Elderly Mobility Scale
Elderly Mobility Scale is used to assess functioning in older adults. Assessing mobility in the older adult population is important in all rehabilitation settings. Mobility assessments help clinicians determine the type of care and level of support that older adults need to remain safe and maximize functional independence. There are many different functional outcome measures to choose from in rehabilitation. Selecting an outcome measure that has been validated in older adults and is appropriate for your setting helps ensure the results are applicable. For physical therapists working in an acute care setting, the Elderly Mobility Scale is one such option.
What is the Elderly Mobility Scale?
The Elderly Mobility Scale (EMS) is an activity and participation-level outcome measure designed to assess mobility and functional levels in older adults. It tests common movements like sit-to-stand transfers, a timed walk and a functional reach. It was designed specifically for use in the acute setting and found to be reliable and validated in adults over 55 years old and older.
Scores on the Elderly Mobility Scale have been used to identify likely fallers, inform discharge disposition decisions and predict the level of assistance needed for mobility and Activities for Daily Living. It can have a ceiling effect for more capable adults but EMS scores have been associated with the likelihood that an individual will have two or more future falls. It has also been found to be more likely to detect improvements in mobility than the Barthel Index or the Functional Ambulation Category.
How to administer the Elderly Mobility Scale
This outcome measure is free and requires no training. Ensure your patient is safe by having extra help when indicated, using a gait belt and providing rests as needed.
Equipment should be gathered beforehand including these items:
- Stopwatch
- Meter stick or tape measurer
- Bed/treatment table
- Chair
- Walking aid (if typically needed by the patient)
- Wall
- Space for 6m walk
- Form to record scores
What is a mobility score of 20?
The Elderly Mobility Scale Scale consists of seven items:
- Lying to sitting transfer: Score 0-2 points based on level of assistance
- Sitting to lying transfer: Score 0-2 points based on level of assistance
- Sitting to standing transfer: Score 0-3 points based on level of assistance OR time to complete
- Standing: Score 0-3 points based on the amount of support needed and ability to perform a reach while standing
- Gait: Score 0-3 points based on walking aid and level of assist or supervision
- 6-meter timed walk: 0-3 points based on time to complete
- Functional reach: 0-4 points based on distance reached
The points are added and reported as being out of a total possible score of 20 points.
Elderly Mobility Scale score interpretation
After administering the outcome measure and totaling the score, the next step is to interpret the score. What does a score of 10 points or 15 points on the Elderly Mobility Scale mean for the patient, their ongoing therapy and discharge needs?
Cut-off scores have been established through several research studies:
(Smith, 1994; n=36; age= 70-93)
Level of independence and EMS scores
- Score > 14 = independent in basic ADLs
- Score 10-13 = borderline in terms of safe mobility and independence in ADLs (require some help with some mobility maneuvers)
- Score < 10 = dependent (requires help with mobility and ADLs)
Discharge outcomes and EMS scores
- Score 14-20 = home (independent in basic ADLs)
- Score 11-13 = part iii accommodation (discharged home with high levels of care - community care package or relative)
- Score 5-13 = home with caretaker
- Score 0-6 = nursing home
- Score 1 = died
- (Chiu et al, 2009, n=78, age= 65+)
Fall risk and EMS scores
- Non-fallers: score = 19 - 20
- Single-fallers: score = 19 - 20
- Multiple fallers: score < 15
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Using the Elderly Mobility Scale to guide patient care
With the knowledge that the EMS has been well-validated in adults over 55 years old in the acute setting, therapists can utilize the EMS to guide treatment and discharge planning. After administering and scoring the EMS, use this data to create a goal based on the known cut-off scores.
For example, if your patient is currently scoring a 4/20 on the EMS, you may create a goal to increase their score to at least 9/20 points before discharge to help them be discharged home versus a skilled nursing facility. A goal of increasing a score from <10/20 points to >15/20 points might be made to reduce the likelihood of multiple future falls.
Additionally, because lower scores are associated with a greater need for assistance, working to increase the patient’s score on the EMS can reduce the need for caregiver support in the home and increase the likelihood they can remain in the home.
Use the minimal detectable change and minimal clinically important difference values to create your goals:
Minimal Detectable Change: 4.3 points
Minimal Clinically Important Difference:
De Morton Et Al, 2008; N=15, 19, 28; Age= 78-93, 71-91, Not Provided
Estimated MCID = 2 Points
De Morton Et Al, 2015; N=120; Mean Age (SD)= 82.2 (7.5); Within 48 Hours Of Hospital Discharge)
- Using distribution-based method
- MCID = 2.73
- Using criterion based approach
- MCID = 6.97
Interventions to improve functional mobility and balance in older adults should be individualized to the body structure/function impairments, activity restrictions and participation limitations of each patient.
- Manual therapy techniques may be needed to address pain, range of motion and joint mobility limitations.
- Balance training can be implemented to address anticipatory and reactive balance strategies and sensory weighting and selection strategy deficits.
- Therapeutic exercises are often necessary to address impairments in isolated and functional strength, cardiorespiratory endurance and flexibility while gait training may be needed to improve a patient’s ability to walk.
Outcome measures like the EMS can give you an idea of how mobility is affected but you should perform a thorough physical exam to identify underlying factors that contribute to impaired mobility.
Caring for elderly clients
Caring for our elderly clients is a privilege. As a physical therapist, you can help improve their quality of life and independence. The Elderly Mobility Scale is an activity and participation-level outcome measure most applicable to the acute care setting that you can administer to help evaluate fall risk, discharge disposition and treatment planning in adults 55 years of age and older. With this information, you can establish goals and create a comprehensive treatment plan to enhance functional mobility and independence, reduce fall risk and ensure safe placement after an inpatient stay.
Resources
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References
Chiu, A. Y. Y., Au-Yeung, S. S. Y., Lo, S. K. (2009). “A Comparison Of Four Functional Tests In Discriminating Fallers From Non-Fallers In Older People.” Disabil Rehabil 25(1): 45-50. Find It On Pubmed
De Morton, N. A., Berlowitz, D. J., Keating, J. L. (2008). “A Systematic Review Of Mobility Instruments And Their Measurement Properties For Older Acute Medical Patients.” Health Qual Life Outcomes 6(44). Find It On Pubmed
De Morton, N. A., Nolan, J. S., O'Brien M. J., Thomas, S. K., Govier, A. V., Sherwell, K., Harris, B. N., Markham, N. O. (2015). “A Head-To-Head Comparison Of The De Morton Mobility Index (DEMMI) And Elderly Mobility Scale (EMS) In An Older Acute Medical Population.” Disabil Rehabil 37(20): 1881-1887. Find It On Pubmed
Shirley Ryan Ability Lab (JULY 01, 2019); Elderly Mobility Scale. https://www.sralab.org/rehabilitation-measures/elderly-mobility-scale
Smith, R. (1994). “Validation And Reliability Of The Elderly Mobility Scale.” Physiotherapy 80(11): 744-747. Find It On Sciencedirect
