Understanding the Elderly Mobility Scale (EMS)
The Elderly Mobility Scale (EMS) is a standardized, validated tool used primarily by healthcare professionals, such as physiotherapists, to assess the functional mobility of frail older patients. A quick and effective measure, it evaluates seven key dimensions of functional performance, including bed mobility, transfers, standing, and walking. The total score, from 0 to 20, is an important data point for guiding treatment, determining care needs, and assessing a patient's potential for returning home after a hospital stay. A higher score on the EMS indicates greater independence and better mobility, while a lower score suggests a greater need for assistance.
The Seven Tasks of the Elderly Mobility Scale
To perform and score the EMS accurately, an assessor evaluates a patient's ability to perform seven specific tasks. The scoring for each item varies based on the level of assistance required and, in some cases, the time taken to complete the task.
- Lying to Sitting: The patient is assessed on their ability to move from a lying position to a sitting position on the edge of a bed. This task is scored from 0 to 2 points based on the level of assistance required.
- Sitting to Lying: This is the reverse of the first task, where the patient is scored on their ability to transition safely from a sitting to a lying position. Like the previous task, the maximum score is 2 points, dependent on assistance needed.
- Sit to Stand: The patient is asked to rise from a chair to a standing position. Scoring for this task, up to 3 points, depends on the time taken to stand or the amount of assistance required. Independent standing in under 3 seconds earns the maximum score.
- Standing: This task assesses the patient's balance and stability while standing. Points, up to a maximum of 3, are awarded based on the amount of support needed and their ability to reach while standing.
- Gait: Evaluating the patient's walking ability, this task awards points based on the need for a walking aid and the level of supervision or assistance required. A maximum of 3 points is possible.
- 6-Meter Timed Walk: The patient is timed walking a distance of six meters. Scoring, up to 3 points, is based on how long it takes them to complete the walk. Faster times earn higher scores.
- Functional Reach: This task measures how far the patient can reach forward from a standing position without moving their feet. The score, up to 4 points, is based on the distance reached, measured in centimeters.
Detailed Scoring Criteria
Each of the seven EMS tasks has a specific scoring rubric. Here is a breakdown of how points are allocated:
- Lying to Sitting & Sitting to Lying (Max 2 points each):
- 2 points: Independent with the maneuver.
- 1 point: Requires assistance from one person.
- 0 points: Requires assistance from two or more people.
- Sit to Stand (Max 3 points):
- 3 points: Independent and takes 3 seconds or less.
- 2 points: Independent but takes more than 3 seconds.
- 1 point: Requires minimal assistance from one person.
- 0 points: Requires substantial assistance from one or more persons.
- Standing (Max 3 points):
- 3 points: Stands independently with no support and can reach.
- 2 points: Stands independently with no support but can only reach with help.
- 1 point: Can stand but requires support from an aid or wall.
- 0 points: Requires assistance to stand.
- Gait (Max 3 points):
- 3 points: Walks independently without an aid.
- 2 points: Walks independently with a walking frame or aid.
- 1 point: Walks with an aid but is unstable or needs supervision.
- 0 points: Requires assistance to walk.
- 6-Meter Timed Walk (Max 3 points):
- 3 points: Completes the walk in under 15 seconds.
- 2 points: Completes the walk in 16–30 seconds.
- 1 point: Completes the walk in over 30 seconds.
- 0 points: Unable to complete the walk.
- Functional Reach (Max 4 points):
- 4 points: Reaches 20 cm or more.
- 2 points: Reaches 10–20 cm.
- 0 points: Reaches less than 10 cm.
Interpreting the Final EMS Score
The EMS is a summative scale, meaning the total score from all seven tasks is added up to give a final score between 0 and 20. The interpretation of this score is crucial for clinical decision-making.
- 14–20 points: Indicates good mobility and independence in basic activities of daily living (ADLs). These individuals can often return home with minimal support.
- 10–13 points: Suggests borderline safe mobility, with the individual potentially needing some assistance with mobility maneuvers and ADLs. This range often signals the need for physiotherapy or home care support.
- <10 points: Indicates a higher level of dependency, with the patient requiring significant help with mobility and ADLs. This may suggest the need for long-term care or more intensive support.
EMS Compared to Other Mobility Scales
While the EMS is an effective tool, it is one of many used to assess senior mobility. Below is a comparison table outlining how it differs from other common assessments like the Timed Up and Go (TUG) and the Berg Balance Scale (BBS).
| Feature | Elderly Mobility Scale (EMS) | Timed Up and Go (TUG) | Berg Balance Scale (BBS) |
|---|---|---|---|
| Focus | Comprehensive functional mobility (transfers, gait, balance, reach). | Balance and walking speed (risk of falls). | Static and dynamic balance abilities. |
| Scoring Range | 0 to 20 | Time in seconds | 0 to 56 |
| Items Assessed | 7 tasks | 1 task (stand, walk, turn, sit) | 14 items |
| Administration Time | Typically under 15 minutes. | Typically under 2 minutes. | Approximately 15–20 minutes. |
| Target Population | Primarily frail elderly patients. | General older adult population. | Older adults with impaired balance. |
| Key Insight | Overall mobility function for care planning. | Mobility, gait speed, and fall risk. | Specific balance deficits and fall risk. |
For a deeper dive into the clinical applications of the EMS and other mobility measures, physiotherapists can consult resources from the American Physical Therapy Association (APTA), which provides guidance and assessment forms, including one for the Elderly Mobility Scale available in a PDF format at https://www.apta.org/contentassets/fb58958a7c774637b33b41f1379092fa/elderly-mobility-scale-with-changes.pdf.
The Importance of a Complete Assessment
While the EMS provides a quick and reliable measure of mobility, it is not a complete picture of an individual's health. The EMS score does not account for cognitive function, motivation, or specific diagnoses that may impact mobility. Therefore, it is often used alongside other assessments and clinical judgment to form a comprehensive care plan. For instance, a low score may indicate the need for intensive physiotherapy, while a moderate score might suggest ongoing support or assistive devices.
Conclusion
The Elderly Mobility Scale is a valuable tool for healthcare professionals seeking to quantify and monitor mobility in older adults. By systematically assessing seven key functional tasks and summing the points, it provides a simple yet effective score ranging from 0 to 20. Interpreting this score helps clinicians make informed decisions regarding patient care, discharge planning, and fall prevention. By understanding how do you score the elderly mobility scale, providers can better tailor interventions to enhance a patient's independence and quality of life.
