Tinetti Performance Oriented Mobility Assessment
The Tinetti Performance Oriented Mobility Assessment (POMA) measures balance and gait in older adults to estimate fall risk. Enter scores for each of the 17 observed items below; the tool calculates your balance subscore (max 16), gait subscore (max 12), and a combined total (max 28), then classifies fall risk as low, moderate, or high with a plain-English interpretation. This tool is designed for trained clinicians observing a patient, not for self-assessment.
What is the Tinetti POMA?
The Tinetti Performance Oriented Mobility Assessment, introduced by Mary Tinetti in 1986, is one of the most widely used clinical tools for evaluating fall risk in older adults. It scores two components: a balance component (9 tasks, maximum 16 points) and a gait component (8 to 10 observations, maximum 12 points), giving a combined total of up to 28 points. A higher score indicates better mobility and independence. The tool requires a trained clinician to observe the patient performing each task, sitting in a firm armless chair and then walking approximately 10 feet. It takes 10 to 15 minutes to complete and requires no special equipment beyond a chair and a flat walking surface.
How to administer and score the POMA
Seat the patient in a firm, armless chair. For the balance section, observe sitting balance, then ask the patient to stand, maintain standing, withstand a gentle sternal push with eyes open and then closed, turn 360 degrees, and return to the seated position. For the gait section, ask the patient to walk at their normal pace for about 10 feet, turn, and return. Score each item using the descriptors provided, where 0 represents the most impaired and 1 or 2 represents the least impaired, depending on the item. Sum the balance items for the balance subscore (max 16) and the gait items for the gait subscore (max 12). Add them together for the total POMA score (max 28). Scores of 24 or above indicate low fall risk; 19 to 23 indicate moderate risk; 18 or below indicate high risk.
Clinical evidence and limitations
The Tinetti POMA has good interrater reliability for the total score (R = 0.4 to 0.93) and moderate to good reliability for individual subscores. Sensitivity for identifying fallers is approximately 62.5 to 95.5 percent and specificity is 60 to 100 percent depending on the threshold used. The tool has been validated in community-dwelling older adults, nursing home residents, and patients with Parkinson disease, stroke, and hip fracture. Limitations include ceiling effects in high-functioning patients, the need for a trained observer, and the fact that it does not capture all physiological fall risk factors such as vision, cognition, or medication side effects. It should be used as part of a comprehensive falls assessment, not in isolation.
Normative data and age-related decline
Population normative data from the original validation and subsequent studies show that total POMA scores decline with age. Adults aged 65 to 79 typically score around 25 to 26 (men slightly higher than women). Adults aged 80 and older show a marked decline, with men averaging approximately 23 and women averaging around 17, reflecting the greater prevalence of gait and balance impairment in the oldest age groups. A score close to the normative value for a patient's age group is reassuring, but the absolute fall-risk thresholds (18 and 23) are used regardless of age in routine clinical practice.
Tinetti POMA score interpretation
| Total score | Fall risk | Recommended action |
|---|---|---|
| 0-18 | High | Immediate falls prevention referral, home assessment, medication review |
| 19-23 | Moderate | Individualized exercise program, reassess in 3-6 months |
| 24-28 | Low | Continue preventive measures, annual reassessment |
Based on the original Tinetti (1986) thresholds. Normative values: age 65-79 men average 26.2, women 25.2; age 80+ men 23.3, women 17.2.
Frequently asked questions
What is a normal Tinetti score?
For adults aged 65 to 79, average scores are approximately 26 for men and 25 for women. For adults aged 80 and over, averages drop to about 23 for men and 17 for women. In clinical practice, any score of 24 or above is considered low fall risk, 19 to 23 moderate fall risk, and 18 or below high fall risk, regardless of age.
Can patients complete the Tinetti test themselves?
No. The Tinetti POMA must be administered and scored by a trained healthcare professional who observes the patient performing each task. It is an observed performance test, not a self-report questionnaire. Self-scoring would not be valid because the observer must judge the quality of movement, not just whether the task was completed.
How is the Tinetti different from the Berg Balance Scale?
Both tools assess balance and gait, but the Tinetti POMA (28 points maximum) also captures a dedicated gait component with observations about step length, foot clearance, symmetry, trunk stability, and walking base, whereas the Berg Balance Scale (56 points maximum) focuses entirely on balance tasks. The Tinetti takes less time (10 to 15 minutes vs. 15 to 20) and is often preferred in geriatric outpatient and community settings. The Berg is more detailed for balance alone and may have a higher ceiling.
How often should the Tinetti be repeated?
For patients at low or moderate risk, annual reassessment or reassessment after a fall event or major health change (new medication, surgery, acute illness) is appropriate. For patients at high risk or undergoing a falls prevention program, reassessment every 3 to 6 months helps track progress and adjust interventions.
Does a high Tinetti score mean the patient will not fall?
Not definitively. The test has sensitivity of approximately 62 to 95 percent and specificity of 60 to 100 percent, meaning some high-risk patients score above the threshold and some low-risk patients score below it. Falls are multifactorial: cognition, vision, medications, home environment, and footwear all contribute independently of POMA scores. A low fall-risk score should not replace a comprehensive falls assessment.