Cross-national differences in grip strength among 50+ year-old Europeans: results from the SHARE study

Sex disparities of human neuromuscular decline in older humans

Females typically live longer than males but, paradoxically, spend a greater number of later years in poorer health. The neuromuscular system is a critical component of the progression to frailty, and motor unit (MU) characteristics differ by sex in healthy young individuals and may adapt to ageing in a sex-specific manner due to divergent hormonal profiles. The purpose of this study was to investigate sex differences in vastus lateralis (VL) MU structure and function in early to late elderly humans. Intramuscular electromyography signals from 50 healthy older adults (M/F: 26/24) were collected from VL during standardized submaximal contractions and decomposed to quantify MU characteristics. Muscle size and neuromuscular performance were also measured. Females had higher MU firing rate (FR) than males (P = 0.025), with no difference in MU structure or neuromuscular junction transmission (NMJ) instability. All MU characteristics increased from low- to mid-level contractions (P < 0.05) without sex × level interactions. Females had smaller cross-sectional area of VL, lower strength and poorer force steadiness (P < 0.05). From early to late elderly, both sexes showed decreased neuromuscular function (P < 0.05) without sex-specific patterns. Higher VL MUFRs at normalized contraction levels previously observed in young are also apparent in old individuals, with no sex-based difference of estimates of MU structure or NMJ transmission instability. From early to late elderly, the deterioration of neuromuscular function and MU characteristics did not differ between sexes, yet function was consistently greater in males. These parallel trajectories underscore the lower initial level for older females and may offer insights into identifying critical intervention periods. KEY POINTS: Females generally exhibit an extended lifespan when compared to males, yet this is accompanied by a poorer healthspan and higher rates of frailty. In healthy young people, motor unit firing rate (MUFR) at normalized contraction intensities is widely reported to be higher in females than in age-matched males. Here we show in 50 people that older females have higher MUFR than older males with little difference in other MU parameters. The trajectory of decline from early to late elderly does not differ between sexes, yet function is consistently lower in females. These findings highlight distinguishable sex disparities in some MU characteristics and neuromuscular function, and suggest early interventions are needed for females to prevent functional deterioration to reduce the ageing health-sex paradox.

The association of depressive sarcopenia and cognitive decline among the elderly: Evidence from the Survey of Health and Retirement in Europe

OBJECTIVES

The present study aimed to explore the relationship between baseline different sarcopenia statuses combined with different depression statuses and long-term cognitive functions.

METHODS

Finally, a total of 4289 individuals aged 50 years or older from wave 2 to wave 8 of the Survey of Health, Ageing and Retirement in Europe were included in this study. The generalized estimated equation model was used to explore the baseline effect of depression with sarcopenia on long-term cognitive function. Stratified Analyses according to gender, education, region, and family economic level were performed. Sensitivity analyses of wave 5 to wave 8 were conducted to ensure the robustness of the results.

RESULTS

Groups of depression with non-sarcopenia (β = -0.40, 95%CI: -0.59 ~ -0.20, P < 0.001), non-depression with sarcopenia (β = -1.11, 95%CI: -1.91 ~ -0.31, P = 0.007), and depression with sarcopenia (β = -1.19, 95%CI: -1.89 ~ -0.50, P = 0.001) were inversely associated with cognition scores compared with the group of non-depression with non-sarcopenia. Stratified Analysis displayed differences in negative association of depression status with sarcopenia status and cognition. Sensitivity analyses yielded similar results. Other than numeracy, depression with sarcopenia (β = -1.81, 95%CI: -2.45 ~ -1.18, P < 0.001; β = -10.68, 95%CI: -1.05 ~ -0.31, P < 0.001; β = -0.51, 95%CI: -0.65 ~ -0.37, P < 0.001; β = -0.41, 95%CI: -0.55 ~ -0.27, P < 0.001) were inversely associated with cognitive function, orientation, words list learning test and fluency.

CONCLUSIONS

Preliminary depressive sarcopenia appears to increase the risk of cognitive decline. There was a downward trend in total cognitive function. The effect of depression combined with sarcopenia on cognitive function may exist in differences in gender, education, region, and family economic level.

The effect of body mass index on self-rated health in middle-aged and older adults: evidence from the China health and retirement longitudinal study

BACKGROUND AND AIMS

Health promotion for middle-aged and older people has received a lot of attention recently in the context of healthy aging. Furthermore, it is unclear how body mass index (BMI) presently affects self-rated health (SRH), a reliable and representative indicator of health.

METHODS

This study used longitudinal follow-up data from the China Health and Retirement Longitudinal Study (CHARLS). Systematic collection of information on the socio-demographic, lifestyle, and health status of the subjects. Binary logistic regression was used to investigate the relationship between BMI and SRH, and gender-specific variations were examined. Subgroup analysis was used to examine interactions, and the results of the research stability were demonstrated.

RESULTS

After adjusting for age, gender, education level, marital status, place of residence, number of chronic diseases, alcohol consumption, smoking, depressive symptoms, and SRH at baseline, it was found that obesity grade 1 and obesity grade 2 were good contributors to SRH compared to normal weight individuals, and this association was different in males and females. According to the results of the subgroup analyses, those under 65 years old, with junior high school or less education, with a spouse, residing in a city, having one chronic disease, and not smoking or drinking, respectively, all had stable positive associations between obesity and SRH.

CONCLUSIONS

Our findings suggest that obesity may be associated with good SRH. Teams of healthcare professionals should revisit the potential impact of obesity among middle-aged and older adults and focus on developing prevention strategies for morbid obesity.

Grip strength cut-points from the Swiss DO-HEALTH population

BACKGROUND

While grip strength (GS) is commonly assessed using a Dynamometer, the Martin Vigorimeter was proposed as an alternative method especially in older adults. However, its reference values for Swiss older adults are missing. We therefore aimed to derive sex- and age-specific GS cut-points for the dominant and non-dominant hand (DH; NDH) using the Martin Vigorimeter. Additionally, we aimed to identify clinically relevant weakness and assess convergent validity with key markers of physical function and sarcopenia in generally healthy Swiss older adults.

METHODS

This cross-sectional analysis includes baseline data from Swiss participants enrolled in DO-HEALTH, a 3-year randomized controlled trial in community-dwelling adults age 70 + . For both DH and NDH, 4 different definitions of weakness to derive GS cut-points by sex and age category (≤ 75 vs. > 75 years) were used: i) GS below the median of the 1st quintile, ii) GS below the upper limit of the 1st quintile, iii) GS below 2-standard deviation (SD) of the sex- and age-specific mean in DO-HEALTH Swiss healthy agers (i.e. individuals without major chronic diseases, disabilities, cognitive impairment or mental health issues) and iv) GS below 2.5-SD of the sex- and age-specific mean in DO-HEALTH Swiss healthy agers. To assess the proposed cut-points' convergent validity, we assessed their association with gait speed, time to complete the 5 Times Sit-To-Stand (5TSTS) test, and present sarcopenia.

RESULTS

In total, 976 participants had available GS at the DH (mean age 75.2, 62% women). According to the 4 weakness definitions, GS cut-points at the DH ranged from 29-42 and 25-39 kPa in younger and older women respectively, and from 51-69 and 31-50 kPa in younger and older men respectively. Overall, weakness prevalence ranged from 2.0% to 19.3%. Definitions of weakness using the median and the upper limit of the 1st GS quintile were most consistently associated with markers of physical performance. Weak participants were more likely to have lower gait speed, longer time to complete the 5TSTS, and sarcopenia, compared to participants without weakness.

CONCLUSIONS

In generally healthy Swiss older adults, weakness defined by the median or the upper limit of the 1st GS quintile may serve as reference to identify clinically relevant weakness. Additional research is needed in less healthy populations in order to derive representative population-based cut-points.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01745263.

Handgrip strength is associated with risks of new-onset stroke and heart disease: results from 3 prospective cohorts

BACKGROUND

Stroke and heart disease are two major contributors to the global disease burden. We aimed to evaluate and compare the roles of different handgrip strength (HGS) expressions in predicting stroke and heart disease in three nationally representative cohorts.

METHODS

This longitudinal study used data from the Health and Retirement Study (HRS), the Survey of Health, Ageing, and Retirement in Europe (SHARE), and the China Health and Retirement Longitudinal Study (CHARLS). The Cox proportional hazard model was applied to analyze the relationship between HGS and stroke and heart disease, and Harrell's C index was used to assess the predictive abilities of different HGS expressions.

RESULTS

A total of 4,407 participants suffered from stroke and 9,509 from heart disease during follow-up. Compared with the highest quartile, participants in the lowest quartile of dominant HGS, absolute HGS and relative HGS possessed a significantly higher risk of new-onset stroke in Europe, America, and China (all P < 0.05). After adding HGS to office-based risk factors, there were minimal or no differences in the increases of Harrell's C indexes among three HGS expressions. In contrast, the modest association between HGS and heart disease was only seen in SHARE and HRS, but not in CHARLS.

CONCLUSION

Our findings support that HGS can be used as an independent predictor of stroke in middle-aged and older European, American and Chinese populations, and the predictive ability of HGS may not depend on how it is expressed. The relationship between HGS and heart disease calls for further validation.

Grip strength values and cut-off points based on over 200,000 adults of the German National Cohort - a comparison to the EWGSOP2 cut-off points

BACKGROUND

The European Working Group on Sarcopenia in Older People (EWGSOP) updated in 2018 the cut-off points for low grip strength to assess sarcopenia based on pooled data from 12 British studies.

OBJECTIVE

Comparison of the EWGSOP2 cut-off points for low grip strength to those derived from a large German sample.

METHODS

We assessed the grip strength distribution across age and derived low grip strength cut-off points for men and women (peak mean -2.5 × SD) based on 200,389 German National Cohort (NAKO) participants aged 19-75 years. In 1,012 Cooperative Health Research in the Region of Augsburg (KORA)-Age participants aged 65-93 years, we calculated the age-standardised prevalence of low grip strength and time-dependent sensitivity and specificity for all-cause mortality.

RESULTS

Grip strength increased in the third and fourth decade of life and declined afterwards. Calculated cut-off points for low grip strength were 29 kg for men and 18 kg for women. In KORA-Age, the age-standardised prevalence of low grip strength was 1.5× higher for NAKO-derived (17.7%) compared to EWGSOP2 (11.7%) cut-off points. NAKO-derived cut-off points yielded a higher sensitivity and lower specificity for all-cause mortality.

CONCLUSIONS

Cut-off points for low grip strength from German population-based data were 2 kg higher than the EWGSOP2 cut-off points. Higher cut-off points increase the sensitivity, thereby suggesting an intervention for more patients at risk, while other individuals might receive additional diagnostics/treatment without the urgent need. Research on the effectiveness of intervention in patients with low grip strength defined by different cut-off points is needed.

Who uses technical aids in old age? Exploring the implementation of technology-based home modifications in Europe

Introduction

Home modifications and features, e.g., handrails or ramps for people using wheelchairs, should allow residents with functional limitations to maintain social participation, health, and wellbeing for aging in place. However, there is little evidence in relation to the individual characteristics shaping this implementation of technology-based home modifications. Current studies often focus on describing the distribution of certain implementations in households but do not provide information on factors predicting the implementation or detailed and multifaceted data on associations with characteristics of the older user. This article, therefore, examines the use of well-established technological aids and home modifications (e.g., ramps, handrails, automatic doors, bathroom or kitchen modifications, chair lifts, and alerting devices) in the households of older adults in Europe. We refer to Lawton's and Nahemow's concept of personal-environment fit and describe the use of technical aids across 18 countries, analyze associations with individual characteristics and social resources, and compare those associations and variance explanation between older adults in their third age ("young-old", 65-79 years) and older adults in their fourth age ("old-old", 80+).

Methods

Drawing on representative data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), wave 6, a total of N = 38,553 older adults aged 65-105 years (M = 74.4 years, SD = 7.1; 55% women) were analyzed by performing hierarchical logistic regression analyses.

Results

Indicators of functioning explained the highest proportion of variance, followed by social resources, and variance explanation was higher for the fourth age than for the third age. In particular, older adults with physical limitations, a larger social network, and those who received care from a child outside the household were more likely to have home modifications installed.

Discussion

The study provides an overview of associations of diverse variables with assistive devices and modifications in the home and can serve as a starting point for public health activities concerning the heterogeneity of people aged 65 years and older.

Handgrip Strength Is Related to Hippocampal and Lobar Brain Volumes in a Cohort of Cognitively Impaired Older Adults with Confirmed Amyloid Burden

BACKGROUND

Strength and mobility are essential for activities of daily living. With aging, weaker handgrip strength, mobility, and asymmetry predict poorer cognition. We therefore sought to quantify the relationship between handgrip metrics and volumes quantified on brain magnetic resonance imaging (MRI).

OBJECTIVE

To model the relationships between handgrip strength, mobility, and MRI volumetry.

METHODS

We selected 38 participants with Alzheimer's disease dementia: biomarker evidence of amyloidosis and impaired cognition. Handgrip strength on dominant and non-dominant hands was measured with a hand dynamometer. Handgrip asymmetry was calculated. Two-minute walk test (2MWT) mobility evaluation was combined with handgrip strength to identify non-frail versus frail persons. Brain MRI volumes were quantified with Neuroreader. Multiple regression adjusting for age, sex, education, handedness, body mass index, and head size modeled handgrip strength, asymmetry and 2MWT with brain volumes. We modeled non-frail versus frail status relationships with brain structures by analysis of covariance.

RESULTS

Higher non-dominant handgrip strength was associated with larger volumes in the hippocampus (p = 0.02). Dominant handgrip strength was related to higher frontal lobe volumes (p = 0.02). Higher 2MWT scores were associated with larger hippocampal (p = 0.04), frontal (p = 0.01), temporal (p = 0.03), parietal (p = 0.009), and occipital lobe (p = 0.005) volumes. Frailty was associated with reduced frontal, temporal, and parietal lobe volumes.

CONCLUSION

Greater handgrip strength and mobility were related to larger hippocampal and lobar brain volumes. Interventions focused on improving handgrip strength and mobility may seek to include quantified brain volumes on MR imaging as endpoints.

Lower body muscle strength, dynapenic obesity and risk of type 2 diabetes -longitudinal results on the chair-stand test from the Survey of Health, Ageing and Retirement in Europe (SHARE)

BACKGROUND

The chair-stand test is a measure of lower body muscle strength. In a longitudinal study with older adults, we investigated whether results of the five-repetition chair-stand test (CST-5) are associated with incident type 2 diabetes, and whether diabetes risk in obese persons is modified by dynapenia (age-related loss of muscle strength) in the lower limbs.

METHODS

We used data of the Survey of Health, Ageing and Retirement in Europe (SHARE), a panel study with eight waves carried out between 2004 and 2020 in 28 European countries and Israel mainly in persons aged 50 years or older. Forty-six thousand one hundred nineteen persons (mean age 63.5 years, 44.1% men) with CST-5 data and follow-up data for diabetes were included from wave 2 and waves 4 to 7. The mean follow-up time was 5.3 years (standard deviation 2.9 years). Relative risks with 95% confidence intervals (CI) were estimated from log-linear models with a Poisson working likelihood and robust standard errors.

RESULTS

In the crude model, increased risks of diabetes were found for persons who considered the CST-5 as not safe, or whose times for the test were in the highest or second highest quartiles (relative risks 2.18 (95% CI: 1.95-2.43), 1.71 (1.54-1.91), 1.44 (95% CI: 1.29-1.61), reference: lowest quartile). These associations were attenuated in the fully adjusted regression model (relative risks 1.32 (95% CI: 1.17-1.48), 1.23 (1.10-1.37), 1.19 (1.06-1.33)). Furthermore, in fully adjusted models, the risk of diabetes in obese persons did not depend on whether they had low muscle strength or not. In obese persons with times for 5 sits and stands > 15 seconds, the adjusted risk of diabetes was 2.56 (95% CI: 2.22-2.95) times higher than in non-obese persons with times ≤15 seconds. The corresponding relative risk in obese persons with times ≤15 seconds was 2.45 (2.25-2.67).

CONCLUSIONS

Poor results in the CST-5 were associated with an increased risk of diabetes. Among obese persons, the risk of diabetes was not modified by results of the CST-5.

Functional Capacity and Difficulties in Activities of Daily Living From a Cross-National Perspective

Objectives: This study investigated whether physical and cognitive functioning predicts developing difficulties in basic or instrumental activities of daily living (ADL/IADL), and whether country-level factors moderated the associations. Methods: 69,227 adults aged 50+ from 19 countries were followed for up to 14 years. Cox regression and meta-regression analyses were used. Results: Higher grip strength was associated with a 45% lower risk of developing ADL limitations and a 47% lower risk of IADL limitations. The corresponding values were 22% and 23% for peak flow, 20% and 23% for word recall, and 20% and 24% for temporal orientation. The associations were similar and statistically significant in most countries, but some associations were weaker in countries with lower GDP and lower service coverage. Discussion: Good physical and cognitive functional capacity protects from ADL and IADL limitations consistently across Western countries. The associations may be stronger in countries with more resources.

Sex Differences in Age-Associated Rate of Decline in Grip Strength When Engaging in Vigorous Physical Activity

Handgrip strength (GS) is used as an indicator of overall muscle strength and health outcomes for aging adults. GS has also been evaluated as a potential link with sport performances. We quantified the age-associated decline in grip strength for males and females engaged in weekly vigorous physical activity, differentiated by body mass, and investigated whether there was an acceleration of decline at any age. The Survey of Health, Ageing and Retirement in Europe is a multinational complex panel data survey with a target population of individuals aged 50 years or older. Data from 48,070 individuals from 20 European countries, collected from 2004 to 2015, were used in multivariable regression models to study the association of age and body weight with grip strength for individuals engaged in vigorous physical activity at least once a week. The annual rate of change in GS differed for males and females; it was constant from ages 50 to 55 years and then accelerated for females, possibly due to the menopausal transition. In contrast, the decline in GS accelerates with each year of increase in age for males. Higher body mass was associated with an increase in GS, but the increase was less pronounced for older males. The increase in GS diminished with a body mass above the median even with engagement in weekly vigorous physical activities. GS reference values for individuals engaged in vigorous physical activity add to existing reference values for general populations.

Gendered work-family life courses and late-life physical functioning: A comparative analysis from 28 European countries

Combining work and family roles can have beneficial consequences on health but could also result in chronic stress and adverse health outcomes at older ages. This study aimed to examine combined employment, parenthood, and partnership histories of men and women during the childbearing period (ages 15-49), and to investigate the links of these work and family roles with physical functioning later in life. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with retrospective information on employment, parenthood, and partnership histories for 18,057 men and 20,072 women (n = 38,129) living in 28 different countries belonging to six European welfare clusters. We applied multichannel sequence analysis (MCSQA) and hierarchical clustering to group work-family trajectories into 12 clusters for men and 15 clusters for women. We assessed the association between work-family life courses and grip strength by estimating multivariable linear regression models. Delayed work and family transitions, unstable employment, and the absence of combinations of work and family roles between age 15 and 49 were associated with weaker grip strength in later life for both men and women. Results differed by gender and were framed by the welfare context in which gendered work and family responsibilities unfold across individual life courses. The findings make an important contribution to the domain of gender and health in later life and stress the need to engage more with issues related to the mechanisms linking work and family trajectories to poor health in later life.

Lower grip strength and insufficient physical activity can increase depressive symptoms among middle-aged and older European adults: a longitudinal study

Objectives

The present study aimed to identify the gender-specific trajectories of grip strength using group-based trajectories, explore the interaction between grip strength and physical activity on depression, and investigate the association of physical activity with the change in depression by different grip strength groups among middle-aged and older European adults.

Methods

A total of 14,098 participants aged 50 years or older from the Survey of Health, Ageing and Retirement in Europe 2007–2019 were included in this study. Group-based trajectory modeling was used to identify the low, middle and high group of grip strength by gender. Generalized estimated equations were fitted to analyze the interaction effect. The data of wave 2-wave 5 and wave 2-wave 7 were chosen to conduct sensitivity analyses.

Results

Significant interactions between grip strength group and physical inactivity were found (x²_interaction = 11.16, P = 0.004). Significant interactions between physical inactivity and time on depression were identified in low (x²_interaction = 27.83, P < 0.001) and moderate (x²_interaction = 23.67, P < 0.001) grip strength, but a similar result was not found in high grip strength (x²_interaction = 4.39, P = 0.495). Participants in the physical inactivity group had higher depression scores in the low and moderate grip strength groups. Sensitivity analyses yield almost similar results.

Conclusions

Grip strength and physical inactivity interact with depression. Lower grip strength and insufficient physical activity can increase depressive symptoms. People with lower grip strength and physical inactivity should pay special attention to the prevention of depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03392-x.

Development in life expectancy with good and poor cognitive function in the elderly European Population from 2004-05 to 2015

BACKGROUND

Living not just longer, but also cognitively healthier, and more independent lives is essential if European countries are to cope with the financial challenges that the shifting age composition of Europe's population presents. Here we investigate the change in life expectancy (LE) spent with good and poor cognitive function among older adults across Europe.

METHODS

LE with good/poor cognitive function was estimated by the Sullivan Method. Cross-sectional data on cognitive functioning was obtained from 23,213 (wave 1, 2004-05) and 40,874 (wave 6, 2015) 50+-year-olds of the Survey of Health, Ageing and Retirement in Europe (SHARE). Information on mortality was obtained from the Eurostat Database. Results for 70+-year-olds were emphasized.

RESULTS

LE with good cognitive function increased with 1.6 years from 10.7 years (95% CI: 10.6-10.9) in 2004-05 to 12.4 years (95% CI: 12.3-12.5) in 2015 for 70+-year-olds. Disparity was observed across sex and region. In 2004-05, a 70+-year-old woman could expect to spend 30.9% (95% CI: 29.4-32.4) of her remaining LE with poor cognitive function compared to 27.7% (95% CI: 26.0 -29.4) for men. In 2015, women (24.4% (95% CI: 23.4-25.3)) had considerably caught up with men (24.8% (95% CI:23.7.25.8)), shifting the pattern in favor of women. In 2004-05 and 2015, Northern Europeans had the lowest LE with poor cognitive function while Southern Europeans had the highest, but made the most improvement during the period.

CONCLUSIONS

Overall we find that LE with poor cognitive function has been compressed in the European population of 70+-year-olds.

Relationship among the quality of cognitive abilities, depression symptoms, and various aspects of handgrip strength in the elderly

Background/Aim. Both the cognitive and physical functioning changes occur within the normal aging, suggesting possible common biological processes. The aging process is often characterized by a reduction of adaptive responses, an increasing vulnerability and functional limitations. The aim of this study was to determine if there were correlations between particular cognitive abilities (verbal ability, spatial ability, processing speed, memory, verbal fluency, divergent thinking, memory, attention, executive functions, conceptualization, orientation, computation), depression symptoms and different dynamometric parameters of muscle contraction, during handgrip (HG) of both hands, in the elderly population. Methods. The sample consisted of 98 participants, 16 males and 82 females, aged from 65 to 85. Neuropsychological assessment included Montreal Cognitive Assessment (MoCA), Frontal Function Test (Go/No-Go), Categorical and Phonemic fluency tests and Geriatric Depression Scale Short Form (GDS-SF). Physical measures were assessed by Handgrip Dynamometry Tests (HG), and included: the maximum force (Fmax), maximal rate of force development (RFDmax), static endurance HG time realized at 50% of maximal HG force (tFmax50%) of dominant (Do) and non-dominant (NDo) hand. Results. Higher MoCA score was followed by higher values of muscle endurance of dominant hands. Higher values of F max of dominant hand were associated with higher values of Alternating Trail Making that is by visuoconstructive abilities (MoCA). The variable Categorical fluency was in a small, positive correlation with Fmax. No correlation of depressive symptoms with HG parameters was found except in the subgroup of female subjects. Conclusion. Better cognitive performance was associated with better HG muscle strength. Therefore, HG strength can be a useful tool in geriatric practice in monitoring not only physical, but also cognitive function status and de-cline. The link between lower cognitive functioning and lower values of HG variables, emphasize the need for in-creased awareness about it in clinical practice.

Between-study differences in grip strength: a comparison of Norwegian and Russian adults aged 40-69 years

BACKGROUND

Identifying individuals with low grip strength is an initial step in many operational definitions of sarcopenia. As evidence indicates that contemporaneous Russian populations may have lower mean levels of grip strength than other populations in northern Europe, we aimed to: compare grip strength in Russian and Norwegian populations by age and sex; investigate whether height, body mass index, education, smoking status, alcohol use and health status explain observed differences and; examine implications for case-finding low muscle strength.

METHODS

We used harmonized cross-sectional data on grip strength and covariates for participants aged 40-69 years from the Russian Know Your Heart study (KYH) (n = 3833) and the seventh survey of the Norwegian Tromsø Study (n = 5598). Maximum grip strength (kg) was assessed using the same protocol and device in both studies. Grip strength by age, sex and study was modelled using linear regression and between-study differences were predicted from these models. Sex-specific age-standardized differences in grip strength and in prevalence of low muscle strength were estimated using the European population standard of 2013.

RESULTS

Normal ranges of maximum grip strength in both studies combined were 33.8 to 67.0 kg in men and 18.7 to 40.1 kg in women. Mean grip strength was higher among Tromsø than KYH study participants and this difference did not vary markedly by age or sex. Adjustment for covariates, most notably height, attenuated between-study differences but these differences were still evident at younger ages. For example, estimated between-study differences in mean grip strength in fully adjusted models were 2.2 kg [95% confidence interval (CI) 1.4, 3.1] at 40 years and 1.0 kg (95% CI 0.5, 1.5) at 65 years in men (age × study interaction P = 0.09) and 1.1 kg (95% CI 0.4, 1.9) at age 40 years and -0.2 kg (95% CI -0.7, 0.3) at 65 years in women (age × study interaction P < 0.01).

CONCLUSIONS

We found between-study differences in mean grip strength that are likely to translate into greater future risk of sarcopenia and poorer prospects of healthy ageing for Russian than Norwegian study participants. For example, the average Russian participant had a similar level of grip strength to a Norwegian participant 7 years older. Our findings suggest these differences may have their origins in childhood highlighting the need to consider interventions in early life to prevent sarcopenia.

Normative Static Grip Strength of Saudi Arabia's Population and Influences of Numerous Factors on Grip Strength

Most daily tasks require exerting static grip strength which can be challenging for the elderly as their strength diminishes with age. Moreover, normative static grip strength data are important in ergonomics and clinical settings. The goal of this study is to present the gender, age-specific, hand-specific, and body-mass-index-specific handgrip strength reference of Saudi males and females in order to describe the population's occupational demand and to compare them with the international standards. The secondary objective is to investigate the effects of gender, age group, hand area, and body mass index on the grip strength. A sample of 297 (146 male and 151 female) volunteers aged between 18 and 70 with different occupations participated in the study. Grip strength data were collected using a Jamar dynamometer with standard test position, protocol, and instructions. The mean maximum voluntary grip strength values for males were 38.71 kg and 22.01 kg, respectively. There was a curvilinear relationship of grip strength to age; significant differences between genders, hand area, and some age groups; and a correlation to hand dimensions depending on the gender.

The Relationship of Grip and Pinch Strength to Musculoskeletal Disorders in Female Carpet Weavers in Southeastern Iran, 2019

Background:

The repetitive and prolonged exertion of grip and pinch strength are current among carpet weaver tasks. The three objectives of this study were (1) to investigate the relationship between symptoms of musculoskeletal disorders and grip and pinch strength of carpet weavers in carpet weaving workshops in Kerman province, (2) to compare the grip and pinch strength of carpet weavers with normal values, and (3) to identify the relationship between hand postures of carpet weavers during work and force exertion.

Methods:

In this cross-sectional study, grip strength and key, tip and palmar pinch strengths of 101 female carpet weavers aged 20 to 71 years were measured in Kerman province, in 2018. Nordic Musculoskeletal Questionnaire (Extended version) was also used to evaluate musculoskeletal disorders.

Results:

Bivariate and multivariate linear regression analyses showed that participants who suffered from musculoskeletal disorders had lower grip and pinch strength than others and this decrease was statistically significant in upper back, wrists/hands, and knees. Moreover, there was a significant difference between grip and three types of pinch strength of carpet weavers and normal values. Furthermore, for both hands, the grip strength in the position recommended by American Society of Hand Therapists was significantly greater than that in the normal position carpet weavers usually adopt.

Conclusion:

Based on the results, the high prevalence of musculoskeletal disorders has led to a significant decrease in the grip and pinch strength of carpet weavers. Therefore, it is necessary to undertake ergonomic interventions in designing the carpet weaving workstation.

Subjective Age and Late-Life Functional Status: Mediating and Moderating Effects

OBJECTIVES

The present study examined the longitudinal relationships between subjective age (SA) and future functional status in later life, via depressive symptoms. Additionally, we assessed the role of subjective nearness to death (SNtD) as a potential moderator within these pathways.

METHODS

Older adults (average age 81.14 at T1) were interviewed once a year for three consecutive years (N=224 at T1, N=178 at T2, and N=164 at T3), Participants reported their SA, SNtD, depressive symptoms, and functional status. Additionally, grip strength was employed as an objective measure of functional status.

RESULTS

Data analysis revealed distinct pathways leading from T1 SA to T3 functional status through T2 depressive symptoms. Moreover, T1 SNtD was found to significantly moderate most of these indirect pathways, so that the mediation model of T1 SA-T2 depressive symptoms-T3 functional status was mostly significant among those who felt closer to death.

DISCUSSION

The findings contribute to our understanding of the underlying mechanism through which SA predicts long-term functioning sequelae by underscoring the indirect effect of depressive symptoms. They further indicate the importance of gauging the effects of SNtD on these longitudinal relationships. Present results may further contribute to establishing an integrative model for predicting long-term functional outcomes based on older adults' earlier subjective views of aging.

Correlation between the Ability to Manipulate a Touchscreen Device and Hand Strength and Manual Dexterity among Community-Living Older Individuals

Information regarding the relationship between the degree of hand function among the elderly as measured by traditional assessments and the ability to manipulate touchscreens is lacking. This study aimed to examine the correlation between the ability to manipulate a touchscreen device, as assessed using the touchscreen assessment tool (TATOO) (University of Haifa, Israel & Universetiy of Bologna, Italy), and hand strength and manual dexterity among independent community-living older individuals. Thirty-four community-living older adults (average age 79.4 ± 6.7 years) participated in single-session assessments lasting 45 min each. The assessment included hand strength measurement using the manual hand dynamometry and hydraulic pinch gauge, a functional dexterity test (FDT), and TATOO. No significant correlations were observed between most of the TATOO items (22 out of 26) and handgrip strength, pinch strength, and FDT results. Moderately significant correlations were demonstrated between the number of drag attempts in the “Drag to different directions” task and handgrip strength and manual dexterity (r value: −0.39, p value: 0.02; r value: 0.36, p value: 0.04, respectively). In addition, a moderately significant correlation was noted between the number of double taps and manual dexterity (r value: 0.32, p value: 0.07). These results indicate that more complex gestures that require greater accuracy (dragging task) or rapid movements (double tapping) are related to hand strength and manual dexterity. These results suggest that the manual gestures necessary for touchscreen operation entail unique and specific capabilities that are generally not captured by traditional tools. The clinical implication is that the hand function assessment toolbox should be expanded. Tools such as the TATOO should be used to capture skills required for touchscreen manipulation in the context of the modern digital milieu.

Effects of backhand stroke styles on bone mineral content and density in postmenopausal recreational tennis players: a cross-sectional pilot investigation

Background

One-handed backhand (OB) and two-handed backhand (TB) styles are commonly used in tennis, but only TB generates loadings on the non-dominant arm and a greater extension torque on the rear leg, leading to a greater axial torque involving rotation of the hip and trunk. The current study investigated whether those effects can further affect bone area (BA), bone mineral content (BMC) and density (BMD) in postmenopausal recreational tennis players.

Methods

BA, BMC and BMD of the lumbar spine, hip and distal radius were assessed using dual-energy X-ray absorptiometry in TB, OB, and swimmers’ group as a control (SG) (all participants self-reported for at least 5 years of exercise history, n = 14 per group). Muscular strength was assessed with a hand dynamometer. Among these three groups, the BA, BMC and BMD of distal radius and muscle strength were assessed using one-way ANOVA, and those of the lumbar region and the hip joint were tested by one-way ANCOVA.

Results

TB showed higher BMC and BMD for both lumbar spine and femoral neck than SG (all, p < 0.05). Both OB and TB showed greater BMD inter-trochanter than SG (both, p < 0.05). OB demonstrated greater inter-arm differences in the distal radius, which involved 1/3 distal for BMC and mid-distal radius for BMD compared to the TB and SG (all, p < 0.05). In addition, greater inter-arm asymmetry of grip strength was found in OB compared to TB and SG (both, p < 0.05).

Conclusion

For postmenopausal women, performing two-handed backhand strokes, leads to higher BMC and BMD in the non-dominant arm, the lumbar region, and hips, indicating potential benefit to maintain bone health and strength. Whether this result leads to reducing the risk of osteoporosis needs to be investigated in further research.

Role of handgrip strength in predicting new-onset diabetes: findings from the survey of health, ageing and retirement in Europe

BACKGROUND

Diabetes is a major concern for the global health burden. This study aimed to investigate the relationship between handgrip strength (HGS) and the risk of new-onset diabetes and to compare the predictive abilities between relative HGS and dominant HGS.

METHODS

This longitudinal study used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including 66,100 European participants aged 50 years or older free of diabetes at baseline. The Cox proportional hazard model was used to analyze the relationship between HGS and diabetes, and the Harrell's C index, net reclassification index (NRI), and integrated discrimination improvement (IDI) were calculated to evaluate the predictive abilities of different HGS expressions.

RESULTS

There were 5,661 diabetes events occurred during follow-up. Compared with individuals with lowest quartiles, the hazard ratios (95 % confidence intervals) of the 2nd-4th quartiles were 0.88 (0.81-0.94), 0.82 (0.76-0.89) and 0.85 (0.78-0.93) for dominant HGS, and 0.95 (0.88-1.02), 0.82 (0.76-0.89) and 0.60 (0.54-0.67) for relative HGS. After adding dominant HGS to an office-based risk score (including age, gender, body mass index, smoking, and hypertension), the incremental values of the Harrell's C index, NRI, IDI of relative HGS were all slightly higher than those of dominant HGS in both training and validation sets.

CONCLUSIONS

Our findings supported that HGS was an independent predictor of new-onset diabetes in the middle-aged and older European population. Moreover, relative HGS exhibited a slightly higher predictive ability than dominant HGS.

Association Between Muscle Strength and Cystatin C-Based Estimated Glomerular Filtration Rate Among Middle-Aged and Elderly Population: Findings Based on the China Health and Retirement Longitudinal Study (CHARLS), 2015

Background

Patients with chronic kidney disease (CKD) are prone to muscle strength degeneration. However, the relationship between mild-to-moderate renal insufficiency and low muscle strength remains unclear. As cystatin C is not subject to muscular conditions and is a sensitive serum marker in preclinical renal disease, we aimed to investigate the association between estimated glomerular filtration rate (eGFR) based on cystatin C and muscle strength in the Chinese population.

Methods

This was a cross-sectional study enrolling 12,398 Chinese participants aged above 45 years (5762 men and 6636 women) from the 2015 China Health and Retirement Longitudinal Study. Handgrip strength (HGS) was used to assess muscle strength. Locally weighted scatterplot smoothing (LOWESS) curves were employed to visualize the relationships between eGFR and HGS. Multivariable logistic regression was conducted to analyze the correlation between kidney function and low muscle strength.

Results

Significant differences in HGS by CKD stage were observed in both sexes after adjusting for age and body mass index. LOWESS curves demonstrated concomitant decreases in HGS and kidney function at eGFR levels below 120 mL/min/1.73 m² in both sexes. According to multivariate logistic regression, participants with CKD stages 2 (odds ratio [OR]: 1.256, 95% confidence interval [CI]: 1.120–1.409), 3 (OR: 2.725, 95% CI: 2.2585–3.288), and 4–5 (OR: 3.069, 95% CI 1.747–5.392) had higher risk of low muscle strength than those who were normal or had CKD stage 1 after adjusting for demographic and clinical variables.

Conclusion

Our study illustrated that CKD stage was independently associated with low muscle strength in Chinese middle-aged and elderly populations.

Impact of physical activity, protein intake and social network and their combination on the development of frailty

BACKGROUND

Frailty is a geriatric condition associated with adverse health outcomes. As physical inactivity, low protein intake and poor social network are known risk factors, we aimed to assess the influence of these parameters and their interaction in an 11-year follow-up study on a Europe-wide level.

METHODS

Data from the Study on Health, Ageing and Retirement in Europe were used, including 22 226 community-dwelling robust and prefrail persons aged ≥50 years, from 11 countries. Frailty was assessed with the 'Frailty Instrument for Primary care of the Survey of Health, Ageing and Retirement in Europe'. Additionally, self-reported physical activity (PA), protein intake and satisfaction with social network were assessed. The impact of these parameters on the development of frailty was calculated using multivariate cox regressions.

RESULTS

Performing no regular PA, was associated with higher hazards ratio (HRs) for frailty compared with performing regular PA [men: 1.90 (95%CI: 1.50-2.42); women: 1.65 (95%CI: 1.25-2.18)]; HRs for low protein intake were 1.16 (95%CI: 0.93-1.46) for men and 1.05 (95%CI: 0.80-1.37) for women. And HR for poor social network were 0.92 (95%CI: 0.74-1.15) for men and 1.72 (95%CI: 1.31-2.27)] for women. In general, persons with a combination of two of the assessed risk factors had a higher risk for frailty compared with those with no or only one of the risk factors. However, no significant synergy index could be found.

CONCLUSION

The results illustrate the importance of PA, but also of nutritional and social network to prevent frailty.

Reference values and factors associated with hand grip strength among older adults living in southeastern Poland

Handgrip strength (HGS) is used as a biomarker for the state of health of older people, but the number of research publications containing the normative values of HGS in older adult populations is limited. The aim of the study was to define reference values and factors associated with HGS in older adults living in southeastern Poland. A cross-sectional study including 405 participants aged 65 and older was conducted. Handgrip strength for the dominant hand was assessed by the average of three trials using a JAMAR dynamometer. The sample was categorized into the following age groups: 65–69 years, 70–74 years, 75–79 years, 80–84 years, 85 and over. The average HGS was 19.98 kg (16.91 kg for women and 26.19 kg for men). There was a decrease in handgrip strength across the age range in both sexes. The average handgrip strength of the older people was 17.97 kg (14.47 kg for women and 25.66 kg for men) for those aged 80–85 and 16.68 kg (13.51 kg for women and 21.77 kg for men) in the group over 85 years old. In both sexes, marital status was an independent factor associated with reduced handgrip strength. In conclusion, this study described, for the first time, handgrip strength values for the southeastern Polish population aged ≥ 65 years according to age and gender.

The Reciprocal Relationship between Socioeconomic Status and Health and the Influence of Sex: A European SHARE-Analysis Based on Structural Equation Modeling

It is well recognized that socioeconomic status (SES) is an important determinant of health, but many studies fail to address the possibility of reverse causation. We aim to investigate the reciprocal relationship between trajectories of SES and health, and how these associations differ by sex. We performed a longitudinal study including 29,824 men and 37,263 women aged 50+ participating in at least two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using structural equation modeling, we found that baseline household income and wealth led to improvements in cognitive function, grip strength, quality of life and depressive symptoms, and a better initial health led to higher income and wealth for both sexes. However, the results indicated that the relative effect of cognitive function and grip strength on SES trajectories was overall greater than the corresponding effect of SES on health changes, particularly regarding income among women, but for quality of life and depressive symptoms, the reverse was indicated, though most pronounced for the associations with wealth. The reciprocal associations between SES and physical function were stronger for men than for women, whereas most associations with cognitive function and mental health were similar between sexes. This study demonstrates that both social causation and health selection contribute to social inequalities in health, but the influence of each direction and the importance of sex differences may vary according to the health outcomes investigated.

Extent of aging across education and income subgroups in Thailand: Application of a characteristic-based age approach

Aim

This study aimed to identify differences in physical performance across various socioeconomic groups within an older population and to convert those differences into a common metric to facilitate comparisons of aging speed across socioeconomic subgroups.

Methods

We employed data from the 2009 National Health Examination Survey of Thailand. Physical performance was assessed using three health characteristics: grip strength, as a measure of upper body strength; walking speed, as a measure of lower body strength; and a combined measure of grip strength and walking speed, to capture the strength of the whole body. Education level and income were used to distinguish socioeconomic subpopulations. We followed a characteristic-based age approach to transform these population characteristics, which were measured in different units, into a common and comparable aging metric, referred to as α − age.

Results

Physical aging trajectories varied by sex and socioeconomic status. Some education, particularly secondary or higher education levels, was significantly associated with greater physical strength in older age for both men and women, whereas higher income was significantly associated with physical strength only for men. Across the three health characteristics, having a primary education slowed age-related declines by up to 6.3 years among men and 2.8 years among women, whereas being in a higher income group slowed age-related declines by 8.2 years among men and up to 4.9 years among women.

Conclusions

This study adds new evidence from a developing Asian country regarding the difference in aging speeds across subpopulations associated with different levels of education and income.

Reference Values for Handgrip Strength in the Basque Country Elderly Population

Simple Summary

Functional impairment is a growing global problem that increases with age and acute hospitalisations. Handgrip strength (HGS) is one of the tests used as a predictor of low skeletal muscle strength in the diagnosis of weakness. The aim of this study is to provide reference values of HGS in adults and older adults in the Basque Country by identifying cut-off points to measure weakness and compare the values with other populations. A health-promoting programme seems to be effective in obtaining better values as age increases with respect to the general population in the HGS test, delaying and even avoiding reaching the cut-off values for detecting weakness as a criterion for frailty. Despite the current findings available to health professionals for more effective detection of frailty, many of them have not been yet translated into clinical practice. Determining HGS values by population will allow to obtain clinically fast and effective cut-off values to detect weakness and probable risk in an ageing population.

Abstract

Strength training is currently the most recommended primary therapeutic strategy to prevent and reverse the decline of muscle mass, strength, and functional deterioration associated with age. The aim is to provide reference values of handgrip strength (HGS) in the Basque Country population and compare the values with other populations. A total of 1869 subjects from the health-promoting programme for adults and older adults run by the Bilbao City Council were assessed using HGS with a digital dynamometer and anthropometric data measured by Tanita to obtain the mean values according to age distribution. From the 1869 subjects, 87.5% were women and 12.5% men. The HGS was higher among men than women, 32.4 ± 6.6 versus 20.1 ± 4.7 kg, respectively, p < 0.001 at all ages. Weak HGS cut-off points by age groups ranged from 31.0 to 23.8 and from 18.9 to 12.4 in men and women, respectively. The sample data were compared (d, t, and α) with those of other populations in all age groups (group > 60 years at 95% df, p < 0.05). A health-promoting programme appears to be effective in the general population in obtaining better values in the HGS test as age increases.

Using grip strength to compute physical health-adjusted old age dependency ratios

The standard approach for comparing the potential challenges of population aging across countries based on conventional old-age dependency ratios (OADR) does not account for cross-population differences in health, functional capacity or disability, despite their importance for labor force participation and dependency more broadly. We investigate how OADRs observed across selected low-, middle-, and high-income countries change if population differences in physical health measured by hand-grip strength are accounted for. Specifically, we propose and calculate an adjusted measure of the OADR based on hand-grip strength, which serves as an objective indicator of muscle function and has been shown to predict future morbidity, disability and mortality. We show that adjusting the OADR for differences in hand-grip strength results in substantial changes in country rankings by OADR compared to a ranking based on the conventional OADR definition. Accounting for cross-population differences in hand-grip strength, the estimated OADRs for low- and middle-income countries tend to increase compared to the conventional OADR approach based on age only, whereas the estimated OADRs in high-income countries decline substantially relative to the standard approach. Since hand-grip strength is an important prerequisite for maintaining functional capacity and productivity and preventing disability -especially in economies in low-income settings- our grip-strength-adjusted OADRs clearly show that population aging is not just a challenge in high-income countries but also an important concern for economies in the developing world.

Cultural differences in the association between subjective age and health: evidence from the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel)

Research has demonstrated that holding a young subjective age (i.e. feeling younger than one's chronological age) has been associated with various positive aspects of physical and psychological health. However, little is known about how such associations differ between cultural sub-groups within a given society. Accordingly, the current study focused on the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) and aimed to explore the moderating role of culture on the association between subjective age and objective physical health, subjective physical health and psychological health. Data were collected from 1,793 respondents, who were classified into three groups: veteran Israeli Jews, immigrants from the former Soviet Union and Israeli Arab citizens. Age ranged from 50 to 105 (mean = 69.65, standard deviation = 9.49). All participants rated their subjective age and filled out scales examining six dimensions covering psychological health, as well as objective and subjective physical health. Across all examined dimensions, an older subjective age was associated with unfavourable health outcomes. For the majority of health dimensions, the subjective age–health links were most prominent among Israeli Arabs. Results are discussed from both a general societal standpoint (i.e. group differences in access to health services), as well as from the individual's specific role in his or her culture and society.

Handgrip Strength in Young Adults: Association with Anthropometric Variables and Laterality

The measurement of handgrip strength (HGS) is an indicator of an individual's overall strength and can serve as a predictor of morbidity and mortality. This study aims to investigate whether HGS is associated with handedness in young adults and if it is influenced by anthropometric characteristics, body composition, and sport-related parameters. We conducted a cross-sectional study on a sample of 544 young Italian adults aged 18-30 years. We measured HGS using a dynamometer and collected data on handedness and physical activity, along with anthropometric measurements. In both sexes, the HGS of the dominant side was significantly greater than that of the non-dominant side. Furthermore, in ambidextrous individuals, the right hand was stronger than the left. A comparison between the lowest and the highest tercile of HGS highlighted its significant association with anthropometric and body composition parameters in both sexes. Moreover, sex, dominant upper arm muscle area, arm fat index, fat mass, and fat-free mass were found to be significant predictors of HGS by multiple regression analysis. Our findings suggest that HGS is especially influenced by body composition parameters and handedness category. Therefore, HGS can be used as a proxy for unhealthy conditions with impairment of muscle mass, provided that the dominance in the laterality of the subject under examination is taken into account.

Factors Affecting Reliability of Grip Strength Measurements in Middle Aged and Older Adults

Background: Grip strength is a well-established marker of frailty and a good predictor of mortality that has been measured in a diverse range of samples including many population studies. The reliability of grip strength measurement in longitudinal studies is not well understood. Methods: Participants (n=130) completed a baseline and repeat health assessment in the Irish Longitudinal Study on Ageing. Grip strength was assessed using dominant and non-dominant hands (two trials on each). Repeat assessments were conducted 1-4 months later and participants were randomised into groups so that 50% changed time (morning or afternoon assessment) and 50% changed assessor between assessments. Intra-class correlation (ICC) and minimum detectable change (MDC95) were calculated and the effects of repeat assessment, time of day and assessor were determined. Results: Aggregated measures had little variation by repeat assessment or time of day; however, there was a significant effect of assessor (up to 2 kg depending on the measure used). Reliability between assessments was good (ICC>0.9) while MDC95 ranged from 5.59–7.96 kg. Non-aggregated measures alone, taken on the non-dominant hand were susceptible to repeat assessment, time of day, assessor and repeated measures within-assessment effects whereas the dominant hand was only affected by assessor.   Conclusions: Mean and maximum grip strength had a higher ICC and lower MDC95 than measures on the dominant or non-dominant hands alone. The MDC95 is less than 8 kg regardless of the specific measure reported. However, changing assessor further increases variability, highlighting the need for comprehensive assessor training and avoiding changes within studies where possible.

Biases in health expectancies due to educational differences in survey participation of older Europeans: It's worth weighting for

Health expectancies are widely used by policymakers and scholars to analyse the number of years a person can expect to live in good health. Their calculation requires life tables in combination with prevalence rates of good or bad health from survey data. The structure of typical survey data, however, rarely resembles the education distribution in the general population. Specifically, low-educated individuals are frequently underrepresented in surveys, which is crucial given the strong positive correlation between educational attainment and good health. This is the first study to evaluate if and how health expectancies for 13 European countries are biased by educational differences in survey participation. To this end, calibrated weights that consider the education structure in the 2011 censuses are applied to measures of activity limitation in the Survey of Health, Ageing and Retirement in Europe. The results show that health expectancies at age 50 are substantially biased by an average of 0.3 years when the education distribution in the general population is ignored. For most countries, health expectancies are overestimated; yet remarkably, the measure underestimates health for many Central and Eastern European countries by up to 0.9 years. These findings highlight the need to adjust for distortion in health expectancies, especially when the measure serves as a base for health-related policy targets or policy changes.

Indicators of Abnormal Hand Grip Strength Among Older Egyptian Adults

Background

Hand grip strength (HGS) is gaining the attention of researchers and clinicians, including geriatricians as a readily available, inexpensive, and useful measure of muscle strength.

Objective

To identify the indicators of abnormal HGS as measured by a Jamar handheld dynamometer in community-dwelling Egyptian senior citizens.

Study Design

The study was approved by the relevant ethical committee. This cross-sectional study included 200 randomly selected older adults of both sexes who attended geriatric and internal medicine outpatient clinics. Informed consent was obtained, and comprehensive geriatric assessment was performed, including assessment of the health-related quality of life by the 12-Item Short-Form Health Survey (SF-12).

Measurement

HGS was measured, and values of 20 kg or less in females and 30 kg or less in males were considered abnormal.

Statistical Methods

IBM SPSS statistics v25.0 was used for data analysis. Data were expressed as the mean ± SD for quantitative parametric measures and as the number and percentage for categorical data. Student’s t-test, the chi-squared test, the diagnostic validity test, and multiple logistic regression analysis were performed. The ROC (receiver operating characteristic) curve was constructed, and the AUC (area under the curve) was also calculated.

Results

The subjects’ ages ranged from 60 to 95 years with a mean age of 69 ± SD 7.1 years. The sample consisted of 117 females (58.5%) and 83 males (41.5%). The chi-squared test showed that abnormal findings for grip strength were significantly more common among females than males (67.7% vs 32.3%). Student’s t-test showed that both height and weight were significantly lower among subjects with abnormal than normal HGS, while body mass index (BMI) showed a non-significant difference. Stepwise multiple logistic regression analysis showed that there was no actual relationship between sex and abnormality of HGS.

Conclusion

The best indicators of abnormal HGS were found to be a general health score below 25 points on the SF-12 and a height of less than 178 cm. As the values of general health and height decrease below those cut-off points, HGS decreases as well, and vice versa.

Trends in grip strength: Age, period, and cohort effects on grip strength in older adults from Germany, Sweden, and Spain

Grip strength is seen as an objective indicator of morbidity and disability. However, empirical knowledge about trends in grip strength remains incomplete. As trends can occur due to effects of aging, time periods and birth cohorts, we used hierarchical age-period-cohort models to estimate and disentangle putative changes in grip strength. To do this, we used population-based data of older adults, aged 50 years and older, from Germany, Sweden, and Spain from the SHARE study (N = 22500) that encompassed multiple waves of first-time respondents. We found that there were contrasting changes for different age groups: Grip strength improved over time periods for the oldest old, whereas it stagnated or even decreased in younger older adults. Importantly, we found strong birth cohort effects on grip strength: In German older adults, birth cohorts in the wake of the Second World War exhibited increasingly reduced grip strength, and in Spanish older adults, the last birth cohort born after 1960 experienced a sharp drop in grip strength. Therefore, while grip strength increased in the oldest old aged 80 years and older, grip strength stagnated or decreased in comparatively younger cohorts, who might thus be at risk to experience more morbidity and disability in the future than previous generations. Future studies should investigate factors that contribute to this trend, the robustness of the observed birth cohort effects, and the generalizability of our results to other indicators of functional health.

Association of baseline hand grip strength and annual change in hand grip strength with mortality among older people

BACKGROUND

Clinicians have increasing access to longitudinal data on hand grip strength (HGS), often measured for frailty or sarcopenia assessment, of their older clients. Evidence on the association of change in HGS with mortality is mixed. We investigated whether baseline hand grip strength (HGS) and annual change in HGS are associated with mortality among older Singaporeans.

METHODS

Data from a national longitudinal survey (3 waves: 2009, 2011 and 2015) of older people (≥60 years) in Singapore was utilized. All-cause mortality, until end-December 2015, was assessed primarily from administrative databases. Two datasets, with 4446 (Dataset 1: baseline HGS with mortality) and 2673 (Dataset 2: annual change in HGS with mortality) participants, with maximum follow-up time of 7 and 4.6 years respectively, were derived from the survey data. Associations of interest were assessed using Cox proportional hazard models.

RESULTS

835 (18.8%) and 317 (11.9%) participants died during follow-up, with mean survival times of 3.6 and 2.6 years, in Dataset 1 and 2 respectively. The likelihood of mortality was lower by 4% (Hazard Ratio [95% Confidence Interval]: 0.96 [0.94-0.97]) for each unit (kilogram) increase in baseline HGS, and by 13% (0.87 [0.82-0.93]) for each kg increase in HGS over 1-year.

CONCLUSIONS

Higher (alternatively, lower) baseline HGS and an increase (alternatively, decrease) in HGS over 1-year were associated with lower (alternatively, higher) likelihood of all-cause mortality among community-dwelling older people. There is clinical value, for assessing the risk of mortality, of both the cross-sectional and longitudinal measurement of HGS among older people.

Sex Differences in Comorbidity and Frailty in Europe

OBJECTIVES

To examine sex differences in prevalent comorbidity and frailty across age and European regions.

METHODS

This is a cross-sectional study based on 113,299 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe from 2004-2005 to 2015. Sex differences in the Comorbidity Index and the Frailty Phenotype were investigated using ordinal logistic regressions.

RESULTS

European women had generally higher odds of prevalent comorbidity (OR 1.11, 95% CI 1.07-1.15) and frailty (OR 1.56, 95% CI 1.51-1.62). Sex differences increased with advancing age. No overall sex difference in comorbidity was found in Western Europe, but women had more comorbidity than men in Eastern (OR 1.30, 95% CI 1.18-1.44), Southern (OR 1.23, 95% CI 1.15-1.30), and Northern (OR 1.08, 95% CI 1.01-1.16) Europe. Women were frailer than men in all regions, with the largest sex difference in Southern Europe (OR 1.84, 95% CI 1.72-1.96).

CONCLUSIONS

European women are frailer and have slightly more comorbidity than European men lending support for the male-female health survival paradox.

Alcohol Consumption and Functional Limitations in Older Men: Does Muscle Strength Mediate Them?

OBJECTIVES

To evaluate the dose-response relationships between alcohol consumption and functional limitations in older European men, and explore the role of muscle strength as a mediator of these relationships.

DESIGN

Cross-sectional study of older men participating in the Survey of Health, Aging and Retirement in Europe (SHARE).

SETTING

Urban and rural households in 17 European countries and Israel.

PARTICIPANTS

A total of 17 870 men aged 65 years and older from the SHARE (Wave 6, 2015) were included in this study.

MEASUREMENTS

Outcome variables were functional limitations: mobility limitation, arm function limitation, and fine motor limitation. Main exposure variable was alcohol consumption. Mediating factor was grip strength. Basic demographics, life habits, and health status were considered as potential confounders. Dose-response analyses with restricted cubic splines and the Karlson/Holm/Breen method were conducted.

RESULTS

A total of 17 870 participants were included in this study. Dose-response analyses revealed that moderate alcohol consumption was related to the lower odds of reporting mobility limitation (≤35 units/wk) and arm function limitation (≤41 units/wk), with a minimum odds ratio (OR) occurring at 10 units/week drinks for mobility limitation (OR = .71; 95% confidence interval [CI] = .62-.81) and arm function limitation (OR = .66; 95% CI = .59-.75). The odds of reporting the fine motor limitation monotonically increased with alcohol consumption when alcohol consumption was beyond 15 units/week. No significant mediating effect of grip strength on the relationships between alcohol consumption and mobility limitation and arm function limitation was found.

CONCLUSION

Moderate alcohol consumption has a protective role in mobility and arm function limitation in older European men. Grip strength is not the main mediator of these associations, suggesting that the protective effect is independent of muscle strength. Alcohol consumption is associated with higher odds of reporting fine motor limitation in older European men. J Am Geriatr Soc 67:2331-2337, 2019.

Gender differences in cognitive function and grip strength: a cross-national comparison of four European regions

BACKGROUND

Cross-national comparison studies on gender differences have mainly focussed on life expectancy, while less research has examined differences in health across countries. We aimed to investigate gender differences in cognitive function and grip strength over age and time across European regions.

METHODS

We performed a cross-sectional study including 51 292 men and 62 007 women aged 50 + participating in the Survey of Health, Ageing and Retirement in Europe between 2004-05 and 2015. Linear regression models were used to examine associations.

RESULTS

In general, women had better cognitive function than men, whereas men had higher grip strength measures. Sex differences were consistent over time, but decreased with age. Compared with men, women had higher cognitive scores at ages 50-59, corresponding to 0.17 SD (95% CI 0.14, 0.20) but slightly lower scores at ages 80-89 (0.08 SD, 95% CI 0.14, 0.00). For grip strength, the sex difference decreased from 18.8 kg (95% CI 18.5, 19.1) at ages 50-59 to 8.5 kg (95% CI 7.1, 9.9) at age 90 + . Northern Europeans had higher cognitive scores (19.6%) and grip strength measures (13.8%) than Southern Europeans. Gender differences in grip strength were similar across regions, whereas for cognitive function they varied considerably, with Southern Europe having a male advantage from ages 60-89.

CONCLUSION

Our results illustrate that gender differences in health depend on the selected health dimension and the age group studied, and emphasize the importance of considering regional differences in research on cognitive gender differences.

Comparison of cognitive and physical functioning of Europeans in 2004-05 and 2013

Background

Adult mortality has been postponed over time to increasingly high ages. However, evidence on past and current health trends has been mixed, and little is known about European disability trends.

Methods

In a cross-sectional setting, we compared cognitive and physical functioning in same-aged Europeans aged 50+ between 2004–05 (wave 1; n = 18 757) and 2013 (wave 5 refresher respondents; n = 16 696), sourced from the Survey of Health, Ageing and Retirement in Europe (SHARE).

Results

People in 2013 had better cognitive function compared with same-aged persons in 2004–05, with an average difference of approximately one-third standard deviation. The same level of cognitive function in 2004–05 at age 50 was found in 2013 for people who were 8 years older. There was an improvement in cognitive function in all European regions. Mean grip strength showed an improvement in Northern Europe of 1.00 kg [95% confidence interval (CI) 0.65; 1.35] and in Southern Europe of 1.68 kg (95% CI 1.14; 2.22), whereas a decrease was found in Central Europe (-0.80 kg; 95% CI −1.16; −0.44). We found no overall differences in activities of daily living (ADL), but small improvements in instrumental activities of daily living (IADL) in Northern and Southern Europe, with an improvement in both ADL and IADL from age 70 in Northern Europe.

Conclusions

Our results indicate that later-born Europeans have substantially better cognitive functioning than earlier-born cohorts. For physical functioning, improvements were less clear, but for Northern Europe there was an improvement in ADL and IADL in the oldest age groups.

Women's mid-life health in Low and Middle Income Countries: A comparative analysis of the timing and speed of health deterioration in six countries

BACKGROUND

Mid-life is a neglected stage of women's lives, particularly in Low and Middle Income Countries (LMICs). Birth injuries, menopause and manual labour can contribute to health problems in the mid-life.

OBJECTIVES

This study analyses the relationship between women's health deterioration and age across socio-economic groups in 6 countries (China, Ghana, Mexico, Russia, South Africa and India).

METHODS

Using constrained cubic splines, I analysed data from the WHO SAGE survey to examine age and wealth patterns in the onset of deterioration in objective proxies of ageing.

RESULTS

Results show a clear pattern of deterioration in health in middle-aged women. Ageing processes differ dramatically between rich and poor strata within countries and between countries.

DISCUSSION

This study clearly shows that the onset of ageing in women in LMICs begins in the early forties. The paper highlights the need to focus more on mid-life health of women, in particular poorer ones.

Impact of obesity and physical inactivity on the long-term change in grip strength among middle-aged and older European adults

BACKGROUND

Grip strength is a well-established predictor of various chronic conditions and all-cause mortality. Body weight and physical activity (PA) are considered potential determinants of muscle strength. This study aimed to investigate gender-specific associations of baseline obesity and physical inactivity with long-term changes in grip strength among middle-aged and older European adults.

METHODS

Data from the Survey of Health, Ageing and Retirement in Europe 2004-2015 which was conducted in 12 countries were analysed. Grip strength was repeatedly measured at five follow-up visits with average 2-year intervals. Obesity and physical inactivity at baseline were primary exposures. Generalised estimated equations stratified by gender were fitted.

RESULTS

This study included 8616 males and 10 088 females with a median follow-up of 9.42 years. Significant interactions between obesity and time with grip strength were identified in both males (χ² _interaction=16.65, p = 0.002) and females (χ² _interaction=10.80, p = 0.029). No significant interaction between physical inactivity and time with grip strength was identified in males (χ² _interaction=9.42, p = 0.051) or females (χ² _interaction=5.62, p = 0.230). Those who were less physically active at baseline had weaker grip strength from the beginning at baseline (β = -2.753, p < 0.001 for males and β = -1.529, p < 0.001 for females) to Visit 6 (β = -2.794, p < 0.001 for males and β = -1.550, p < 0.001 for females). Further combined analysis suggested a trend that exposure to both obesity and physical inactivity was related to the fastest decline rate of grip strength.

CONCLUSIONS

This study provides the additional evidence that PA and obesity prevention earlier in life play an important role in maintaining grip strength during ageing.

Handgrip strength in old and oldest old Swiss adults - a cross-sectional study

Background

Handgrip strength is indicative of overall physical health and mobility in the elderly. A reduction in strength below a certain threshold severely increases the risk of mobility limitations and is predictive for adverse outcomes such as dependence in daily activities and mortality. An overview of age- and geography- specific handgrip strength values in older adults provide a reference for further investigations and measures in clinical practice to identify people at risk for clinically meaningful weakness. The aim of this study was to evaluate handgrip strength in the Swiss-German population aged 75 and over.

Methods

In a cross-sectional study, maximal isometric handgrip strength of the dominant hand was evaluated in 244 Swiss people aged 75 years and over (62.7% women), with mean age (SD) of 84.5 (5.6) years in men and 83.1 (5.9) years in women. Demographic data and information about comorbidities, medication, fall history, global cognitive function, self-reported physical activity and dependence in activities of daily living were collected, and correlated with grip strength measures. Age- and gender specific grip strength values are reported as means, standard deviations and standard error of mean.

Results

Sex-stratified handgrip strength was significantly lower with advancing age in men (p < .01), from 37.7 (6.5) kg to 25.6 (7.6) kg and in women (p < .01) from 22.2 (4.0) kg to 16.5 (4.7) kg. Handgrip strength in our sample was significantly higher than in Southern European countries. Handgrip strength was independently associated with age, height and ADL dependence in men and women. Overall, 44% of men and 53% of women had handgrip strength measures that were below the clinically relevant threshold for mobility limitations.

Conclusion

This study reports the age- and sex-stratified reference values for handgrip strength in a representative sample of the Swiss population, aged 75–99 years. Although grip strength decreased with advancing age in both sexes; the relative decline was greater in men than women. Nonetheless men had significantly higher grip strength in all age groups. While the Swiss population sampled had greater grip strength than that reported in other European countries, about 50% were still classified as at risk of mobility limitations.

Weak Grip Strength and Cognition Predict Functional Limitation in Older Europeans

OBJECTIVES

To estimate the effects of baseline grip strength and cognition on the trajectory of functional limitation over time.

DESIGN

Longitudinal study of older adults participating in the Survey of Health, Ageing and Retirement in Europe (SHARE).

SETTING

Urban and rural households in 11 European countries and Israel.

PARTICIPANTS

Individuals aged 50 and older from SHARE (2004-2015) (N=14,073; 52.5% female).

MEASUREMENTS

Outcomes were functional limitation scores from five panel wave. Main exposure variables were grip strength and cognitive measures including memory, verbal fluency, and numeracy at baseline. Basic demographic characteristics, life habits, and health status were considered as potential confounders. Mixed-effect linear regression models were fitted.

RESULTS

Functional limitation increased significantly over time (follow-up range 0.9-11.6 years) (β = 0.051, P < .001). Mixed-effect linear regression models identified significant interactions between grip strength (β = -0.001, P < .001), numeracy (β = -0.012, P < .001), verbal fluency (β = -0.003, P < .001), word recall (β = -0.006, P < .001) and time on functional limitation.

CONCLUSION

Stronger baseline grip strength and better cognition predicted a slower rate of increase in functional limitation over time in older adults. Grip strength and cognitive function appeared to be useful indicators of the functional limitation process and attested to their value in monitoring functional change in European older adults. J Am Geriatr Soc 67:93-99, 2019.

Associations of Grip Strength and Change in Grip Strength With All-Cause and Cardiovascular Mortality in a European Older Population

Objective:

(1) To examine the associations between 3 measures of grip strength: static grip strength, change in grip strength, and the combination of grip strength and its change, with all-cause and cardiovascular mortality, and (2) to determine which measure is the most powerful predictor of all-cause and cardiovascular mortality among the European older population.

Method:

Data come from the first 4 waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). A Cox proportional hazard model and a competing risk regression model were used to assess the associations. To determine the best predictor, Akaike information criterion was applied.

Results:

Grip strength and the combination of grip strength and its change were associated with all-cause and cardiovascular mortality. Change in grip strength was correlated with only all-cause mortality. Among the 3 measures, the static measure of grip strength was the best predictor of cardiovascular mortality whereas the combined measure is that of all-cause mortality.

Discussion:

Grip strength is a significant indicator of all-cause and cardiovascular mortality. The combination of grip strength and its change can be used to increase the accuracy for prediction of all-cause mortality among older persons.