Providing care for the elderly and older adults are incredibly challenging for family members and caretakers. This is due to the challenge of determining what kind of assistance they need to maintain a high quality of life.
When it comes to mobility, the right treatment method is crucial to the quality of life and is typically very time-sensitive. The quicker the implementation, the higher the chance of success. It’s for this reason that health professionals use the Elderly Mobility Scale. It’s a quick and efficient way to assess a patient’s needs to decide on a long-term care plan.
This article will detail how the EMS works and how you can help you decide on the treatment option for your patient.
Why is mobility important for the elderly?
Mobility in the elderly is one of the most important indicators of how well they can sustain their quality of life. Unfortunately, as time progresses, a patient’s mobility often declines and affects their ability to continue living without assistance.
Loss of mobility is also an indicator of other conditions that may arise as a result. For example, there is a strong correlation between a loss in cognitive abilities and loss of mobility.
Also, loss of mobility elevates the risk of falls which can lead to fractures. Finally, the patient’s age can dramatically mean painful recovery and increase the risk of other conditions.
What are the challenges to determine the amount of mobility
How much and how well a person can move can vary significantly from person to person. For this reason, it’s challenging to put a number or quantifiable value to the range of motion a person exhibits.
Several systems have been developed to set standards, but they have often been used for other applications such as sports or to gauge the impact of orthopedic surgery.
When it comes to connecting a patient’s ability to move with their quality of life, the problem becomes twofold. There is a need to define what mobility means for the elderly and define the ability to live unassisted. This spurred the concept of Activities of Daily Living (ADL).
Definition of Activities of daily living
Activities of Daily Living is a term coined by the healthcare industry to contain all the self-care activities a person needs daily. The activities typically include five main groups.
- Personal Hygiene: Bathing, oral care, hair and nails
- Continence: This refers to a person’s physical and cognitive ability to use the bathroom properly.
- Dressing: the ability to take one’s clothes and footwear on and off without assistance.
- Feeding: being able to prepare food and feed oneself.
- Ambulating: how able a person can move from one place to another and change their position unassisted. For example, standing up from the ground.
The Elderly Mobility Scale
The Elderly Mobility Scale (EMS) is a tool, initially from the mid-’90s (Smith et al. 1994), for evaluating the mobility of frail elderly patients. It’s a scale made up of 20 points attributed across seven different aspects of an elderly patient’s ability to move.
It was designed to use a minimal amount of equipment, get results immediately and be, above all, actionable. Therefore, the requirements to do the test, as stated earlier, are minimal. It would be best to have a bed, a wall, a chair, and 6m of floor space where the patient could walk without interruptions. The test, on average, takes about 15 minutes.
Why it started
The elderly mobility scale is to determine the movement capabilities and risk of falling of a patient.
These two aspects of an elderly patient’s health are challenging to gauge since it’s common for the interview method used on younger demographics not to be reliable.
The other primary reason is that falls are one of the most dangerous health problems for frail elders. Since decreased muscle mass and bone density are common health problems for the elderly, falls are often much more dangerous than for younger patients.
The risk of fractures in the elderly is greatly elevated, and the outcome of procedures to treat fractures, such as immobilization and surgical interventions, are much less successful. As a result, the quality and lifespan of frail elderly patients are sometimes negatively impacted.
The seven functional movements
The elderly mobility scale divides what it considers as the most representative movements and scores them based on three criteria each. The 7 movement patterns that make up the ems scores are the following.
- Lying to sitting: the score is based on a patient’s ability to do this with or without assistance.
- Sitting to lying: the score is based on the patient’s ability to do this without assistance.
- Sitting to standing: A measurement gauging the patient’s ability to stand from sitting in under 3 seconds.
- Standing: This is a measurement of the patient’s ability to remain standing without support and their ability to reach in the vertical plane, for example, reaching for something on a shelf without the support and without losing their balance.
- Gait: Gait measures the ability to walk and do consecutive steps with or without a cane or other form of walking aid.
- Timed walk: This evaluates the patient’s ability to cover 6 meters walking in under 15 seconds.
- Functional reach: this measures the patient’s ability to reach for an object that’s at least 20 centimeters away from them.
Score results and how to interpret them
One of the most important aspects of the EMS is that it does not weigh all functional movements equally. Therefore, the rubric will have either 3 or 4 different criteria and a score assigned to each one.
To obtain the total score, add the results for each movement. Based on this score, there are three main outcomes.
- 14-20 points: The patient has the capability to do all their activities of daily life. Even if they require minor assistance.
- 10-13 points: The patients will require a more significant amount of assistance to do their daily life activities.
- 0-9 points: the patient can not live independently and will require long-term care.
Limitations of the EMS
As any test that takes overall values, it has certain limitations. However, these limitations are accepted trade-offs compared to other more detailed tests.
It’s important to know what they are so that you can make sure you base your decision on the most reliable indicators from this test.
- If the patient is in a home with limited space or a shared space such as a hospital setting, 6 meters may not be available.
- It does not provide reliable results for patients that have problems with motivation or cognitive impairment.
- It is susceptible to the ceiling effect because it loses relevance for more able patients and patients in the early stages of their mobility decline.
Potential care options based on EMS score
Mobility is such a major aspect of the frail elderly’s health. Therefore, being able to determine the best course of treatment is paramount.
Here are some treatment options for consideration. Make sure you discuss these with your medical practitioner before implementing them with your patient.
- Weight management: maintaining a healthy weight can significantly impact a patient’s ability to move from both a cardiovascular and muscular perspective. Maintaining a healthy weight also has an impact on the effectiveness of a walking aid.
- Diet and supplements: Adapting the dietary needs to the patient’s needs and requirements is a very efficient way to ensure the individual receives healthy fuel for their movement.
- Physiotherapy and physical therapy: These great options help the patient maintain their mobility and reduce pain.
- Companion Care: if the patient is in the lower end of the EMS score, then companion care is an excellent option since it can help guarantee that they consistently receive the care they need.
Determining what kind of care frail elderly patients need is a challenge. There is a combination of physiological and psychological conditions that they may present.
It’s for this reason that relying on tests often increases the objectivity of the need. Knowing a person or loved one’s capabilities and limitations is invaluable. The EMS ensures your elderly patient has the best possible quality of life by knowing the best interventions. The EMS is a great tool for periodical assessments in the patient’s ability to move. Then, using the results to advise and prescribe the right interventions.