Using the Elderly Mobility Scale (EMS) to Assess Mobility in Seniors

Change in physical ability is normal with advanced age— especially loss of mobility. Walking speed, flexibility, strength, and balance are important to watch in senior patients. These abilities are critical for safety, independence, and health while reducing injury.

Loss of these functions in elder years should be assessed over time. But when can you really pinpoint when a patient requires improved care? This is where the Elderly Mobility Scale, a rubric for health professionals, can be useful.

In this article, we will take a close look at using the Elderly Mobility Scale (EMS). This helps assess mobility in seniors and make the right decisions for their welfare.

What is the Elderly Mobility Scale Score?

Referred to as EMS for short, this scale is a basic tool for assessing physical capability. It is usable by both health professionals and non-professionals— even family members.

The EMS was developed in 1994. It helps determine function in adults of advanced age while determining future care. Designed for this rite of passage decision, the scale evaluates individual mobility. These include movement, reach, range, balance, gait, and more. The EMS can also help care providers keep track of how factors change as aging progresses.

EMS results help providers warrant important changes to the patient’s lifestyle. This is especially where their safety and welfare are concerned. These may include changes to in-home care, public care, living situations, and more. So may a senior’s health routine, accessibility, walking accommodations, and other physical accommodations.

What exactly is assessed with the Elderly Mobility Scale or EMS?

There are 7 different functional movement tests included in the scale, each with its own point system. There is a score assigned to each test based on how much assistance the patient needs to move. Some score only based on basic abilities.

Among these functional movement tests are:

• Test 1: Ability to reach from a static position (such as for an object, cane, doorknob, etc.)
• Test 2: Ability to move from sitting to standing position
• Test 3: Ability to move from sitting to lying position
• Test 4: Ability to move from lying to sitting position
• Test 5: Ability to stand with good balance
• Test 6: Ability to walk independently (gait)
• Test 7: Speed of walking from point A to point B (timed)

Higher scores show stronger mobility and independence in a senior. This also indicates less urgency for any new accommodations or changes. Lower scores mean that the patient is highly dependent on others. They likely need help to complete basic everyday movements or tasks.

What specifics are evaluated in each of the 7 EMS scoring categories?

Each category looks closely at a specific assessed activity in an individual. It may look at other components, too. You can find different Elderly Mobility Scale charts from different online health resources. While each chart looks more or less the same, you may also notice some small differences. The general structure and categories found in the rubric will be universal.

Specific (and more) components in the 7 EMS general scoring categories may include

• Bed mobility. – General ability to get in and out of bed, and use bed
• Position transfers. – Subject completes movements from bed to chair, chair back to bed, etc.
• Walking speed. – Time walking from point A to point B to determine function
• Turning 360 degrees. – Simple test for the amount of time and steps required to turn a full circle (in place). This helps determine both physical ability and dynamic balance
• Basic balance test. – The Tinetti test may be used. This tests an individual’s balance with a small push both when the patient’s eyes are closed and open
• Reaction to a pull. – Like the test above. A pull may be administered instead of a push to assess the balance

How does scoring work with the Elderly Mobility Scale (EMS)?

Each activity is tested, then scored, using the chart (see below). Going through the entire scale and each category takes a total of 15 minutes on average. Each category tallies a certain number of points. Finally, all scored categories are combined to complete and then interpret the test.

The highest score possible is 20 points, indicating high mobility and independence. A lower score (or no points) indicates very low mobility and dependence. Consideration for better accommodations should be made.

Sample Standard Scoring Worksheet

A score of 10 points or lower (dependence). – The patient is very dependent on another (or others) for most basic functions. They will need help with basic living activities such as bathroom, dressing, etc. If living independently, this score may mean reconsideration for improved accessibility or accommodations.

Scores between 10 and 13 (borderline mobility). – Only some new accommodations may be needed to improve quality of life. Patients should be watched closely for gradual or rapid changes in physical function.

Scores 14 and higher (independence). – The patient is still relatively independent. They can complete most daily tasks and movements safely and without any help. Scores closer to 14 may show a need for closer observation and further testing. This is especially relevant if one notices sudden new changes in physical mobility.

Strengths and Limitations of the EMS (Pros and Cons)

The Elderly Mobility Scale (EMS) remains widely used by health professionals. It is considered a standard today. The EMS has been clinically tested and studied in research for its effectiveness. It has also been studied alongside (and in comparison with) other similar assessments.

Authority health resources highlight EMS benefits. These include ease of use, simple functionality, and very basic equipment or training to administer. Family members and health professionals alike can easily use the EMS. It is used to safely and accurately inform both personal and professional decisions.

The EMS may have some limitations to note: including a “ceiling effect.” This means most testers are likely to score the highest points possible— the test can be easy to “pass.” On its own, the scale is not 100% accurate or fault-free at assessing senior mobility. It may also have situational or contextual limitations. These should be adapted to–such as pre-existing disabilities.

Further, the EMS may be limited in how well it assesses certain physical skills. Most indoor situations do not have the required walking distance of 6 meters or 20 feet. This can be adapted to. The EMS also does not account for strength or fitness along with mobility. It also doesn’t factor an individual’s emotional well-being, mental health, or confidence. It may also leave out other possible cultural or personal biases.

That said, the EMS is still widely and reliably used today. It uses only trustworthy metrics that ultimately benefit elderly care, well-being, and lifestyle. Reviews of the EMS have shown that score results strongly accurate. Results are often correlated with the amount of falls an individual has had. Low scores on the EMS are often associated with having 2 or more falls.

It is also important to remember: the Elderly Mobility Scale is only one tool. There are others that can further help one make an informed decision. A scale score should not be the “end-all-be-all” factor for decision making. Health professionals should make choices that feel best for them and the assessed. Health decisions should not rely on data only!

Applications of the EMS How and Where to Use the Elderly Mobility Scale Calculator

Administering EMS with a patient takes place in a hospital or similar setting. It usually follows considerable illness or injury. It is in these recovery settings that new mobility concerns should be addressed. The test should only be carried out once the patient has recovered to their best ability. Normal or baseline functioning levels should be the focus of the evaluation.

The EMS is a simple enough tool for family members to also use. That said, it is best used in clinical settings by a health professional or caregiver.

Requirements for carrying out the EMS:

• Room with enough space for walking test (6 meters, 20 feet)
• Chair for sitting test
• Bed for laying test
• Stopwatch
• Elderly Mobility Scale form (see above) for scoring
• Any needed walking aids to complete the walking test (cane, walker, etc.)

The EMS test itself is simple. It is adapted to many clinical situations, and health cases, and for different purposes. For example:

• Identifying new mobility risks and limitations. EMS is a great way to catch any unprecedented or new physical issues. This is important following sickness, injury, or falls that could impact safety.
• Monitoring progress in rehabilitation and intervention programs. Scoring on the scale can be used to assess a patient routinely. It can help gauge improvement and return to independent living as well.
• Informing clinical decision-making and care planning. EMS can be one of many tools used to help define the next steps in the care of a senior individual. These can include new or improved accommodations, accessibility, or transition to new care.
• Research interventions and predicting mobility outcomes. For clinicians, EMS scores across many different individuals can be very useful. Data may identify patterns, trends, and future developments to help senior care.

Future Directions: Is EMS still useful and valid today?

The Elderly Mobility Scale was developed thirty years ago. It remains a professional standard today, and few improvements have been needed to keep it so. While the EMS has some setbacks, this alone is evidence of just how useful and impactful this tool can be.

To improve EMS outcomes, other assessment tools can be used along with it. These can improve accuracy and track progress in elderly mobility, recovery, and more.

Other useful assessment tools for elderly mobility and next-care steps:

• 8 Foot-Up-and-Go (UG) (speed, ability, and dynamic balance)
• Backward Walking (BW) (walking ability)
• Figure of 8 Walk (F8W) Test (walking and balance ability)
• Physical Performance Test (PPT) (physical functions and capabilities)
• Pick-Up Weight Test (reaching, balance, and strength)

According to PubMed there is no “universal perfect index” for assessing elderly mobility. Having different reputable, accurate, and simple assessment strategies available is needed. All these together (including EMS) help determine patient capabilities. Together, these can continue delivering the best outcomes for seniors in healthcare.

Final Thoughts

The Elderly Mobility Scale has a strong history as a helpful tool in healthcare. It helps assess physical capabilities and improvements in patients. It may also aid in informing next care steps for the elderly. Finally, it can provide useful data for interventions and trends in senior care.

The Elderly Mobility Scale (EMS) Calculator also:

• Helps improve the safety and lifestyle of individuals as they reach advanced age
• Evaluate many physical capabilities of seniors: including mobility, balance, reach, and more
• Easy to use and understand in both clinical and personal settings
• Helps determine next steps in care needs and accommodations. May involve illness, injury, or any other cause for loss of physical function
• Will remain a standard assessment tool along with many other tests

EMS and other assessment strategies are important for both families and health providers. They help determine what is best for their patients or loved ones and are quite easy to use.

If you are a professional making decisions for senior patients, be sure to consider the EMS. Consider other mobility assessments, too. These will both inform and guide you in your clinical evaluations and decisions.

References

• Prosser L, Canby A. (1997) Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalized elderly people. Clin Rehabil; 11(4):338-43.
• Nolan JS, Remilton LE, Green MM. (2008) The Reliability and Validity of the Elderly Mobility Scale in the Acute Hospital Setting. IJAHSP; 6 (4)
• Smith R (1994) Validation and Reliability of the Elderly Mobility Scale. Physiotherapy 80, 744-747
• Spilg EG, Martin BJ, Mitchell SL, Aitchison TC. (2001) A comparison of mobility assessments in a geriatric day hospital. Clin Rehabil; 15(3):296-300.