# Tinetti Balance and Gait Assessment Calculator

Score the Tinetti Balance and Gait Assessment (POMA) to evaluate fall risk in older adults. Calculates balance (0-16), gait (0-12), and total score (0-28).

## What this calculates

The Tinetti Assessment Tool (also called the Performance-Oriented Mobility Assessment or POMA) is a widely used clinical test that evaluates balance and gait to predict fall risk in older adults. Score each item based on your observation of the patient to get the total score and fall risk category.

## Inputs

- **Sitting Balance** — options: 0 - Leans or slides in chair, 1 - Steady, safe
- **Arises from Chair** — options: 0 - Unable without help, 1 - Able, uses arms to help, 2 - Able without using arms
- **Attempts to Arise** — options: 0 - Unable without help, 1 - Able, requires >1 attempt, 2 - Able to arise in 1 attempt
- **Immediate Standing Balance (first 5 sec)** — options: 0 - Unsteady (sways, grabs objects), 1 - Steady but uses walker/support, 2 - Steady without support
- **Standing Balance (prolonged)** — options: 0 - Unsteady, 1 - Steady but wide stance or uses support, 2 - Steady, narrow stance, no support
- **Nudge (sternum push x3)** — options: 0 - Begins to fall, 1 - Staggers, grabs, catches self, 2 - Steady
- **Eyes Closed (standing)** — options: 0 - Unsteady, 1 - Steady
- **Turning 360 Degrees** — options: 0 - Discontinuous steps, 1 - Continuous steps
- **Turning 360 Stability** — options: 0 - Unsteady (grabs, staggers), 1 - Steady
- **Sitting Down** — options: 0 - Unsafe (misjudges distance, falls), 1 - Uses arms or not smooth, 2 - Safe, smooth motion
- **Gait Initiation** — options: 0 - Any hesitancy or multiple attempts, 1 - No hesitancy
- **Step Length and Height (R foot)** — options: 0 - Does not pass L foot or foot not fully off floor, 1 - Passes L foot and fully clears floor
- **Step Length and Height (L foot)** — options: 0 - Does not pass R foot or foot not fully off floor, 1 - Passes R foot and fully clears floor
- **Step Symmetry** — options: 0 - Right and left step length unequal, 1 - Right and left step appear equal
- **Step Continuity** — options: 0 - Stopping or discontinuity between steps, 1 - Steps appear continuous
- **Path (estimated 12-ft course)** — options: 0 - Marked deviation, 1 - Mild/moderate deviation or uses aid, 2 - Straight without walking aid
- **Trunk Sway** — options: 0 - Marked sway or uses walking aid, 1 - No sway, flexion, or arm use for stability, 2 - No sway, no flexion, no arm use, no aid
- **Walking Stance** — options: 0 - Heels apart, 1 - Heels almost touching while walking

## Outputs

- **Balance Score** — formatted as text — Total balance subscale score (out of 16)
- **Gait Score** — formatted as text — Total gait subscale score (out of 12)
- **Total Tinetti Score** — formatted as text — Combined balance + gait score (out of 28)
- **Fall Risk Assessment** — formatted as text — Fall risk category based on total score

## Details

The Tinetti Assessment has two sections:

**Balance section (0-16 points):** 10 items covering sitting balance, rising from a chair, standing balance (immediate and prolonged), response to a nudge, eyes closed standing, turning 360 degrees, and sitting back down.

**Gait section (0-12 points):** 8 items covering gait initiation, step length and height for each foot, step symmetry, step continuity, path deviation, trunk sway, and walking stance width.

**Scoring interpretation:**

- **25-28:** Low fall risk
- **19-24:** Moderate fall risk
- **<= 18:** High fall risk

The test was developed by Dr. Mary Tinetti at Yale in 1986 and remains one of the most validated tools for fall risk assessment in geriatric medicine. It takes about 10-15 minutes to administer and requires only a hard armless chair and a flat walking surface.

**Clinical use:**

The Tinetti is used in hospitals, rehabilitation facilities, nursing homes, and outpatient geriatric clinics. It helps guide decisions about physical therapy referrals, assistive device prescriptions (cane vs. walker), home safety modifications, and the need for supervision during ambulation. Serial assessments can track improvement after interventions or decline over time.

A score drop of 5 or more points between assessments is clinically meaningful and warrants investigation into possible causes (new medications, deconditioning, neurological changes, or other medical issues).

## Frequently Asked Questions

**Q: What is a good Tinetti score?**

A: A total score of 25-28 out of 28 indicates low fall risk and good mobility. Scores of 19-24 indicate moderate risk, and scores of 18 or below indicate high fall risk. For reference, healthy community-dwelling older adults typically score 25-28, while frail nursing home residents often score below 20.

**Q: How often should the Tinetti be repeated?**

A: In long-term care settings, the Tinetti is often reassessed quarterly or whenever there is a significant change in a patient's condition (after a fall, hospitalization, medication change, or new diagnosis). In outpatient settings, reassessment every 6-12 months is common. After starting a new exercise or therapy program, retesting at 4-6 weeks can demonstrate early improvement.

**Q: How does the Tinetti compare to the Timed Up and Go (TUG) test?**

A: Both are validated fall risk tools, but they serve slightly different purposes. The TUG is faster (takes about 1 minute) and gives a single time-based score, making it a good screening tool. The Tinetti provides more detailed information about specific balance and gait deficits, which is more useful for targeting interventions. Many clinicians use the TUG for screening and the Tinetti for detailed assessment when problems are identified.

**Q: Can the Tinetti be used for non-elderly patients?**

A: While it was developed for and is most commonly used with older adults (65+), the Tinetti can be applied to any adult with balance or mobility concerns. It has been used in studies of patients with Parkinson's disease, stroke, multiple sclerosis, and other neurological conditions regardless of age. However, the fall risk score cutoffs were established in elderly populations and may not apply directly to younger patients.

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Source: https://vastcalc.com/calculators/health/tinetti
Category: Health & Fitness
Last updated: 2026-04-08