Tinetti Balance Form – Fill Out and Use This PDF

Updated: Nov 9, 2026

The Tinetti Balance Assessment Tool is a comprehensive evaluation used to assess an individual's risk of falling, particularly in elderly patients. It encompasses both a balance section and a gait section, quantitatively scoring the patient's ability to perform various movements safely and independently. To ensure accurate fall risk assessment and tailored intervention plans, completing the Tinetti Balance form correctly is essential for healthcare professionals.

For a detailed guide on how to fill out the Tinetti Balance form, click the button below.

Get Form Now Download PDF

How to Fill Out Tinetti Balance Assessment Tool

Tinetti Balance Assessment Tool at a glance

What it is: The Tinetti Balance Assessment Tool has a balance section with a balance score out of 16.

A filled-in Tinetti Balance Assessment Tool example: a therapist scores one balance assessment

Tinetti Balance Assessment Tool example filled out, example: a therapist scores one balance assessment — A therapist fills in the Tinetti Balance Assessment Tool for one patient. The therapist scores ten balance items on the first date and enters a total of 13. The picture shows page one; its names and figures are sample values. The second Date column stays empty because the patient is assessed on one date only. Nothing goes in the gait section, indication of gait, step length and foot clearance boxes because the therapist has not yet walked the patient. Nothing goes in the step symmetry, continuity, path, trunk and walking time boxes because the therapist has not yet walked the patient.

How to fill out Tinetti Balance Assessment Tool, box by box

Patient name, D.o.b. and ward

Fill in the patients name, the D.o.b. and the Ward.

Balance section: sitting, rises and immediate standing

Patient is seated in hard, armless chair. Under Date, for Sitting Balance, enter 0 for Leans or slides in chair or 1 for Steady, safe.

For Rises from chair, enter 0 for Unable to without help, 1 for Able, uses arms to help, or 2 for Able without use of arms.

For Attempts to rise, enter 0 for Unable to without help, 1 for Able, requires > 1 attempt, or 2 for Able to rise, 1 attempt.

For Immediate standing Balance (first 5 seconds), enter 0 for Unsteady (staggers, moves feet, trunk sway), 1 for Steady but uses walker or other support, or 2 for Steady without walker or other support.

Balance section: standing balance, nudged and eyes closed

For Standing balance, enter 0 for Unsteady, 1 for Steady but wide stance and uses support, or 2 for Narrow stance without support.

For Nudged, enter 0 for Begins to fall, 1 for Staggers, grabs, catches self, or 2 for Steady.

For Eyes closed, enter 0 for Unsteady or 1 for Steady.

Turning 360 degrees and sitting down

For Turning 360 degrees, enter 0 for Discontinuous steps or 1 for Continuous. Enter 0 for Unsteady (grabs, staggers) or 1 for Steady.

For Sitting down, enter 0 for Unsafe (misjudged distance, falls into chair), 1 for Uses arms or not a smooth motion, or 2 for Safe, smooth motion.

Balance score

Enter the Balance score out of /16.

Gait section: indication of gait, step length and foot clearance

Patient stands with therapist, walks across room (+/- aids), first at usual pace, then at rapid pace. Enter the Date.

For Indication of gait (Immediately after told to 'go'.), enter 0 for Any hesitancy or multiple attempts or 1 for No hesitancy.

For Step length and height, Step to = 0, Step through R = 1, Step through L = 1.

For Foot clearance, Foot drop = 0, L foot clears floor = 1, R foot clears floor = 1.

Step symmetry, continuity, path, trunk and walking time

For Step symmetry, enter 0 for Right and left step length not equal or 1 for Right and left step length appear equal.

For Step continuity, enter 0 for Stopping or discontinuity between steps or 1 for Steps appear continuous.

For Path, enter 0 for Marked deviation, 1 for Mild/moderate deviation or uses w. aid, or 2 for Straight without w. aid.

For Trunk, enter 0 for Marked sway or uses w. aid, 1 for No sway but flex. knees or back or uses arms for stability, or 2 for No sway, flex., use of arms or w. aid.

For Walking time, enter 0 for Heels apart or 1 for Heels almost touching while walking.

Gait score, total score and risk of falls

Enter the Gait score out of /12.

Enter the Balance score carried forward /16. Enter the Total Score = Balance + Gait score /28.

Risk Indicators: Tinetti Tool Score ≤18 is High Risk of Falls, 19-23 is Moderate, and ≥24 is Low.

Sources

[1] Tinetti Balance Assessment Tool, Tinetti ME, Williams TF, Mayewski R, Am J Med 1986:80:429-434 (the Official source link on this page).

Tinetti Balance Form PDF Details

Navigating through the complexities of assessing and managing fall risks among the elderly, the Tinetti Balance Assessment Tool emerges as a beacon of meticulous design and practical utility. Developed by Tinetti ME, Williams TF, and Mayewski R in 1986, this tool has carved its niche in the medical field as an effective instrument for identifying individuals at varying levels of fall risk based on the examination of their balance and gait. It distinguishes itself through a structured examination that unfolds in two main sections: the Balance Section and the Gait Section. Each section meticulously evaluates different components of a patient's mobility; starting with simple tasks like sitting and rising from a chair, to more complex ones such as walking with or without aids and turning 360 degrees. The assessment quantifies performance in these areas, assigning scores that ultimately consolidate into a comprehensive risk indicator—categorizing fall risk as high, moderate, or low. This tailored approach not only highlights the specific areas of weakness in balance and gait but also directs interventions to mitigate these fall risks effectively. Indeed, the Tinetti Balance Assessment Tool serves as a cornerstone for clinicians and healthcare providers in constructing targeted and effective care plans for the elderly population, making fall prevention strategies more nuanced and personalized than ever before.

Question	Answer
Form Name	Tinetti Balance Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	tinetti balance assessment, tinetti balance, tinetti balance test, tinetti balance test calculator