Stages of Dying
Estimating Life Expectancy
Assessing the Physical Stages of Dying
We are pleased to provide you access to the resources below through this website. These resources consist of standard tools used by hospice organizations and other medical providers, to assess the physical stages of dying and to predict life expectancy.
Please note that are not the authors of these tools. We have merely attempted to provide you with easy access to them through this website.
In addition to the resources below, also see the Hospice Admissions Guidelines document we use at Hospice of The Gorge, which provides a summary of the Medicare guidelines for determining life expectancy at the end-of-life.
Please let us know if these tools related to the physical stages of dying and life expectancy are useful to you. Also, let us know if you are aware of other on-line tools that we could provide others with access to through this website.
You may contact us at Hospice of The Gorge.
Tools for Any Condition
Victoria Palliative Performance Scale
Click to access the Victoria Palliative Performance Scale.
Like most other hospice agencies, Hospice of The Gorge has replaced the Karnofsky e scale (below), used in earlier years, with the Victoria PPS. A hospice patient’s physical decline may not always be promptly reflected in lower scores, but the Victoria PPS typically offers a good baseline and can provide helpful interval monitoring. You will find PPS scores on the Care Plans sent periodically to you by Hospice of The Gorge when we are serving your patient.
The Karnofsky Scale (modified)
Click to access the Karnofsky Scale.
Still certainly useful, and long used by hospice professionals. First developed for cancer patients.
Mini-Mental Status Exam
Click to access the Mini-Mental Status Exam.
You may have learned to administer this simple tool during your training years. It can indicate cognitive impairment and, in the sense of prognostication in patients with chronic terminal illnesses, can be followed over time. If you would like a Spanish-language version (and some disclaimers), please contact Hospice of The Gorge.
Tools for Cancer Patients
Four Scoring Instruments Described: PaP, PPI, CPS, TCP
Click to access the Four Scoring Instruments.
(select "tables" to see the scoring systems ... you may need a medscape registration to view these.)
Helpful to many primary care clinicians,, these four simple scoring instruments for estimating survival time for cancer patients are reviewed in the article linked, which notes that the PaP is the best validated among them. To use the PaP you will need to have “scored” the patient with the Karnofsky scale, preceding.
Tools for Alzheimer's Dementia Patients
FAST Score
Click to access the FAST Score Instrument.
The FAST score is considered a highly useful tool for prognistication purposes in cases of Alzheimer’s Dementia.
In the absence of significant comorbidities or other factors clearly contributing to a predicted short life expectancy, patients admitted to hospices for end-stage Alzheimer’s would usually have a FAST score of 7C or higher. However, a patient with a lower score may well be hospice-eligible.
For example, although the patient still articulates a dozen or more words, they do not represent meaningful communication. As another example, a patient with a lower FAST score may still have end-stage A.D. and be appropriately predicted to die from the disease within 6 months, if he or she has already fallen frequently, lack reliable caregivers, or have health care representatives who have elected against further treatment with antibiotics if urosepsis or pneumonia should recur.
As a scoring system, the FAST is not validated for other dementias. However, like the Mini-Mental Status Exam, it can be a rough indicator (baseline or monitoring) of functional or cognitive abilities in vascular, Lewy Body, or other dementias.
Tools for Cardiac Patients
New York Heart Association Functional Class
Click to access the New York Heart Association Function Class System.
This too is probably a familiar classification system. It is not a scoring tool nor regarded as a sensitive predictor of life expectancy, but it can be contributory. For example, Medicare tends to regard hospice eligiblity on the basis of “end-stage CHF” or “end-stage cardiac disease” as requiring NYHA Classification IV.
