild Cognitive Decline: A bit like forgetting where you placed your keys. It’s normal forgetfulness.

  3. Mild Cognitive Decline: This stage is like a cloudy day. People might struggle with finding the right words or remembering names.

  4. Moderate Cognitive Decline: Here, the clouds start to get thicker. Daily tasks become more challenging, and assistance is needed.

  5. Moderately Severe Cognitive Decline: The clouds are now a steady rain. Memory gaps become more pronounced, and confusion sets in.

  6. Severe Cognitive Decline: The storm intensifies. Basic activities, like bathing and dressing, become difficult without help.

  7. Very Severe Cognitive Decline: The storm is at its peak. People lose the ability to communicate and usually need round-the-clock care.

Understanding these stages helps us adapt our care to the changing needs of our loved ones.


The 3-stage model was the original model. It is simple but does not provide enough information for the Caregiver to address the ever changing needs of the person living with dementia.

Early Stage: Memory problems may become noticeable. A person may forget appointments or names. It’s essential to be patient and offer gentle reminders.

Middle Stage: Memory loss becomes more obvious and daily activities become challenging. Loved ones might need assistance with dressing, eating, or even using the bathroom. Create a safe environment and maintain a consistent routine.

Late Stage: Communication becomes very difficult and physical abilities decline. Constant care is needed. Provide comfort and ensure the person living with dementia is as comfortable as possible.

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