# Intra-Individual Changes in Ambulation and Functional Outcomes among Frail Elders

> **NIH VA I01** · PHILADELPHIA VA MEDICAL CENTER · 2021 · —

## Abstract

Behavioral changes associated with ambulation activity among older adults with dementia may indicate
underlying physiological vulnerabilities. Using a real-time locating system (RTLS), work by the author
shows intra-individual changes in ambulation activity (e.g., continuous ambulation) are meaningful
changes in behaviour associated with fall vulnerability in a population of institutionalized older adults
with dementia and may indicate the onset of acute medical conditions. Other research using RTLS
technology in a similar sample suggests increased tortuosity (e.g., random changes in direction during
movement) and/or the onset of dementia-related wandering behaviours (lapping and pacing ambulation
patterns) may be linked to a fall and other acute changes in physical health. Thus, changes in the
quantity (e.g., increased time and distance travelled) and/or quality (e.g., random changes in direction,
lapping and pacing patterns) of ambulation activity may increase fall vulnerability as these older adults
are ambulating more or in a more tortuous path or may be an early sign of an acute medical condition
that the person cannot communicate.
Specific Aim 1, Study 1: With a larger more heterogeneous sample, test a new model of ambulation
activity. H1a: Intra-individual changes in ambulation activity (e.g., path characteristics, tortuosity) will be
significantly associated with a fall H1b: and the onset of acute medical conditions.
Specific Aim 2, Study 2: Enhance the predictive capability of the model to capture patterns of
changes in ambulation activity associated with acute changes in physical health. RQ: How will using
innovative predictive analytics such as random forest (RF), partial least squares (PLS) and linear
classifiers to identify additional predictive factors and ambulation patterns (e.g., lapping, pacing)
improve the predictive capability of the model?
Specific Aim 3, Study 3: Translate model findings in to clinical strategies that may be used to modify
individual plans of care. Rationale: Findings from machine-learning approaches may need additional
interpretation to be clinically feasible; identifying underlying mechanisms through collaboration with
experts in a descriptive pilot and translating these into practice with focus groups of VA CLC clinicians
will lead to strategies that may be used in VA CLC's to improve patient care.
Study Design: A prospective longitudinal natural history study design will be used in Study 1. In Study
2, a predictive modeling design will be used to identify additional factors that improve the predictive
capability of the model. In study 3, a qualitative study design will be used.
Methodology: In Study 1, ambulation activity including time and distance travelled, gait speed, path
characteristics (e.g., continuous walking), ambulation patterns (lapping and pacing) and tortuosity
(random changes in direction and movement) will be measured continuously by a RTLS and
associated with falls and acute medical cond...

## Key facts

- **NIH application ID:** 10093995
- **Project number:** 5I01RX002413-04
- **Recipient organization:** PHILADELPHIA VA MEDICAL CENTER
- **Principal Investigator:** Mary E. Bowen
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-03-01 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10093995

## Citation

> US National Institutes of Health, RePORTER application 10093995, Intra-Individual Changes in Ambulation and Functional Outcomes among Frail Elders (5I01RX002413-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10093995. Licensed CC0.

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