Tinetti Calculator - 0-28 POMA Balance and Gait Score

The tinetti calculator is a clinical fall risk assessment that scores 20 POMA balance and gait items into a 0-28 total, with published <19 high, 19-24 moderate, and 25-28 low fall risk bands. The instrument is also called the Performance Oriented Mobility Assessment (POMA) and has been a standard paper tool in geriatric, stroke, and rehabilitation practice since 1986.

• • Geriatric fall risk screening: An older adult takes the 20 POMA items for a baseline and again three to six months later to track change in the 0-28 total.
• • Stroke and neuro-rehab tracking: A physiotherapist repeats the POMA at admission, discharge, and the first outpatient visit.
• • Pre-discharge planning: A hospital team uses the 0-28 total to inform home support and equipment needs.
• • Family and caregiver documentation: A caregiver records a reading between clinic visits so the next appointment starts with a current total.

The 20 items split into a 10-item balance section that scores 0-16 and a 10-item gait section that scores 0-12, and the two subscores add into the 0-28 POMA total. The result is a screening number, not a diagnosis, so it is read with a fall history, a medication review, a vision check, and a home safety review.

A balance-only 14-item screen is often used in the same geriatric visit, and the Berg Balance Test applies the 0-56 total and fall risk bands to the same patient.

The calculator adds the published per-item scores for the 10 balance and 10 gait sub-items, totals the two subscores into a 0-28 POMA total, and maps the total to a fall risk band.

• balance_subscore (0-16): Sum of the 10 POMA balance sub-items, each scored 0-1 or 0-2.
• gait_subscore (0-12): Sum of the 10 POMA gait sub-items, each scored 0-1 or 0-2.
• tinetti_total (0-28): The combined POMA total. Higher is better; lower means higher fall risk.
• fall_risk_band: Published interpretation: <19 high, 19-24 moderate, 25-28 low fall risk.

Each per-item input is rounded to the nearest integer and clamped to its 0-1 or 0-2 range, so accidental out-of-range entries cannot inflate or deflate the 0-28 total.

According to Tinetti ME, 1986 - POMA validation in JAGS, the POMA pairs a 0-16 balance subscale with a 0-12 gait subscale, summed into a 0-28 structured balance and gait screen for elderly patients.

According to Tinetti ME, Williams TF, and Mayewski R, 1986 - Fall Risk Index in Am J Med, the Fall Risk Index paired the 0-28 total with chronic-disability counts to define the <19 high, 19-24 moderate, and 25-28 low fall risk bands still used in geriatric and rehabilitation practice.

A POMA total is usually read next to a basic ADL score in the same stroke or rehabilitation note, and the Barthel Index applies the 10-item ADL total to the same patient visit.

Four ideas drive how the 0-28 POMA total and the 0-16 plus 0-12 subscores should be read.

A change of 5 points in the 0-28 total is often cited as a meaningful change in community-dwelling older adults.

A nurse-led fall risk screen often pairs a structured gait and balance test with a chart-based risk score, and the Morse Fall Scale Calculator applies the 6-item Morse total to the same patient.

The 20 POMA items need a hard chair, a stopwatch, a flat 10-foot walkway, and the patient's usual indoor footwear.

1. 1 Set up the room: Use a standard armless or armrest chair against a wall, a flat level walkway about 10 feet long, a stopwatch, and the patient's usual indoor shoes.
2. 2 Explain and demonstrate each action: Show the action once, then watch the person perform it. Use the 0-1 or 0-2 anchors and help only if safety requires it.
3. 3 Score the 10 balance sub-items: Record the 0-1 or 0-2 anchor for each balance sub-item. The balance subscore is the sum of the 10 sub-items and runs 0 to 16.
4. 4 Score the 10 gait sub-items: Ask the patient to walk the 10-foot course with their usual walking aid. Score step length and height for each side, foot clearance for each side, step symmetry, step continuity, path, trunk, and walking stance. The gait subscore runs 0 to 12.
5. 5 Read the 0-28 total and the fall risk band: Press Calculate to add the two subscores into the 0-28 POMA total and label the result with the high, moderate, or low fall risk band.
6. 6 Plan the next step: A 0-18 reading is the signal for a multi-factor fall review. A 19-24 reading is the signal for a structured balance and gait program. A 25-28 reading is the signal for a maintenance program.

An 80-year-old returning home after a hip replacement scores 9 of 16 on balance and 10 of 12 on gait for a POMA total of 19 of 28. Twelve weeks later, the same person scores 13 of 16 on balance and 12 of 12 on gait for a total of 25 of 28, above the 5-point meaningful change.

In stroke and neuro-rehabilitation the POMA is read next to an 11-item NIH Stroke Scale tally, and the NIH Stroke Calculator applies the 0-42 severity band to the same visit.

Using the POMA in a structured way offers practical advantages for older adults, hospital and rehabilitation teams, and the families and caregivers who support them.

• • A validated 0-28 POMA total: Turns a vague impression of standing and walking balance into a single published number that teams already understand.
• • Built-in fall risk bands: The 0-18, 19-24, and 25-28 bands are the published Fall Risk Index bands, so readings travel across teams.
• • Balance and gait subscores alongside the total: The 0-16 balance and 0-12 gait subscores stay visible next to the 0-28 total so a clinician can see which section drove the band.
• • Reusable baseline and follow-up scores: The same 20 POMA items can be filled in again after a strength program, a hospitalization, a medication change, or a joint replacement.
• • Pairs naturally with other geriatric scores: The POMA total sits next to a Berg, a Morse, and a Barthel in most geriatric notes.

A digital form like this one turns the same paper scoring into a 0-28 total and a fall risk band that can be saved.

A Rockwood deficit accumulation tally is often read alongside a POMA total in a geriatric assessment, and the Frailty Index applies the 0-1 ratio and the robust, pre-frail, and frail bands to the same patient.

A few everyday factors can move a POMA reading without changing the underlying balance.

• • The POMA is a screening tool, not a diagnosis, so a high fall risk band always travels with a fall history, a medication review, a vision check, and a home safety review.
• • The 20 items cover a specific set of balance and gait actions, so a meaningful balance picture in a movement that is not on the list can still leave the patient in the low fall risk band.
• • The 0-1 or 0-2 per-item scoring collapses a wide range of ability into a small number of anchor points, so a ceiling effect is possible for fit adults.

A 0-18 high band is the signal for a multi-factor fall review. A 19-24 moderate band is the signal for a structured balance and gait program. A 25-28 low band is the signal for a maintenance program, and CDC STEADI still recommends repeating the screen yearly.

According to CDC STEADI - Older Adult Fall Prevention, healthcare providers should use validated gait and balance assessment tools such as the Tinetti and Berg tests when screening older adults for fall risk.

A multi-factor fall review usually pairs a structured gait and balance test with a bone density referral screen, and the Osteoporosis Risk Score applies the OST, SCORE, and MORES bands to the same visit.