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How to Use the Elderly Mobility Scale (EMS) to Assess Mobility

Friday, June 12, 2020

Are you concerned about the safety and well-being of an elderly family member because you’ve recently noticed that they’re having mobility issues?


Maybe you’ve noticed that it has been taking them longer than usual to get up from the chair, or that they’ve been walking more slowly and cautiously than before. Or perhaps you’ve noticed that your loved one is neglecting some of the daily living activities like cleaning, shopping, or even personal grooming. 


And you might be wondering if it is time to have a conversation with your family member about a home care provider to assist with the daily chores and to ensure their safety and wellness.


One of the tools that you can use to determine whether an older adult in your life needs care is the elderly mobility scale (EMS). The EMS is a diagnostic tool with a few simple tests designed to assess the mobility level of seniors.


In this guide, we’ll discuss what the EMS is, how to take the test, and how you can use it in your decision-making process when it comes to home care for your loved one. 


What is the elderly mobility scale (EMS)?


The elderly mobility scale (EMS) is a standardized test used by health professionals, like physiotherapists, to assess the level of mobility in older adults. 


They might use EMS to measure the success of physiotherapy or an exercise program in improving mobility in frail seniors. The therapist or trainer might conduct an EMS test before the program, and then again after a specific to track progress.


The EMS test can also be used when trying to determine if an elderly family member could benefit from a mobility aid like a walker, or caregiving services.


How does mobility affect the elderly?


Aging adults tend to start having various mobility issues, which can have a significant impact on their safety and wellbeing. 


Older adults may suffer from joint health conditions, weaker muscles, pain, neurological issues, among others, and these conditions may contribute to their mobility issues


Mobility issues can cause someone to become more reluctant to do the things they once enjoyed, like exercising, socializing with friends, or engaging in the community. 


It can also put them at a higher risk of falling, which is one of the major causes of death and injury among seniors. Older adults also tend to have more fragile bones, which could impact the healing process.


For these reasons, and more, it is vital to check your eldely family member’s mobility periodically, so you can identify any issues to address them through therapy or with a care attendant.


How is the elderly mobility scale (EMS) used?


There are a few key mobility metrics that are used to come up with a mobility score in the EMS test, which is ultimately used to make decisions when it comes to the need for exercise programs or therapy.


The EMS test involves going through the different activities measuring the time and difficulty level for each task.


Here are the different mobility tests used to calculate the EMS score.


  • If one needs help to go from a lying position to a sitting position
  • If one needs help to go from a sitting position to a lying position
  • How much time and/or assistance is required to go from sitting to standing
  • The ability to stand with or without support
  • The presence of gait (balance issues) during walking
  • Timed walk for 6 meters
  • Functional reach (ability to reach something while standing in place)



When the test is done, you will get a total score, and it would provide you with an assessment of the overall mobility level. You can use this score to make further necessary decisions.


The EMS score will range between 0 and 20, 20 being the best possible score.


In the following sections, we will discuss why people use EMS, how to perform the test, and how to interpret the test scores to decide if your loved one needs a care provider.

What are the benefits of using the elderly mobility scale? 


So why do people use the elderly mobility scale? Is it reliable?


The answer is yes, it is very reliable, although it has it’s limitations as we’ll discuss below. But the test is widely regarded as a standard among healthcare professionals.  


Another benefit of the EMS is that it requires very little training and equipment, although it is ideal that you ask a healthcare professional to conduct the test.


How do you assess mobility in the elderly (step-by-step)?


In this section, we’ll go through each step of an EMS and explain them in detail. You can also download a printable EMS test PDF to keep track of your family member’s test score.


Equipment requirements for an EMS test


The requirements for an EMS test are basic. You need a room big enough to allow your loved one to be able to complete the 6-meter walking test. 


Here’s what you’ll need to complete the test:


  • An EMS worksheet to keep track of the scores
  • A bed for the lying down to sitting test
  • A chair for the sitting to standing test
  • A stopwatch to record time
  • A walking aid if your family member needs one to complete the 6-meter walk


The entire test should take only around 15 minutes to complete.

The EMS test process and scoring method


Now that we have all the required tools, let’s delve into how to actually conduct the test.


As we explained before, the test will consist of 7 functional movement tests, and you will assign a score based on performance, as follows.


Test 1: Lying to sitting


Ask your loved one to go from a lying position on the bed to a sitting up position. Here’s how to score the test.


  • They can sit up on their own with no help (independent): 2 points
  • Requires the help of 1 person: 1 point
  • Requires the help of 2+ people: 0 points


Test 2: Sitting to lying


Ask your loved one to go from a sitting position on the bed to a lying position. Here’s how to score the test.


  • They can lie down on their own with no help (independent): 2 points
  • Requires the help of 1 person: 1 point
  • Requires the help of 2+ people: 0 points


Test 3: Sitting to standing


Ask your loved one to go sitting on a chair to standing up. Here’s how to score the test.


  • They can stand up their own with no help (independent) in 3 seconds or less: 3 points
  • They can stand up their own with no help (independent) in more than 3 seconds: 2 points
  • Requires the help of 1 person: 1 point
  • Requires the help of 2+ people: 0 points


Test 4: Standing


Ask your loved one to stand up and extend their arms. Here’s how to score the test.


  • They can stand with no support and able to reach (extend arms) without help: 3 points
  • They can stand with no support and able to reach (extend arms) only with help: 2 points
  • They can stand but need support: 1 point
  • They can stand only with assistance from another person: 0 points


Test 5: Gait


Ask your loved one to walk around the room. Here’s how to score the test.


  • They can walk with no help (independent): 3 points
  • They can walk on their own but only with the help of a frame (walking aid): 2 points
  • Can walk with aid, but unstable: 1 point
  • Requires the help of another person to walk: 0 points

Test 6: Timed walk


Ask your loved one to walk 6 meters. Here’s how to score the test.


  • They can walk 6 meters under 15 seconds: 3 points
  • They can walk 6 meters in 16-30 seconds: 2 points
  • They can walk 6 meters in more than 30 seconds: 1 point
  • They’re not able to cover 6 meters: 0 points


Test 7: Functional reach


Measure the reach of your family member as they’re standing in place. Here’s how to score the test.


  • They can reach over 20 cm: 4 points
  • They can reach 10-20 cm: 2 points
  • They can reach under 10 cm: 0 points


Calculate the mobility score


Record the score from each of the tests above in the EMS worksheet. When the test is complete, add up all the individual scores from the 7 tests. The total would be the mobility score, ranging between 0 and 20, with 20 being the best possible score, and 0 being the worst.


Calculating your loved one’s mobility score is the first step. The next thing to do is to use the score to make decisions to improve your loved one’s quality of life. 


We have the EMS score. Now what?


In this section, we’ll cover how to interpret the EMS score, and suggest some potential next steps based on the mobility score. While we will discuss some general recommendations, always remember to consult with your loved one’s doctor before making any decisions regarding their physical health. 

Mobility score: 14 - 20


A score between 14 and 20 suggests that your older family member has good mobility overall and that they should be able to handle most daily living activities on their own. Although, depending on the individual, they might require some assistance.


In this score range, the focus moving forward might be to prevent mobility issues, and to improve overall fitness.


What causes mobility issues in the elderly?


If your loved one scored high on the test, that’s great news. But that does not mean they don’t need to be proactive about their mobility and fitness.


Let’s take a look at some of the major factors that contribute to mobility issues in the elderly, so that you can take steps to prevent them in the future.


Osteoporosis - It is a common condition among the aging population that causes bones to get weaker and more brittle. Osteoporosis may have an impact on the movement of older adults, because they might be more cautious to reduce the risk of breaking any bones. It might also play a role in posture issues if the bones aren’t able to support the muscles and frame.


Neuromuscular issues – Neurological conditions like multiple sclerosis, muscular dystrophy, and others, can impact nerve and muscle function. If muscles aren’t functioning optimally, one can have problems with mobility.


Arthritis – Arthritis is very common among the aging population. It is a condition that is associated with the inflammation of the joints. Besides causing pain and stiffness, arthritis can also affect one’s movement and mobility.


How to improve mobility in seniors?


Here are some things that your family member or loved one can do to maintain good mobility and physical health.


Weight management - Maintaining a healthy weight is a good idea for many reasons, like the reduced risk of diabetes or cardiovascular disease. But it also puts less pressure on the joints, and makes it easier to move around. 


Encourage your family member to exercise regularly. They can go for walks, or to the local senior center if they offer exercise classes for the elderly. 


Diet/supplements - along with exercise, a healthy diet is a vital component of maintaining optimal weight. Encourage your loved one to focus on high quality sources of proteins, healthy fats, and plenty of vegetables and fruits.


To go one step further, you can encourage them to take supplements to promote bone health. Collagen peptides, vitamin K, calcium, and vitamin D, have all been shown to improve bone health, which would reduce the risk of osteoporosis. 


Yoga - Improved mobility is among the countless benefits of yoga. Yoga will also help your family member increase core strength and balance, both of which can protect against injuries from falling. 


Yoga also reduces stress and improves cardiovascular health.


Hobbies - A hobby, whether it’s gardening, painting, playing an instrument, or anything else, will not only keep your family member more active to promote mobility, but it can also help them fill up their time in a way that is fun and productive.


Of course, if they are still engaged in professional work, that is also great for their mobility and wellness.

Mobility score: 10 - 13


If your loved one scored between 10 and 13, then he or she is determined to be borderline independent, which means there is enough mobility to perform some daily living activities, but may require help with some. It is also borderline when it comes to safety and wellbeing.


Physiotherapy - Physiotherapy might be an option at this stage. Although your loved one has some deficiencies when it comes to mobility, a carefully planned exercise program might help them move back into the 14+ score range.


The therapist will also use the elderly mobility scale, among other metrics, to track progress.


Companion care - Companion care focuses on providing the elderly with emotional support and friendship, as well as assisting with various activities of daily living, depending on the older adult’s mobility limitations.


A companion care provider may also may help and encourage your loved one to stick to his or her exercise program, maintain a healthy diet, pursue hobbies, all of which could promote overall wellness as well as increased mobility.

Mobility score: under 10


A mobility score under 10 means that your family member will have to depend on someone for help with activities of daily living such as dressing, going to the bathroom, cleaning, personal hygiene and grooming, etc.


Of course, you should still try to improve their quality of life through measures such as physiotherapy, a healthy diet, social engagement, etc. But if your loved one’s score is less than 10, then they will require assistance in the short term.


Here are a couple of ways you can go about getting your family member the help they need.


Assisted living facility - If you feel like your loved one would benefit most from an assisted living facility like a nursing home, you can bring it up to them to see how they feel about it. They’d have access to round-the-clock care and it could be the safest option in many cases when mobility score is under 10.


But many seniors tend to prefer living in their own homes due to privacy/security concerns, and because they don't want to be separated from their community. In such cases, home care might be an option.


Home care - There are various types of home care available for older adults with limited mobility. You can have someone visit your loved one on a regular basis to assist with daily living activities, running errands, administrative tasks, administering medications (with proper qualifications), and monitoring health.


In the state of New York, an added benefit is that you can hire your friends or relatives (other than spouse) as a caregiver through the CDPAP program.


Hire family/friends as a caregiver through CDPAP


CDPAP, or the Consumer Directed Personal Assistance Program, is a New York State Medicaid program that allows beneficiaries to hire their family members and friends for caregiving services. 


It works as an excellent alternative for the elderly who might not be comfortable with strangers looking after them. It also benefits the family caregiver since they can get paid for their services.


Here are some of the benefits of hiring a friend or family member as a caregiver for an older adult with limited mobility.


  • The friend/family member gets paid to care for a loved one. Could alleviate financial stress if you leave another job to take care of a loved one.
  • No special training is required to provide care through CDPAP, as long as you are able to perform the tasks.
  • The friend/family member can perform medical tasks like giving insulin, administering medications, and other functions that are typically carried out by nurses.


Here are the eligibility requirements for CDPAP.


  • The care recipient must have Medicaid.
  • The participant must have a stable medical condition, and they must require assistance with activities of daily living.
  • The participant must be self-directing, or they must have a representative that is willing and qualified to direct care on their behalf.


For more information, including how to apply, please check out our in-depth guide on CDPAP NY.


Limitation of the elderly mobility scale 


Mobility, and how it affects someone’s life, and the necessary steps to address those issues, are all personal and will vary from person to person.


At the end of the day, you, your family member, and your medical professional will know what is best for your family. 


One can have great mobility, but if they have cognitive issues, reduced confidence, depression and anxiety, they might still need care or companion services.


On the other hand, someone with more limited mobility might still be completely self-sufficient depending on their fitness, strength, cognitive abilities, etc.


The EMS test is a good place to start, and a good way to track progress, but it is not meant to be the only tool at the healthcare professional’s disposal.

Final thoughts on assessing mobility with the EMS 


The ability to walk around and move freely is something that most of us take for granted in our younger years. 


But as we age, and the wear and tear begins to take toll on our bones, joints, and muscles, we start realizing the impact lack of mobility can have on our wellbeing, safety, and overall quality of life.


If you have an elderly loved one, and you’re concerned about their mobility, talk to them about taking the elderly mobility test (EMS). Chances are, if you’re not aware of any significant limitations, that they’re in the upper score range, and they can maintain or improve their mobility with yoga, supplements, etc.


And if your loved one has a mobility score under 13, then it might be time to discuss care options. If you’re in the state of New York, be sure to check out CDPAP to see if hiring a friend or family member is an option for you. 

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