Silhouette-Based Gaitomics for Frailty Assessment in Older Adults

Frailty is a condition in aging medicine characterized by diminished physiological reserve and increased vulnerability to stressors. However, frailty assessment remains subjective, heterogeneous, and difficult to scale in clinical practice. Gait is a sensitive marker of biological aging, capturing multisystem decline before overt disability. Yet the application of modern computer vision to gait-based frailty assessment has been limited by small, imbalanced datasets and a lack of clinically representative benchmarks. In this work, we introduce a publicly available silhouette-based frailty gait dataset collected in a clinically realistic setting, spanning the full frailty spectrum and including older adults who use walking aids. Using this dataset, we evaluate how pretrained gait recognition models can be adapted for frailty classification under limited data conditions. We study both convolutional and hybrid attention-based architectures and show that predictive performance depends primarily on how pretrained representations are transferred rather than architectural complexity alone. Across models, selectively freezing low-level gait representations while allowing higher-level features to adapt yields more stable and generalizable performance than either full fine-tuning or rigid freezing. Conservative handling of class imbalance further improves training stability, and combining complementary learning objectives enhances discrimination between clinically adjacent frailty states. Interpretability analyses reveal consistent model attention to lower-limb and pelvic regions, aligning with established biomechanical correlates of frailty. Together, these findings establish gait-based representation learning as a scalable, non-invasive, and interpretable framework for frailty assessment and support the integration of modern biometric modeling approaches into aging research and clinical practice.

Gait is increasingly recognized as a vital sign, yet current approaches treat it as a symptom of specific pathologies rather than a systemic biomarker. We developed a gait foundation model for 3D skeletal motion from 3,414 deeply phenotyped adults, recorded via a depth camera during five motor tasks. Learned embeddings outperformed engineered features, predicting age (Pearson r = 0.69), BMI (r = 0.90), and visceral adipose tissue area (r = 0.82). Embeddings significantly predicted 1,980 of 3,210 phenotypic targets; after adjustment for age, BMI, VAT, and height, gait provided independent gains in all 18 body systems in males and 17 of 18 in females, and improved prediction of clinical diagnoses and medication use. Anatomical ablation revealed that legs dominated metabolic and frailty predictions while torso encoded sleep and lifestyle phenotypes. These findings establish gait as an independent multi-system biosignal, motivating translation to consumer-grade video and its integration as a scalable, passive vital sign.

Frailty assessments are crucial to evaluate the risk of adverse events and the health and social care needs of older adults, yet their administration remains resource-intensive and typically relies on coarse clinical outcomes, such as task completion times, which may overlook biomechanical indicators of functional decline. To address this, we present a robotic framework that guides older adults through standardised frailty and fall-risk tests while capturing clinical scores and additional frailty-related metrics, offering a deeper insight into a user's condition. The system uses a Behaviour Tree architecture that coordinates perception, decision-making, interaction, and measurement modules. Using vision-based skeleton tracking, the robot evaluates established clinical tests, including the Short Physical Performance Battery (SPPB) and the Timed Up and Go (TUG). The framework was co-designed with healthcare professionals and evaluated in situ during six months in a rehabilitation centre's research lab with N=81 older adults. Robot-derived measurements were compared against therapist assessments and clinical reference instruments, including a gait analysis walkway and an inertial measurement unit (IMU). Results showed excellent agreement for most test completion times and gait-related parameters ($ICC > 0.9$). And, substantial agreement for the overall SPPB score comparing the robot and the therapist ($k = 0.67$) and moderate agreement comparing the robot and the IMU ($k=0.55$). The findings highlight that social robots can provide reliable and objective frailty assessments in healthcare settings while enabling the collection of relevant mobility indicators beyond conventional outcomes.