Understanding The Elderly Mobility Scale

The Elderly Mobility Scale (EMS) is a clinical assessment tool used to measure the mobility level of older adults. Using this scale can help to determine what support they need, and can help to reduce falls as a result of poor mobility. Here, we are looking at what this scale is, its benefits, why this is so important for older adults, what the assessment entails, how EMS scores are calculated and interpreted, what this means for care planning, limitations and other considerations, and how this can help home caregivers. 

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For over 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about the Elderly Mobility Scale (EMS), we can help.

Why is assessing mobility so important for older adults? 

A 2021 study found that regular physical activity could help to improve an older person’s functional mobility, autonomy, anxiety levels, balance, social interactions and overall quality of life, so understanding their scope of mobility may be the first step in helping older adults to stay happy and healthy long term. 

It is known that older people tend to experience altered mobility over time, such as changes in their gait (the way they walk), balance, and strength. Bone density typically reduces with age, and post-menopausal women could lose bone density at a rate of up to 2% each year, leading to osteoporosis. In the UK mobility is the most common impairment reported by people of State Pension age, affecting 69% of disabled people in that group, underscoring why assessing mobility is so important for older adults. 

Also, mobility difficulties can cause an increased risk of falling, which can impact an older person’s ability or desire to socialise, go out to run errands, and continue enjoyable activities. Older adults with limited mobility are thought to be more likely to experience health conditions, disability, or be hospitalised. They often experience a generally lower quality of life than older people who can continue to enjoy their usual routines.

Having information on an older person’s level of mobility is thought to reduce medical expenditures and nursing home use, and guide things like physical therapy recommendations, mobility aids, care plans, and exercise routines.

What is involved in the assessment?

The Elderly Mobility Scale can be done in an average of 15 minutes, and requires minimal equipment; a metre stick, a stopwatch, a bed, a chair, and the person’s usual walking aid. You will also need a free wall space and an area of around 6 metres to walk in.

There are 7 parts of the assessment, including: 

1. Lying down to sitting – This section measures if they:

   ☐ Can do this independently
   ☐ Need the help of 1 person
   ☐ Need the help of 2+ people

2. Sitting to lying – This section measures if they:

   ☐ Can do this independently
   ☐ Need the help of 1 person
   ☐ Need the help of 2+ people

3. Sitting to standing – This section measures if they:

   ☐ Can do this independently in under 3 seconds
   ☐ Can do this independently in over 3 seconds
   ☐ Need the help of 1 person
   ☐ Need the help of 2+ people

4. Standing balance – This section measures if they:

   ☐ Can stand without support and are able to reach
   ☐ Can stand without support, but need help to reach
   ☐ Can stand but need support
   ☐ Can stand but need the support of a person

5. Gait patterns – This section measures if they:

   ☐ Can walk independently with or without a stick
   ☐ Can walk independently with a frame
   ☐ Can walk with a walking aid (but unsafely)
   ☐ Need help or supervision to walk

6. Timed walking over a distance of 6 metres – This section measures if they:

   ☐ Can walk 6 metres in under 15 seconds
   ☐ Can walk 6 metres in 16-30 seconds
   ☐ Can walk 6 metres in over 30 seconds
   ☐ Are are unable to cover 6 metres

7. Functional reach (ability to reach while standing) – This section measures if they:

   ☐ Can reach over 20cm
   ☐ Can reach 10-20cm
   ☐ Can reach under 10cm

All of these components reflect aspects of functional mobility and balance that older people are likely to come across every day at home and when out in their community.

How can the EMS results inform future care planning? 

The scores of the Elderly Mobility Scale must be considered with other factors such as the person’s health conditions, cognitive abilities, pain levels, or anything else that could impact their care needs. This means a person’s scores should not become a definitive evaluation of their abilities, but could certainly offer insight into the areas they most struggle with. 

The EMS could help to identify appropriate physiotherapy goals and care interventions to support an older person’s functional mobility and independence at home. Using the score outcomes, older people may be recommended mobility aids such as walkers or wheelchairs, home adaptations such as grab rails or bathing solutions, and supervised exercise programmes to help improve their movements in a safe way. 

This assessment could also help doctors and hospital discharge teams to determine what tailored care must be put in place for an older adult returning home after a time in hospital, for example, following a major surgery. 

The Elderly Mobility Scale should be undertaken on a regular basis to assess how an older person’s mobility has changed over time.

What are the limitations of the Elderly Mobility Scale, and what other tools could be helpful? 

Despite its benefits, there are some limitations to the Elderly Mobility Scale that should be noted alongside results. For example, the EMS cannot assess every aspect of an older person’s mobility, such as their stamina and endurance over distances, or their complex motor skills. It also may not be undertaken in the person’s own home where they spend most of their time, so a holistic assessment that includes social, emotional and medical considerations could offer a more comprehensive overview of their abilities in everyday life.

One 2021 study stated that “due to the multidimensional nature of falling risk, there is no “ideal” tool that can be used in any context or that performs a perfect risk assessment. For this reason, a simultaneous application of multiple tools is recommended…”

While the EMS was originally thought to help predict the likelihood of falling, in more recent years this has been found not to be the case, so using this alongside other assessment tools could be the best way to get more information about an older person’s abilities and risk levels. Some other notable and commonly used assessment tools include:

• The Falls Risk Assessment Tool (FRAT) – This helps to predict a more accurate fall risk, identifies those most at risk, and suggests preventive measures
• The Barthel Index – This measures an older person’s ability to complete activities of daily living (ADL), such as bathing, toilet use, transfers, mobility, stairs and more
• The NICE Falls Risk Pathway – This provides a structured approach to identifying people at increased risk of falling, highlights key contributing factors, and guides clinicians toward appropriate assessment and prevention strategies.
• The Timed Up and Go (TUG) Test – This offers a quick measure of mobility and balance, helps to identify individuals with impaired gait or functional decline, and supports decisions about targeted fall‑prevention interventions.

The Elderly Mobility Scale is thought to be challenging to use in community environments, has a ceiling when assessing those who may be more able, and also lacks sensitivity for older people who have poor confidence. 

What are the benefits of using the EMS for older adults? 

Assessing the mobility of older people can be a necessary first step in implementing the appropriate care that can keep them safe from falls. Falls are known to be the most common cause of traumatic brain injuries in older adults, so it is incredibly important to take measures to avoid this. Research shows 1 in 10 falls causes an injury, so mitigating this could help to improve the confidence and mental health of an older person. 

As well as helping doctors and caregivers discover what treatments and care are needed, an assessment can also help an older person better understand their own abilities which can put their mind at ease if they worry about this. The EMS assessment can promote more tailored care for older adults regardless of their abilities, encourage early intervention if their independence is being affected by a specific issue, and create a shared understanding of their abilities that can inform conversations between older adults, their caregivers, and the healthcare professionals managing their medical needs. 

How can home caregivers use the EMS effectively to help older loved ones?

Home caregivers, whether professional or family members, can use elements of the Elderly Mobility Scale to create a more streamlined and safe home environment for an older person to enhance their independence. Some of the ways this assessment could help include: 

• Ensuring caregivers are following the appropriate protocols and guidelines for the older person’s needs and abilities 
• Providing an alternative source of information alongside daily observations and discussions to better understand an older person’s abilities
• Informing more empathetic communication to explain results and involve the person in care planning decisions
• Identifying the physical activities that could help to promote strength, balance and flexibility for older adults (with professional guidance for safety)
• Adjusting the home environment to maximise safety and accessibility for an older person, such as removing trip hazards and arranging home adaptations 
• Better understanding an older person’s needs to have stronger, more useful communications with healthcare providers

At Home Instead, we help families better understand the abilities of their older loved one in order to provide more compassionate and beneficial care. Our Care Professionals are experienced in providing safe, patient and effective mobility care for older people of all abilities, and can monitor all aspects of the person’s life at home to make things safer and more comfortable for them. 

For support at home, reach out to your local Home Instead office to discuss your options.

We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.