Handgrip strength and mortality in older Mexican Americans

The role of dynapenia and obesity on cognitive function in older adults

BACKGROUND & AIMS

Dynapenia and obesity have been independently associated with cognitive decline in older adults, but their co-occurring effects has not been well-studied. The study objective is to examine the relationship between dynapenic-obesity and cognitive impairment in older adults 75 years and older with normal or high cognitive function at baseline over 12 years of follow-up. We hypothesize that those with dynapenic obesity will have greater odds of cognitive function impairment than those with dynapenia only, obesity only, or no dynapenia no obesity (reference group).

METHODS

A total of 761 participants with a mean age of 81.5 and Mini-Mental State Examination (MMSE) > 21 at baseline were divided into four groups: no dynapenia no obesity (n = 316), obesity only (n = 142), dynapenia only (n = 217), and dynapenic obesity (n = 86). Measures included socio-demographics, medical conditions, body mass index, depressive symptoms, handgrip strength, and limitations in activities of daily living. We performed a mixed models estimate for cognitive decline for these groups over a 12-year period. Handgrip strength (HGS) was measured with a handgrip dynamometer and cognitive function was assessed with MMSE.

RESULTS

Participants in the dynapenia-obesity group experienced a greater (β = - 1.29, Standard Error = 0.60, p-value = 0.0316) cognitive decline over time compared to those in the no dynapenia and no obesity group, after controlling for all covariates.

CONCLUSION

Older adults with dynapenic-obesity were at high risk of cognitive decline over time. These findings highlight the need for interventions that target both conditions in this population to help maintain cognitive health. Community-based strength training programs and educational initiatives on nutrition and diet can help older adults reduce their risk of age-related cognitive decline.

Metabolic syndrome and arthritis among Mexican American older adults: findings from a 23-year follow-up

PURPOSE

To examine the sex differences in the relationship of metabolic syndrome (MetS) criteria with arthritis and symptomatic arthritis among Mexican American older adults aged ≥ 65 without self-reported arthritis at baseline over 23-years of follow-up.

METHODS

Participants (N = 1447) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94-2016). Measures included MetS criteria, arthritis defined as self-reported physician-diagnosed arthritis, socio-demographics, morbidities, depressive symptoms, pain on weight-bearing, cognitive and physical function, handgrip strength, mobility, and activities of daily living (ADLs) limitations. Symptomatic arthritis was defined as self-reported arthritis and having ≥ 1 of the following: pain, mobility limitation, or limited ADLs.

RESULTS

At baseline, the mean age was 72.6 years and 730 (50.5%) of our participants were females. Female participants with 2 and 3 MetS criteria had greater odds of arthritis [odds ratio (OR) = 1.77, 95% Confidence Interval (Cl) = 1.28-2.45 and OR = 2.68, 95% CI = 1.69-4.27, respectively) and symptomatic arthritis (OR = 1.74, 95% Cl = 1.24-2.44 and OR = 3.27, 95% CI = 2.04-5.26, respectively) after controlling for covariates. Male participants with 2 and 3 MetS criteria had greater odds of arthritis (OR = 1.65, 95% Cl = 1.14-2.39 and OR = 2.52, 95% CI = 1.51-4.19, respectively) and symptomatic arthritis (OR = 1.93, 95% Cl = 1.30-2.86 and OR = 2.98, 95% CI = 1.62-5.47, respectively) after controlling for covariates. Both females and males with pain on weight-bearing had greater odds of arthritis than those without pain.

CONCLUSIONS

At 23-years of follow-up, Mexican American older adults with MetS have an increased risk of arthritis and symptomatic arthritis. Early MetS screening and management may reduce arthritis in this population at high risk of disability.

Handgrip strength of young athletes differs based on the type of sport played and age

OBJECTIVE

Handgrip strength may differ depending on the type of sport played during the developmental period. Youth sports in which athletes hold equipment in their hands may be the most effective for improving handgrip strength. This study aimed to examine the age at which differences in handgrip strength appear by comparing sports that involve gripping (kendo) with those that do not involve gripping (soccer) in young athletes.

METHODS

Two hundred and twenty-two male athletes (115 kendo and 107 soccer) between 6 and 15 years old participated in this study. Handgrip strength was measured using a dynamometer, and the average value of both hands was used for analysis. Sports experience was determined when they started practicing each sport. Handgrip strength was compared between sports. Statistical moderation was used to determine if the relationship between sport and handgrip strength depended upon the age of the athlete.

RESULTS

Kendo athletes had significantly higher handgrip strength than soccer athletes (4.77 kg [95% CI: 2.34, 7.19]) in the overall sample. We found that the relationship between sport and handgrip strength depended upon the age of the child (sport*age t = -3.6, p = .004). Using the Johnson-Neyman procedure, we found statistically significant differences between sports from 8.48 years and older.

CONCLUSIONS

Our results suggest that the type of sport played, that is, whether or not an athlete plays with sports equipment in their hands, may influence the development of handgrip strength during the period of growth, and these sports may contribute to a higher level of handgrip strength in adulthood.

Interaction between handgrip strength and vitamin D deficiency on all-cause mortality in community-dwelling older adults: a prospective cohort study

OBJECTIVE

Muscle strength decline and vitamin D deficiency are coexisting conditions associated with multiple adverse health outcomes. This prospective study aimed to investigate the multiplicative and additive interactions between handgrip strength (HS) and serum 25-hydroxyvitamin D [25(OH)D] on all-cause mortality in Chinese community-dwelling older adults.

STUDY DESIGN

This is a population-based cohort study.

METHODS

2635 older adults (85.15 ± 12.01 years) were recruited from the Chinese Longitudinal Healthy Longevity Survey (2012-2018). Low HS was defined according to the Asian Working Group for Sarcopenia 2019 updated consensus (<28 kg for men and <18 kg for women). Serum 25(OH)D < 50 nmol/L were defined as vitamin D deficiency. Cox proportional hazard models were used to examine the association of HS and 25(OH)D with all-cause mortality. Socio-demographics, health status, and clinical characteristics were included as covariates.

RESULTS

1715 (65.09 %) and 1885 (71.54 %) participants had low HS and vitamin D deficiency, respectively. During a median follow-up of 3.52 years, 1107 older people died. After multivariable adjustment, both HS and 25(OH)D levels were inversely associated with all-cause mortality risk (Ps < 0.001). The hazard ratios (HRs) of low HS and vitamin D deficiency for all-cause mortality were 1.73 (95 % CI: 1.41-2.13) and 1.61 (95 % CI: 1.32-1.93), respectively. Although significant multiplicative interactions were not found, the association between low HS and all-cause mortality was attenuated in the higher 25(OH)D subgroup than in the lower 25(OH)D subgroup (stratified by 50 nmol/L). The multiple-adjusted HR of mortality for combined low HS and vitamin D deficiency was 2.18 (95 % CI: 1.73-2.56), which was higher than that for these two conditions alone. Significant additive interactions between low HS and vitamin D deficiency on mortality were observed (relative excess risk due to interaction: 0.71, 95 % CI: 0.37-1.05).

CONCLUSIONS

Low HS and low 25(OH)D levels synergistically increased the risk of all-cause mortality. Our results added new insights to the priority of early detection for older adults with comorbid muscle strength decline and vitamin D deficiency.

Assessing nutrition status, sarcopenia, and frailty in adult transplant recipients

The assessment of nutrition status, sarcopenia, and frailty holds significant relevance in the context of adult transplantation, as these factors are associated with an unfavorable prognosis; thus, transplant candidates must undergo a full nutrition assessment. Screening tools may be used to prioritize patients, this can be done using the Nutrition Risk Screening 2002 or Royal Free Hospital-Nutritional Prioritizing Tool. Subsequently, a thorough nutrition-focused physical examination should be conducted to evaluate clinical signs of nutrition deficiencies, fat and muscle loss, and fluid overload; dietary history and current intake must also be assessed. Apart from physical examination, specific testing for sarcopenia and frailty are recommended. For sarcopenia assessment, specifically for muscle quantification, the gold standard is the cross-sectional measurement of the muscle at L3 obtained from a computed tomography scan or magnetic resonance imaging; dual-energy x-ray absorptiometry is also a good tool especially when appendicular skeletal muscle index is calculated. Other more readily available options include phase angle from bioelectrical impedance or bioimpedance spectroscopy. In the sarcopenia assessment, muscle function evaluation is required, handgrip strength stands as the primary test for this purpose; this test is also part of the subjective global assessment and is included in some frailty scores. Finally, for frailty assessment, the Short Physical Performance Battery is useful for evaluating physical frailty, and for a multidimensional evaluation, the Fried frailty phenotype can be used. Specifically for liver transplant candidates, the use of Liver Frailty Index is recommended.

One-Year Handgrip Strength Change in Kindergarteners Depends upon Physical Activity Status

Free play in kindergarten can be roughly divided into fine and gross motor activities, but the effects of these activities on improving handgrip strength are unknown. Therefore, we aimed to compare one-year changes in handgrip strength and forearm flexor muscle size in children separated by preferred play in a kindergarten. One hundred and eleven children were recruited from a local kindergarten. They underwent handgrip strength and forearm muscle thickness measurements, and 95 (49 boys and 46 girls) underwent a second measurement one year after the first measurement. Class teachers assessed the physical activity of everyone in their class after the second measurement. Using three evaluation scores by the class teachers, we divided children into three groups based on the children's preference to play in kindergarten (fine movement vs. gross motor movement). Handgrip strength did not change differently between groups across one year. However, children who liked active playing outside (i.e., gross motor activity) were stronger than others. Furthermore, children who like playing outside observed greater changes than the other groups in the ulna (right hand) and radius muscle thickness (left hand), suggesting that changes in forearm muscle size might be incongruent with changes in handgrip strength among the three activity groups.

Handgrip Strength and Healthspan: Impact of Sports During the Developmental Period on Handgrip Strength (Juntendo Fitness Plus Study)

Handgrip strength as a biomarker is being studied as a factor in predicting disease onset. However, the effect of improving handgrip strength through physical exercises, such as sports during the developmental period, on disease prevention has yet to be fully elucidated. The Juntendo Fitness Plus (J-Fit Plus) Study is a unique database of anthropometric and physical fitness measurements with over 50 years of accumulated data. It has the potential to explore the effects of sports on the association between handgrip strength and morbidity/mortality. We first outline previous studies on the impact of physical exercise interventions on handgrip strength, separated into adulthood and developmental period. We then introduced a unique effort to investigate the effects of sports using the J-Fit Plus Study database and describe the challenges of finally elucidating the impact of exercise on the association between handgrip strength and health status.

Nativity differences in the relationship between handgrip strength and cognitive impairment in older Mexican Americans over 20 years of follow-up

PURPOSE

To examine nativity differences in the relationship between handgrip strength (HGS) and cognitive impairment among Mexican Americans aged ≥ 65 years with normal or high cognitive function at baseline over a 20-year period.

METHODS

Prospective cohort study of 2,155 non-institutionalized Mexican Americans aged ≥ 65 years from the Hispanic Established Population for the Epidemiological Study of the Elderly) who scored ≥ 21 in the Mini Mental State Examination (MMSE) at baseline. Measures included socio-demographics, body mass index, medical conditions, depressive symptoms, physical function, disability, HGS quartiles (sex-adjusted), and MMSE. We used generalized estimating equation models to estimate the odds ratio (OR) and 95% Confidence Interval (CI) of cognitive impairment (MMSE < 21) as a function of HGS quartile by nativity and adjusted for covariates.

RESULTS

US-born and foreign-born participants in the 4th quartile (highest) of HGS at baseline had lower odds of cognitive impairment over time compared with those in the 1st (lowest) HGS quartile (OR=0.95, 95% CI=0.90-0.99 and OR=0.93, 95% CI=0.89-0.98, respectively), after controlling for all covariates. When we analyzed HGS quartiles as time-varying, we found that US-born participants in the 3rd and 4th HGS quartile had 25% and 30% lower odds of cognitive impairment, respectively, while foreign-born participants in the 3rd and 4th HGS quartile had 27% and 49% lower odds of cognitive impairment over time, respectively, after controlling for all covariates.

CONCLUSION

Foreign-born older Mexican Americans who performed high in HGS experienced 7% lower odds of cognitive impairment over time compared with US-born older Mexican Americans.

Thresholds of handgrip strength for all-cause, cancer, and cardiovascular mortality: A systematic review with dose-response meta-analysis

BACKGROUND

While handgrip strength is associated with all-cause and cause-specific mortality, whether such associations are dose-dependent is largely unknown. Therefore, we conducted a systematic review on the dose-response relationship of handgrip strength with all-cause mortality, cancer, and cardiovascular mortality.

METHODS

The data source included three electronic databases (PubMed/MEDLINE, Web of Science and Scopus) from inception to 8 February 2022. Prospective cohort studies of healthy adults with objective measures of handgrip strength were included. Two researchers independently screened studies, extracted data, and assessed risk of bias. We used estimates regarding handgrip strength categories to conduct a random forest model, and a two-stage random-effects hierarchical meta-regression model pooling study-specific estimates for dose-response relationship. Outcomes included all-cause, cancer, and cardiovascular mortality.

REULTS

Forty-eight studies comprising 3,135,473 participants (49.6% women, age range 35-85 years) were included. Random forest models showed a significant inverse association between handgrip strength and all-cause and cause-specific mortality. Dose-response meta-analyses showed that higher levels of handgrip strength significantly reduced the risk of all-cause mortality within 26-50 kg (Higgin´s I² =45.7%) in a close-to-linear inverse fashion. Cancer and cardiovascular mortality displayed a trend towards a U-shaped association with a significant risk reduction between 16 and 33 kg (Higgin´s I² =77.4%), and a close-to-linear inverse shaped and significant risk reduction ranging from 24 to 40 kg (Higgin´s I² =79.7%) respectively.

CONCLUSION

There is strong evidence for an association between lower handgrip strength with higher all-cause, cancer, and cardiovascular mortality risk. The dose-response relationship of handgrip strength substantially varies depending on the cause of mortality.

Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study

BACKGROUND

Multimorbidity is highly prevalent and associated with several adverse health outcomes, including functional limitations. While maintaining physical functioning is relevant for all adults, identifying those with multimorbidity at risk for faster rates of physical functioning decline may help to target interventions to delay the onset and progression of disability. We quantified the association of multimorbidity with rates of long-term disability and objective physical functioning decline.

METHODS

In the Health and Retirement Study, we computed the Multimorbidity-Weighted Index (MWI) by assigning previously validated weights (based on physical functioning) to each chronic condition. We used an adjusted negative binomial regression to assess the association of MWI with disability (measured by basic and instrumental activities of daily living [ADLs, IADLs]) over 16 years, and linear mixed effects models to assess the association of MWI with gait speed and grip strength over 8 years.

RESULTS

Among 16,616 participants (mean age 67.3, SD 9.7 years; 57.8% women), each additional MWI point was associated with a 10% increase in incidence rate of disability (IRR: 1.10; 95%CI: 1.09, 1.10). In 2,748 participants with data on gait speed and grip strength, each additional MWI point was associated with a decline in gait speed of 0.004 m/s (95%CI: -0.006, -0.001). The association with grip strength was not statistically significant (-0.01 kg, 95%CI: -0.73, 0.04). The rate of decline increased with time for all outcomes, with a significant interaction between time and MWI for disability progression only.

CONCLUSION

Multimorbidity, as weighted on physical functioning, was associated with long-term disability, including faster rates of disability progression, and decline in gait speed. Given the importance of maintaining physical functioning and preserving functional independence, MWI is a readily available tool that can help identify adults to target early on for interventions.

Association between changes in working status and hand-grip strength among Korean middle-aged and older adults: a longitudinal panel study

We investigated the association between working status changes and hand-grip strength (HGS) among middle-aged and older Korean adults using data from the 2006–2018 Korean Longitudinal Study of Aging. After excluding those with less than normal HGS in the baseline year, newly added panels, and missing values, 3843 participants (2106 men; 1737 women) were finally included. After adjusting for potential confounders, we used a 2-year lagged multivariable generalized estimating equation model to examine this association longitudinally. Men who quit working or who continued to be non-working were more likely to have lower HGS than those who continued to work (working → non-working, adjusted odds ratio [OR]: 1.47, 95% confidence interval [CI] 1.26–1.70; non-working → non-working, adjusted OR: 1.52, 95% CI 1.34–1.72). Compared to women who continued to work, the other three groups showed high ORs with low HGS (working → non-working, adjusted OR: 1.19, 95% CI 1.01–1.40; non-working → working, adjusted OR: 1.18, 95% CI 0.98–1.42; non-working → non-working, adjusted OR: 1.38, 95% CI 1.22–1.56). Middle-aged and older adults whose working status changed to non-working were at higher risk of reduced HGS than others and required muscular strength training interventions to improve HGS and prevent sarcopenia.

Hand grip strength, standing balance, and rapid foot tapping in relation to the menopausal transition in Campeche, Mexico

OBJECTIVES

This cross-sectional study investigated menopause status in relation to hand grip strength, standing balance, and rapid foot tapping. A secondary aim was to examine the relationship between physical performance and urban/rural residence with a focus on habitual daily tasks.

METHODS

Maya and non-Maya women (40-60 years) were drawn from urban and rural sites in Campeche, Mexico (n = 543). Demographic, reproductive, and lifestyle information was collected in face-to-face interviews along with anthropometric and physical function measures. Linear regression was used to evaluate menopause status in relation to strength, balance, and foot tapping speed while adjusting for residence, ethnicity, and other variables.

RESULTS

Hand grip strength was 22.5, 21.6, and 20.0 kg in pre-, peri-, and postmenopausal women, respectively, but menopause status was not significantly related to grip strength in models adjusted for age. Grip strength was negatively associated with age and socioeconomic index, and positively associated with height and weight, self-reported health, and hours/week spent grinding corn/making tortillas. Postural stability was 9.4, 6.9, and 5.6 s across menopause categories; and menopause status remained significant in adjusted models. The number of foot taps in 10 s was 35.7, 33.4, and 33.9 taps in pre-, peri-, and postmenopausal women. Parity was negatively associated with foot tapping in adjusted models.

CONCLUSIONS

While age is a key predictor of physical function in women aged 40-60 years, menopausal status appears to have additional influences on postural control beyond age alone. Hours spent grinding corn/making tortillas were significantly associated with grip strength among rural women.

Association between timed up and go test and future incidence of disability: A nationwide representative longitudinal study in Korea

Although previous studies examined the association between mobility and disability, they have used either subjective measure disability such as activity of daily living or instrumental activity of daily living or indirect measure such as long-term care service use with small size of participants. This study aimed to examine the association between timed up and go (TUG) test and disability incidence with national disability registration data in Korea longitudinally, by using a national representative sample. We used the National Health Insurance Service–National Health Screening Cohort (NHIS–HEALS) database of National Health Information Database. The NHIS–HEALS dataset includes disability information of National Screening Programme participants, including registration date and type of disability, which is merged from Korean National Disability Registry (KNDR). We used Cox proportional hazard models to evaluate the association between TUG and disability incidence. We constructed three models with different levels of adjustment; Model 3 was a fully adjusted model. We conducted subgroup analysis according to the risk factors for disability. The study population comprised 81,473 participants; 86 of them were newly registered to KNDR, which were observed during a mean follow-up of 4.1 ± 2.6 (maximum, 8.9) years. For 334,200.9 person-year (PY) follow-up, the disability incidence rate was 0.208 per 1,000 PY. Disability incidence was significantly higher in participants with abnormal TUG results than in those with normal TUG results. (adjusted hazard ratio [aHR] 1.600, 95% confidence interval [CI] 1.036–2.472). In subgroup analysis, the disability incidence increased in participants of normal cognition, without obesity or without cardiovascular (CV) disease. Increased incidence in disability was noted in participants with abnormal TUG results. The increase was more evident for participants with normal cognition, without obesity or CV disease.

Associations of handgrip strength with all-cause and cancer mortality in older adults: a prospective cohort study in 28 countries

Background

mixed evidence exists on the association between muscle strength and mortality in older adults, in particular for cancer mortality.

Aim

to examine the dose–response association of objectively handgrip strength with all-cause and cancer mortality.

Study Design and Setting

data from consecutive waves from the Survey of Health, Ageing and Retirement in Europe comprising 27 European countries and Israel were retrieved. Overall, 54,807 men (45.2%; 128,753 observations) and 66,576 women (54.8%; 159,591 observations) aged 64.0 (SD 9.6) and 63.9 (SD 10.2) years, respectively, were included. Cox regression and Fine-Grey sub-distribution method were conducted.

Results

during the follow-up period (896,836 person-year), the fully adjusted model showed the lowest significant risk estimates for the highest third of handgrip strength when compared with the first third (reference) in men (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.34–0.50) and women (HR, 0.38; 95% CI, 0.30–0.49) for all-cause mortality. We identified a maximal threshold for reducing the risk of all-cause mortality for men (42 kg) and women (25 kg), as well as a linear dose–response association in participants aged 65 or over. No robust association for cancer mortality was observed.

Conclusion

these results indicate an inverse dose–response association between incremental levels of handgrip and all-cause mortality in older adults up to 42 kg for men and 25 kg for women, and a full linear association for participants aged 65 years or over. These findings warrant preventive strategies for older adults with low levels of handgrip strength.

Correlation between hand grip strength and regional muscle mass in older Asian adults: an observational study

BACKGROUND

Previous research has demonstrated a correlation between hand grip strength (HGS) and muscle strength. This study aims to determine the relationship between HGS and muscle mass in older Asian adults.

METHODS

We retrospectively reviewed the dual-energy X-ray absorptiometry (DXA) records of 907 older adults (239 (26.4%) men and 668 (73.6%) women) at one medical institution in Taipei, Taiwan, from January 2019, to December 2020. Average age was 74.80 ± 9.43 and 72.93 ± 9.09 for the males and females respectively. The inclusion criteria were: 1) aged 60 and older, 2) underwent a full-body DXA scan, and 3) performed hand grip measurements. Patients with duplicate results, incomplete records, stroke history, and other neurological diseases were excluded. Regional skeletal muscle mass was measured using DXA. HGS was measured using a Jamar handheld dynamometer.

RESULTS

Total lean muscle mass (kg) averaged 43.63 ± 5.81 and 33.16 ± 4.32 for the males and females respectively. Average HGS (kg) was 28.81 ± 9.87 and 19.19 ± 6.17 for the males and females respectively. In both sexes, HGS and regional muscle mass consistently declined after 60 years of age. The rates of decline per decade in upper and lower extremity muscle mass and HGS were 7.06, 4.95, and 12.30%, respectively, for the males, and 3.36, 4.44, and 12.48%, respectively, for the females. In men, HGS significantly correlated with upper (r = 0.576, p < 0.001) and lower extremity muscle mass (r = 0.532, p < 0.001). In women, the correlations between HGS and upper extremity muscle mass (r = 0.262, p < 0.001) and lower extremity muscle mass (r = 0.364, p < 0.001) were less strong, though also statistically significant.

CONCLUSION

Muscle mass and HGS decline with advancing age in both sexes, though the correlation is stronger in men. HGS measurements are an accurate proxy for muscle mass in older Asian adults, particularly in males.

A Review of Handgrip Strength and its Role as a Herald of Health

Measurement of grip strength using a handheld dynamometer is frequently performed as part of an orthopedic upper extremity examination. We review the technique of grip strength measurement and evaluation of the possible submaximal effort. What constitutes normal grip strength in one part of the world is not necessarily normal elsewhere. Additionally, there is considerable evidence, most of which is outside the orthopedic literature, that diminished grip strength is a proxy for poor health and a predictor of increased mortality.

Role of handgrip strength testing in pre-anaesthetic check-up: A prospective cross-sectional study

Background and Aims

Frailty has been known to be associated with postoperative adverse events and longer hospital length of stay (LOS). Hand grip strength (HGS) is one of the parameters of measuring frailty. The aim of the study was to correlate preoperative handgrip strength and 30-day outcome of patients undergoing major abdominal surgery. It also aimed to evaluate the role of the standard preoperative variables like metabolic equivalents, revised cardiac risk index (RCRI), serum albumin, and serum creatinine along with their association with HGS testing in determining the postoperative outcome in surgical patients.

Material and Methods

This prospective observational study included 149 American Society of Anesthesiologists class III/IV patients presenting for major abdominal surgery. A mean of three measurements of dominant HGS using Camry hand dynamometer was measured. The patients were divided into groups: weak, normal, and strong depending on grip strength. Patients were followed for 30 days and postoperative outcome in terms of ventilatory support, admission to intensive care unit, cardiac complications, in-hospital mortality, and LOS were recorded. Observational data obtained were reported as mean value and analyzed using Student's t-test or Wilcoxon/Mann-Whitney Rank test. Associations between RCRI, serum albumin, and LOS with HGS were evaluated using logistic regression.

Results

The hospital LOS was significantly longer in patients with weak HGS (15.11 ± 11.03 days versus 10 ± 5.71 days, P = 0.001). Patients with weak HGS had significantly lower mean serum albumin levels compared to normal HGS (P = 0.0001) and a statistically significant RCRI score (P = 0.013).

Conclusion

HGS can be used as a preoperative test in predicting hospital LOS after major surgery.

Factors Associated With Urgency Urinary Incontinence Among Older Mexican American Women Aged 65 years and Older

The purpose of this study was to determine which socio-demographic, clinical, or functional factors are associated with urgency urinary incontinence (UUI) over 20-years of follow-up in a community-dwelling sample of Mexican American women aged 65 years and older without UUI at baseline. We included 1,358 women participants from the Hispanic Established Population for the Epidemiologic Study of the Elderly study conducted in the southwestern of US (Arizona, California, Colorado, New Mexico, and Texas). Measures included self-reported UUI, socio-demographics, smoking status, body mass index, medical conditions, depressive symptoms, physical and cognitive function, and handgrip strength. We used generalized estimating equation models to estimate the odds ratio (OR) and 95% Confidence Interval (CI) of UUI as a function of socioeconomic, clinical, and functional factors. Self-reported UUI increased from 3.1% to 21.9% from baseline (1993/1994) to follow-up (2012/2013). Current smokers, obesity, arthritis, previous heart attacks, and depressive symptoms were factors associated with greater odds of UUI over time. Identification of these factors can help clinicians determine those at high risk of developing UUI. Preventing and/or treating the risk factors early may delay UUI and increase quality of life in this underserved population.

Liver Disease Among Mexican Americans Aged 67 Years and Older

Background:

The Center for Disease Control and Prevention (CDC) reports that liver disease is a significant cause of morbidity and mortality in the US, afflicting 4.5 million people in 2018, or approximately 1.7% of the American adult population.

Objective:

To determine the prevalence and risk factors associated with liver disease among older Mexican Americans over 18 years of follow-up.

Methods:

Non-institutionalized Mexican Americans aged ≥67 years (N = 1938) from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/96-2012/13) were studied. Measures included socio-demographic variables, self-reported liver disease, language of interview, medical conditions, hand-grip strength, physical and cognitive function, depressive symptoms, and body mass index. Generalized estimating equation models were used to estimate the odds ratio and 95% confidence interval (CI) of liver disease over time.

Results:

The mean age at baseline was 74.9 ± 6.0 years and 58.4% were female. The prevalence of liver disease ranged from 2.4% to 8.4%. Over time, the odds ratio of reporting liver disease was 1.17 (CI = 1.12-1.22). Older age, Spanish interview, arthritis, diabetes, heart failure, cancer, and high scores on the Mini-Mental-State-Examination were factors associated with greater odds of reporting liver disease over time. Married participants reported lower odds of liver disease over time.

Conclusions:

The prevalence of liver disease in this population was high, ranging from 2.4% to 8.4%. Diabetes, heart failure, arthritis, and cancer were risk factors for liver disease. Screening for liver function among patients with these morbidities may help prevent liver disease in this population with high rates of diabetes and obesity.

Association between relative handgrip strength and abdominal obesity, type-2 diabetes and hypertension in a Mexican population

BACKGROUND

handgrip strength (HGS) is a health-status parameter associated with multicomorbidity in the adult population.

OBJECTIVE

the aim of the present study was to determine the association between HGS (i.e., absolute and relative) and abdominal obesity (AO), type-2 diabetes (T2D), and hypertension (HT), as well as to determine the association between low relative HGS with the presence of multicomorbidity (i.e., the co-occurrence of two or more comorbidities together) in a Mexican population.

METHODOLOGY

a cross-sectional study was carried out in 860 participants from the south of Mexico (661 women and 199 men). The age range evaluated was from 18 to 65 years. Assessments were made of sociodemographic data, clinical history, anthropometric parameters, and measurement of maximal HGS.

RESULTS

the regression models adjusted by age show that the presence of comorbidities (i.e., AO, HT and T2D) was linked negatively to HGS (i.e., absolute and relative). Moreover, in men, a low relative HGS in both hands reported an association with the presence of three simultaneous comorbidities (right, RR: 17.2, p < 0.001; left, RR: 11.92, p = 0.020). In women the same association was found (right, RR: 10.42, p < 0.001; left, RR: 9.90, p < 0.001).

CONCLUSION

lower levels of relative HGS were linked to the presence of simultaneous comorbidities (i.e., the joint presence of AO, T2D and HT). Furthermore, HGS (i.e., absolute and relative) presented an inverse association with individual anthropometric and clinical parameters related to cardiovascular risk in the Mexican population.

Changes in Health-Related Quality of Life and Physical Activity Among Older Adults in the First-Wave COVID-19 Outbreak: A Longitudinal Analysis

The current study aimed to follow the effects of social/physical distancing strategies on health-related daily physical activity and quality of life among older adults during the COVID-19 pandemic. Seventy-two older adults who were enrolled in a University-Community program in March 2020 (age = 66.8 ± 4.82 years, ♀59) answered five phone-based surveys up to 120 days after the COVID-19 outbreak (from April to August 2020). The Short Form 6D and international physical activity (short version) questionnaires were applied. A significant reduction was observed in daily physical activity levels, metabolic equivalent of task, and health-related quality of life scores as well as an increase in sitting time during the week and on weekend days (all p < .01). The authors noted differences in lifestyle conditions at the beginning of the social/physical distancing in the community assessed (p < .01). Health vulnerabilities among older adults have been emphasized during the COVID-19 outbreak, impacting daily physical activity and health-related quality of life.

Thigh circumference and handgrip strength are significantly associated with all-cause mortality: findings from a study on Japanese community-dwelling persons

PURPOSE

In addition to playing a critical role in cardiovascular health, muscle mass and strength independently impact aging-related health outcomes in adults. There are limited predictive data for all-cause mortality, particularly for community-dwelling persons in Japan. This study examined whether handgrip strength (HGS) and thigh circumference are related to survival prognosis based on a 6-year follow-up period.

METHODS

Participants were 787 men (aged 69 ± 11 years) and 963 women (aged 69 ± 9 years) who took part in a Nomura cohort study conducted in 2014 and who continued with follow-ups for the subsequent 6 years (follow-up rate: 95.5%). We obtained adjusted relative hazards of all-cause mortality from the basic resident register. The data were subjected to a Cox regression with age as the time variable and gender, age, anthropometric index, smoking habits, drinking habits, exercise habits, cardiovascular history, blood pressure, lipid levels, diabetes, renal function, and serum uric acid as risk factors.

RESULTS

Of the 1750 participants, a total of 97 (5.5%) were confirmed to have died, of which 56 were men (7.1% of all male participants), and 41 were women (4.3% of all female participants). The multivariable Cox regression analysis revealed that smaller thigh circumference and lower HGS in men were found to predict 6-year all-cause mortality, but in women only baseline HGS was associated with all-cause mortality.

CONCLUSION

Thigh circumference and HGS are useful predictors of death in Japanese community-dwelling men.

Poor Walking Speed Is Associated With Higher Segment-Specific Arterial Stiffness in Older Adult Japanese Community Dwellers: A Cross-Sectional Study

Walking speed as one index of gait ability is an important component of physical fitness among older adults. Walking speed-arterial stiffness relationships have been studied, but whether poor walking speed is associated with higher segment-specific arterial stiffness in older adults is unclear. We thus aimed to examine the relationship between walking speed and segmental arterial stiffness among older community dwellers. This study was a cross-sectional study of 492 older Japanese community dwellers (age range, 65 to 96 years). Heart-brachial PWV (hbPWV), brachial-ankle PWV (baPWV), heart-ankle PWV (haPWV), and cardio-ankle vascular index (CAVI) were used as arterial stiffness indices. Walking speed, strength, flexibility, and cognitive function were also assessed. The participants were categorized into low (Slow), middle (Middle), and high (Fast) tertiles according to walking speed. The CAVI and baPWV were significantly lower in Fast than in Slow. Significant decreasing trends in CAVI and baPWV and a tendency toward decreasing trend in haPWV were observed from Slow to Fast, whereas hbPWV did not significantly differ among tertiles and no trend was evident. The results remained significant after normalizing CAVI and PWVs for multicollinearity of arterial stiffness indices and major confounding factors, such as age, gender, body mass index, blood pressure, cognitive function, and each physical fitness. Therefore, these findings suggest that poor walking speed is associated with higher segment-specific arterial stiffness of the central and lower limbs, but not of upper, in older adult community dwellers.

Smartphone frailty screening: Development of a quantitative early detection method for the frailty syndrome

BACKGROUND

Frailty syndrome in older population generates formidable social cost. The early detection of "prefrail" stage is essential so that interventions could be performed to prevent deterioration. The purpose of this study was to organize appropriate physical performance tests into a computerized early frailty screening platform, called frailty assessment tools (FAT) system, to detect individuals who are in the prefrail stage.

METHODS

Four switches, one distance meter, and one power measure were adopted to build the FAT system that could perform six physical performance tests including single leg standing (SLS), repeated chair rise, timed up and go, self-selected walking speed, functional reach, and grip power. Participants over 65 years old were recruited and classified into three groups according to Fried criteria. The differences in variables between prefrail and robust groups were compared by the χ test, independent samples t test, and Mann-Whitney U test, for nominal variables, normal, and non-normal distributive continuous variables, respectively. The statistically significant level was set at 0.05 (α = 0.05).

RESULTS

Only SLS did not reach significance to distinguish prefrail from robust. Among 35 participants (73.23 ± 5.70 years old), the FAT score predicted that 90.73 ± 19.95% of pre-frail subjects and 15.01 ± 25.25% of robust subjects were in the prefrail stage.

CONCLUSION

The FAT system, which provides results immediately, is an advantageous alternative to traditional manual measurements. The use of the FAT score for predicting the prefrail stage will help to provide early intervention to prevent individuals from progressing into frailty. The FAT system provides a more convenient and comprehensive frailty screening. Using this computerized automatic screening platform, it may be possible to expand the scope of frailty prevention.

Feasibility of substituting handgrip strength for muscle mass as a constituent standard in the Global Leadership Initiative on Malnutrition for diagnosing malnutrition in patients with gastrointestinal cancers

OBJECTIVES

The aim of this study was to determine the feasibility of substituting handgrip strength (HGS) for muscle mass as a constituent in the Global Leadership Initiative on Malnutrition (GLIM) to diagnose malnourished patients with gastrointestinal (GI) cancer.

METHODS

The study included 2209 patients diagnosed with GI cancer from two centers. All patients were evaluated for nutritional risk using Nutritional Risk Screening 2002 within 24 h of admission. The GLIM consensus was then used to diagnose malnourished patients. The evaluation of muscle mass as one of the constituents contained in the GLIM consensus was measured by computed tomography presented as skeletal muscle mass index (SMI) and HGS, respectively. Consistency test was carried out to evaluate the diagnostic value of SMI and HGS.

RESULTS

There were 1042 (47.2%) cases of gastric cancer and 1167 (52.8%) cases of colorectal cancer. Among these cases were 768 patients (34.8%) at nutritional risk. Furthermore, 603 (27.3%) and 593 patients (26.8%) were diagnosed with malnutrition in the GLIM (SMI) group and the GLIM (HGS) group, respectively, and 544 (24.6%) patients in the two groups overlapped. The consistency test results showed that the κ value in the GLIM (HGS) group compared with the GLIM (SMI) group was 0.881 (P < 0.001) in patients with gastric cancer and 0.872 (P < 0.001) in those with colorectal cancer.

CONCLUSION

HGS can be a substitute for muscle mass as a constituent in the diagnostic criteria of GLIM in patients with GI cancer.

Small Steps in Fitness, Major Leaps in Health for Adults With Intellectual Disabilities

Physical fitness is positively related to health outcomes like morbidity and all-cause mortality, with minimally required cutoff values to generate those health benefits. Individuals with intellectual disability (ID) exhibit very low fitness levels well below those cutoff values. Our novel hypothesis is that even among very unfit, older adults with ID, small changes in fitness translate to major changes in health.

Association between disability and cardiovascular event and mortality: A nationwide representative longitudinal study in Korea

This study aimed to examine the association between disability and cardiovascular (CV) disease incidence and mortality in Korea longitudinally, using a national representative sample. We used the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database, which includes information on the disability of the National Screening Program participants such as severity and type of disability, which were obtained from the Korean National Disability Registry. Cox proportional hazard models were used to evaluate the association between disability and CV disease incidence and mortality. We constructed four models with different levels of adjustment, in which Model 3 was a fully adjusted model. This study included 514,679 participants, and 7,317 CV deaths were reported within a mean follow up of 10.8 ± 3.9 years (maximum, 13.9 years). For 5,572,130 person-year (PY) follow-up, the CV mortality rate was 1.313 per 1,000 PY. In Models 1 and 2, CV disease incidence was significantly higher in participants with disability than in those without disability. In Model 3, the incidence was higher only among participants aged 50–64 years and severe disabled participants aged <50 years. CV mortality was significantly higher in participants with disability than in those without disability in all Models, and the mortality increased in both sexes in Models 1 and 2 but only increased in men in Model 3. Similar results were observed in the subgroup analysis of health behavior and chronic diseases. People with disability showed higher CV disease incidence and mortality than those without disability, regardless of the type of disability or risk factors for CV disease.

Handgrip Strength and Mortality in Elderly Koreans: Evidence From the Korea Longitudinal Study of Ageing

Despite substantial research on numerous aspects of health in the elderly, past studies that examined the association between handgrip strength and mortality have been conducted with samples drawn mostly from Caucasian populations, and little is known about whether similar trends are found in non-Western contexts such as Korea. The present study drew data from KLoSA (Korean Longitudinal Study of Aging), a nationally representative sample of middle-aged adults, and followed up for a decade. Results from discrete-time event history analysis of mortality indicated that higher handgrip strength significantly reduces the likelihood of death in both men and women. Men in the highest third of handgrip strength were 53.9% less likely to experience death than those in the lowest third. Women followed a similar pattern: middle and high handgrip strength reduced the odds by 26.4% and 48.3%, respectively. These findings suggest that handgrip strength has a significant impact on elderly mortality and does so in a negatively gradient manner.

Phase Angle as a Marker of Muscular Strength in Breast Cancer Survivors

BACKGROUND

accurate prognostic tools are relevant for decision-making in cancer care. Objective measures, such as bioelectrical impedance (BI), have the potential to improve prognostic accuracy for these patients. This cross-sectional study aimed to investigate whether phase angle (PhA) derived from the electrical properties of the body tissues is a predictor of muscular strength in breast cancer survivors (BCS).

METHODS

a total of 41 BCS (age 54.6 ± 9.2 years) were evaluated. PhA, obtained at frequency 50 kHz, was assessed with BI spectroscopy, and muscular strength with a handgrip dynamometer. Moderate-to-vigorous physical activity (MVPA) was assessed using the International Physical Activity Questionnaire (IPAQ). Measurements were performed in the morning after an overnight fast.

RESULTS

linear regression analysis showed that PhA accounted for 22% (r² = 0.22) of muscular strength variance. PhA remained a borderline predictor of muscular strength variance independently of age and MVPA.

CONCLUSIONS

the findings of this study suggest that PhA is a significant predictor of maximal forearm isometric strength and a potential indicator of disease-related functionality in BCS.

Age-Varying Relationships Between Physical Function and Cognition in Older Adulthood

OBJECTIVES

There are positive relationships between physical and cognitive function in older adulthood; however, the strength of these relationships are inconsistent across studies. Although novel statistical tools provide flexibility to explore age-related differences in relationship magnitude, such methods have not been implemented in gerontological research. This study applied such methods to examine variations in relationship magnitude between physical function and cognition in healthy older adults (N = 2,783).

METHOD

Time-varying effects modeling (TVEM) is an extension of regression that models changes in relationships as a function of time-varying metrics like age. TVEM was used to examine if physical function (Turn 360, grip strength) predicted cognitive performance (memory, processing speed/attention, and reasoning) similarly across adults aged 65-90.

RESULTS

All associations between Turn 360 and all cognitive domains were significant and positive; however, speed of processing had significant magnitude variation across age such that the young-old and the old-old demonstrated the strongest relationships. Associations between grip strength and all cognitive domains significantly strengthened with increased age.

DISCUSSION

Results suggest that depending on the sample age, there may be inconsistencies in the relationships between physical and cognitive performance. Future research should explore these relationships longitudinally to better elucidate discrepant findings.

Life course trauma and muscle weakness in older adults by gender and race/ethnicity: Results from the U.S. health and Retirement Study

Muscle weakness, as measured by handgrip strength, is a primary determinant of physical functioning and disability. There is a high burden of muscle weakness in the United States with close to 50 percent of older Americans meeting criteria for clinical muscle weakness. While previous racial/ethnic disparities have been documented among older adults, the extent to which lifecourse trauma shapes muscle strength trajectories is unknown. Using U.S. Health and Retirement Study (N = 20,472, Mean Age = 63.8 years) data on grip strength (2006-2014, up to 3 assessments) and retrospectively reported traumatic events, we fit gender-stratified growth curve models to investigate whether traumatic events experienced across the lifecourse or at distinct sensitive periods (childhood, early/emerging adulthood or mid-life) predicted later-life trajectories of grip strength. There was no association between cumulative trauma and trajectories of grip strength and the main effects for the life stage models were largely null. However, among White women, our results suggest that traumatic events experienced during childhood (β = -0.012; 95% CI = -0.024, 0.0004) compared to middle adulthood are associated with faster declines in grip strength in later life. Traumatic events reported during childhood was related to a slower decline in grip strength over time among Hispanic women compared to that for White women (β = 0.086, 95% CI = 0.044, 0.128). Among Black men, the association between traumatic events during early/emerging adulthood and age-related declines in grip strength was stronger for Black men than for White men (interaction β = -0.070; 95% CI = -0.138, 0.001). Traumatic events experienced during distinct life stages may influence later life declines in grip strength and exacerbate racial inequalities in later life. This study addresses an important gap by investigating the life course social determinants of later life muscle strength, which is a key driver of physical functioning and mobility.

Associations Between Handgrip Strength and Disease-Specific Mortality Including Cancer, Cardiovascular, and Respiratory Diseases in Older Adults: A Meta-Analysis

Several controversial studies linking handgrip strength and health have suggested that low handgrip strength in older adults may be related to health problems and have investigated whether there is a minimum handgrip strength level associated with reduced mortality. Thus, by meta-analysis, the authors identified an association between handgrip strength in older adults and disease-specific mortality and all-cause mortality. Thirty studies with a total of 194,767 older adult participants were included in this meta-analysis. Higher handgrip strength was associated with an 18% decrease in all-cause mortality. Lower handgrip strength was associated with increased all-cause mortality. The minimum handgrip strength in older women that did not increase all-cause mortality was 18.21 kg. Increased handgrip strength showed a decreased all-cause mortality, whereas decreased handgrip strength was associated with increased all-cause mortality. Strengthening the handgrip may help improve disease-specific mortality in older adults.

Do Nationally Representative Cutpoints for Clinical Muscle Weakness Predict Mortality? Results From 9 Years of Follow-up in the Health and Retirement Study

BACKGROUND

Muscle weakness, as measured by handgrip strength, is associated with cardiovascular and all-cause mortality; however, there are wide inconsistencies in the magnitude of these effects due to divergent definitions used to define muscle weakness across studies. Therefore, the objective of this study was to examine the relationship between previously defined sex- and race-specific cutpoints of clinical muscle weakness and early mortality.

METHODS

Data come from the 2006-2014 Health and Retirement Study. Time-varying clinical muscle weakness, as defined by handgrip strength cutpoints, was the primary exposure. Time to death, ascertained from the National Death Index, was the outcome of interest. The association between time-varying clinical muscle weakness and early mortality across a 9-year observation period was determined using Kaplan-Meier methods and extended Cox regression.

RESULTS

Out of the 8,326 individuals in the study, 1,799 deaths (21%) occurred during the observation period. Median follow-up time was 8.3 years (SD ±1.9 years). Weak individuals had a steeper decline in their survival trajectory, compared to non-weak individuals (Log-Rank test, p < .001). After adjusting for sociodemographic factors and time-varying smoking history, weak individuals were over 50% more likely to die earlier than non-weak individuals (hazard ratio [HR] = 1.52, 95% confidence interval [CI] = 1.15, 1.47).

CONCLUSIONS

This is the first study to use muscle weakness cutpoints derived in a nationally representative sample to identify those individuals who may be at greatest risk for premature mortality. Results underscore the importance of muscle weakness, as defined by handgrip strength, as a key risk factor for premature mortality in older Americans.

What are the association patterns between handgrip strength and adverse health conditions? A topical review

Measures of handgrip strength can be used to conveniently assess overall muscle strength capacity. Although stand-alone measures of handgrip strength provide robust health information, the clinical meaningfulness to determine prevention and treatment options for weakness remains limited because the etiology of muscle weakness remains unclear. Moreover, clinical outcomes associated with handgrip strength are wide-ranging. Therefore, disentangling how handgrip strength is associated with health conditions that are metabolically or neurologically driven may improve our understanding of the factors linked to handgrip strength. The purpose of this topical review was to highlight and summarize evidence examining the associations of handgrip strength with certain health outcomes that are metabolically and neurologically driven. From this perusal of the literature, we posit that stand-alone handgrip strength be considered an umbrella assessment of the body systems that contribute to strength capacity, and a panoptic measurement of muscle strength that is representative of overall health status, not a specific health condition. Recommendations for future strength capacity–related research are also provided.

Hand grip strength is associated with cardiopulmonary function in Chinese adults: Results from a cross-sectional study

Background

The objective of this population-based study was to examine whether there was association of hand grip strength (HGS) with cardiopulmonary function in population without cardiopulmonary disease.

Methods

Data were derived from an ongoing cross-sectional survey of the National Physique and Health in Shanxi Province. There were 908 participants with the cardiac function tests and 380 participants with the pulmonary function tests. Multiple linear regression analysis was used to assess the association of HGS with cardiopulmonary function.

Results

Among participants with the cardiac function tests, HGS was positively associated with left ventricular end diastolic diameter in both genders (male: b = 0.010 (0.005, 0.015), P < 0.001; female: b = 0.008 (0.002, 0.014), P = 0.01) and left ventricular ejection fraction in males (b = 0.114 (0.027, 0.201), P = 0.01). Among participants with the pulmonary function tests, HGS was positively associated with vital capacity (male: b = 0.033 (0.021, 0.045); female: b = 0.033 (0.021, 0.045)), forced expiratory volume in 1 s (male: b = 0.023 (0.014, 0.032); female: b = 0.019 (0.010, 0.028)) and maximal voluntary ventilation (male: b = 1.186 (0.665, 1.708); female: b = 0.965 (0.453, 1.476)) in both genders (all P < 0.001).

Conclusions

These results suggested that greater HGS was associated with favorable cardiopulmonary function in Chinese adults, thus HGS might be an indicator of cardiopulmonary function.

Normative data on functional grip strength of elderly in Singapore

STUDY DESIGN

Cross-sectional study for clinical measurement.

INTRODUCTION

Most daily tasks require individuals to exert grip strength with torque, which can be challenging for elderly as their strength diminishes with age. We postulate that to assess the functional capacity of an individual, it is important to evaluate the functional grip strength instead of the maximal static grip strength.

PURPOSE OF THE STUDY

The objective of this cross-sectional study is to establish normative data for the functional grip strength of elderly aged 60 years and older in the Singapore population.

METHODS

In this study, 233 healthy subjects aged 60 years and older were recruited. Using a custom-made hand strength measurement device, the following measurements were recorded: grip strength at neutral position, grip strength with resistive pronation torque, and grip strength with resistive supination torque.

RESULTS

Grip strengths measured for both genders decreased by 13% and 16% for males and females respectively, when pronation torque was exerted, and with supination torque, the strength decreased by 18% and 17% for males and females respectively.

CONCLUSION

Normative data for the elderly population in Singapore had been established. The findings from this study can complement the existing ergonomic hand data in designing better assistive tools to improve the independent living of elderly.

LEVEL OF EVIDENCE

NA.

Handgrip Strength Cut-Off Values for the Undernutrition Risk Screening among Elderly Men and Women in Bosnia and Herzegovina

OBJECTIVES

To determine the optimal cut-off points of handgrip strength (HGS) to identify the undernutrition risk among individuals older than 65 years of age in Bosnia and Herzegovina.

DESIGN

Cross-sectional study.

SETTING

Towns of Sarajevo, Foca, Rogatica, and Pale in Bosnia and Herzegovina.

PARTICIPANTS

300 community-dwelling older adults and 146 nursing home residents. Comprehensive Geriatric multidimensional assessment (CGA) was carried out to evaluate general health, functional, and cognitive capabilities. Nutritional status and undernutrition risk were assessed by Mini Nutritional Assessment (MNA) and Seniors in the Community: risk evaluation for eating and nutrition, version II (SCREEN II). HGS was measured with a Smedley dynamometer.

RESULTS

According to the classification of nutritional status by MNA, 42% of community-dwelling men and 39% of community-dwelling women were at undernutrition risk. The undernutrition risk was significantly higher among nursing home residing men (89%) and women (78%) (p < 0.001). When nutritional status was assessed by SCREEN II, 100% on nursing home residents, 86% of community-dwelling men and 80% of women were identified as having a high risk for undernutrition. Per MNA, HGS cut-off thresholds were 23.50 kgF (65-74 years) and 19.50 kgF (≥75 years) for men; 15.50 kgF (65-74 years) and 13.50 kgF (≥75 years) for women. Per SCREEN II, cut-points were 28.50 kgF (65-74 years) and 24.50 kgF (≥75 years) for men; 24.50 kgF (65-74 years), 19.50 kgF (≥75 years for women).

CONCLUSION

HGS can be a useful instrument to identify undernutrition risk among the elderly patients. This study provides threshold for men and women older than 65 years of age in Bosnia and Herzegovina.

Influence of physical performance on elderly mortality, functionality and life satisfaction: FIBRA's study data

OBJECTIVE

To verify the influence of physical performance on elderly mortality, functionality and life satisfaction.

MATERIALS AND METHODS

A follow-up was performed on 900 Brazilian non-hospitalized elderly in the period 2008-2016, in which 154 deaths from natural causes were included in the survival analysis.

RESULTS

the worst grip strength (RR = 1.60; CI 95% = 1.15-2.23, p = 0.005) and gait speed (RR = 1.82; CI 95% = 1.30-2.55, p < 0.001) performances were associated with increased mortality risk. Age was a confounding factor for strength (RR = 1.06; CI 95%  =  1.03-1.09, p < 0.001) and rheumatoid arthritis was a confounding factor for speed (RR = 2.02; CI 95% = 1.36-3.01, p < 0.001). The elderly with good physical performance realized more instrumental and advanced activities of daily living, and good gait performance had a significant effect on life satisfaction (F = 6.87, p = 0.009).

CONCLUSIONS

good physical performance seems to be fundamental for longevity and for accomplishing daily tasks. Furthermore, good mobility can affect life satisfaction-related mechanisms.

Association between Handgrip Strength, Mobility, Leg Strength, Flexibility, and Postural Balance in Older Adults under Long-Term Care Facilities

INTRODUCTION

Low muscle strength is common and important in geriatric syndromes including frailty and sarcopenia. The epidemiology of grip strength of older people under long-term care facilities has been little explored.

PURPOSE

The aim of this study was to assess handgrip strength of older women and men covered by institutional care and to analyse the associations between HGS and mobility, leg strength, flexibility, and postural balance.

MATERIALS AND METHODS

This is a cross-sectional study carried out at care homes in southeastern Poland. After considering the inclusion criteria, 209 older people aged 65 to 85 were included in the study. Sociodemographic data were collected, and tests of muscular strength, mobility, flexibility, and postural balance were carried out by the use of the stabilometric platform CQ Stab 2P.

RESULTS

The average handgrip strength in the study group amounted to 19.8 kg, including 14.8 kg in women and 25.9 kg in men. Low grip strength was found in 67.83% women and 52.13% men in institutional care. A negative correlation between handgrip strength (HGS) and the Timed Up and Go (TUG) test was demonstrated, both with and without cognitive task and strength of lower limbs. Gait speed and dynamic balance were positively correlated with HGS. A negative correlation was found between the total length of the centre of pressure (COP) path, the length of the COP path in the lateral-medial direction, and the sway area delimited by the COP and HGS for the dominant hand. Speaking of women, gait speed was most strongly associated with HGS, while among men, it was upper limb flexibility.

CONCLUSION

Regardless of gender, HGS is associated with mobility, strength of the lower limbs, and dynamic balance. By means of simple tools, early diagnosis will facilitate the planning of appropriate interventions in order to prevent disability and mortality in long-term care facilities.

Relevance to assess and preserve muscle strength in aging field

According to the revised European consensus on sarcopenia, muscle strength is the primary parameter of sarcopenia and is associated with adverse outcomes or physical limitation. This literature review aims to clarify how and why to measure and preserve muscle strength in older population. Overall, the relationship between muscle strength and physical function is impacted by level of muscle mass, the degree of obesity (BMI), age and physical activity. Therefore, these factors are to be considered in the evaluation of muscle strength. It is necessary to have objective, reliable and sensitive tools to assess muscle strength, in different populations to detect and quantify weakness, to adapt physical exercises to patients' capacity and to evaluate the effects of treatment. Handgrip strength measurement might be reasonable for clinical practice while the measurement of knee flexors/extensors strength with both 1RM and dynamometers is increasingly important yet restricted by the requirement of special equipment. Physical activity and nutrition are two important behavioral factors to maintain muscle strength. Combined exercise and nutrition interventions improved muscle strength to a more prominent degree than exercise or nutrition alone.

Association of cognitive impairment and grip strength trajectories with mortality among middle-aged and elderly adults

ABSTRACTBackground:This study investigates whether maintaining high levels of cognitive impairment and weak grip strength will predict a higher risk for mortality.

METHODS

Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2014 was assessed using longitudinal data analysis and included 5,812 research subjects. Our modeling approach jointly estimated multi-period trajectories of grip strength and cognitive impairment, and the primary analysis was based on Cox proportional hazards models.

RESULTS

A four-class linear solution fit the data best in both cognitive impairment and grip strength based on the model fitness, respectively. The hazard ratio (HR) of mortality in group 1 (consistently low) of cognitive impairment and of grip strength were 2.114 times higher (p-value 0.001) and 3.405 times higher (p-value &lt;.0001) compared with group 3 (consistently high) and group 4 (consistently high), respectively.

CONCLUSION

This study provides insightful scientific evidence into the specificity of longitudinal changes in grip strength and cognitive impairment on mortality. Our findings suggest that declined cognitive ability and weak grip strength are predictors of mortality in older Korean people.

Relative importance of four functional measures as predictors of 15-year mortality in the older Dutch population

BACKGROUND

Decreased physical function is known to raise mortality risk. Little is known about how different physical function measures compare in predicting mortality risk in older men and women. The objective of this study was to compare four, objective and self-reported, physical function measures in predicting 15-year mortality risk in older men and women.

METHODS

Data were used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of the older Dutch population, sampled from municipal records. The 1995-96 cycle, including 727 men and 778 women aged 65-88 years, was considered as the baseline. Mortality was followed up through September 1, 2011. Physical function measures were: lower-body performance (chair stands test, walk test and tandem stand); handgrip strength (grip strength dynamometer); lung function (peak expiratory flow rate); functional limitations (self-report of difficulties in performing six activities of daily living). Cox proportional hazard models were used to determine the predictive value of each physical function measure for 15-year mortality risk, adjusted for demographic, lifestyle and health variables as potential confounders.

RESULTS

1031 participants (68.5%) had died. After adjustments for confounders, in models assessing single functional measures, peak flow was the strongest predictor of all-cause mortality in men (HR 1.76, CI 1.38-2.26, CI) and lower-body performance in women (HR 1.97,CI 1.40-2.76, CI). In a model including all four functional measures only peak flow was statistically significant in predicting mortality in both genders (men HR 1.54,CI 1.18-2.01 and women HR 1.45,CI 1.08-1.94). In women, lower-body performance (HR 1.66, CI 1.15-2.41) followed by grip strength (HR 1.38, CI 1.02-1.89), and in men, functional limitations (HR 1.43, CI 1.14-1.8) were the other significant predictors of all-cause mortality.

CONCLUSION

Both objective and self-reported measures of physical functioning predicted all-cause mortality in a representative sample of the older Dutch population to different extents in men and women. Peak flow contributed important unique predictive value for mortality in both men and women. In women, however, lower-body performance tests had better predictive ability. A second-best predictor in men was self-reported functional limitations. Peak flow, and possibly one of the other measures, may be used in clinical practice for assessment in the context of time constraints.

Handgrip Strength is Associated with Psychological Functioning, Mood and Sleep in Women over 65 Years

Background: The predictive nature of handgrip strength (HGS) was analyzed, showing a direct association with the functional domains of health, cognitive and social levels, and some inverse association with depressive values. Aim: To analyze the relationship between HGS and the psychological functioning of older people, such as depression, mood and sleep. Method: A total of 38 women, participated in this study (age = 72.29 ± 5.21 year). As measurement instruments a hand dynamometer was used for HGS, Profile of Mood Status (POMS) 29 was used for mood, the geriatric depression scale was used for depression, and the Oviedo questionnaire was used for sleep. A cluster analysis was performed taking into account the performance in the HGS. Results: The group that obtained a high HGS result showed a better total score for vigor, depression, insomnia and sleep. Pearson correlation analysis showed significant correlations between HGS and vigor, depression, insomnia and sleep total score. Conclusion: HGS in women over 65 years was associated with psychological functioning and sleep quality.

Is there an accurate relationship between simple self-reported functional limitations and the assessment of physical capacity in early old age?

Study design

Observational study.

Objective

To assess the relationship between individual self-reports and measurements of physical condition in early old age.

Background

The use of self-reported questions assessing physical limitations remains questionable in large epidemiological studies. We aimed to test whether there is an accurate relationship between objective measures of physical capabilities and answers given to questions asked of general early old age populations.

Methods

20,335 subjects (45 to 69 years old) performed two gait speed tests at usual and at rapid speeds, and a hand grip strength test. They also completed an interview which included questions about general and specific limitations on their ability to walk one kilometer, climb stairs, and carry 5 kg over a distance of 10 meters. The questions were coded by the patients on a 4-point scale according to the severity of the limitation. Analyses were performed using description of distributions and related tests were carried out.

Results

A fair association was found between individual self-reports and measurements of physical state: limitations on walking one kilometer and climbing stairs were more closely related to rapid than to usual gait speed and to carrying a 5 kg load. For general limitations, the strength of these associations was weaker than the other scores. The association between hand grip strength and the reported score for carrying a mass was better than that for gait speed tests.

Conclusion

Such simple self-assessment questions on physical performance might be useful tools for evaluating functional limitations across a large early old age population in epidemiological research.

Objective physical measures and their association with subjective functional limitations in a representative study population of older Thais

Background

In this study, we analyzed elderly people in Thailand to identify the validity of suggested cutoff points of physical measures, handgrip strength, usual walking speed, and a composite score of both measures to predict functional limitations. Moreover, we examined whether these physical performance measures are accurate indicators of the investigated health outcomes.

Methods

Using Receiver Operating Characteristics (ROC) analysis, we investigated a sample of 8272 respondents aged 60 to 79 years. All data were based on the 2009 National Health Examination Survey (NHES IV) of Thailand.

Results

For males aged 60 to 69 years, handgrip strength was used as an indicator of functional limitations. The cutoff point for disabilities in the activities of daily living (ADLs) was 29.5 kg, while in other limitations it ranged from 28.7 to 31.3 kg. In contrast, usual walking speed was able to indicate ADL disabilities at 0.7 m per second (m/s). As one might expect, the cutoff points for males aged 70 to 79 years were lower than for males in the 60 to 69 age group. For females, handgrip strength was able to indicate ADL disabilities at 16.5 kg for both the 60 to 69, and 70 to 79 age groups. Likewise, walking speed was indicative of ADL disabilities at 0.6 m/s for both age groups. Interestingly, the composite measure increases the ability to detect ADL disabilities in the younger group but not in the older group. The area under the curve (AUC) of cutoffs measuring the detection power of a diagnostic test was varied, ranging from 0.535 to 0.7386.

Conclusions

The cutoff points of three measures varied according to sex and type of functional limitations. Our findings also showed that physical performance measures were useful for identifying people with an increased risk of functional limitations, particularly for ADL disabilities. However, although the AUC of the cutoffs of other functional limitations were relatively low, they should be considered with caution.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1093-3) contains supplementary material, which is available to authorized users.

Handgrip Strength and All-Cause Mortality in Middle-Aged and Older Koreans

Aging-related decline in handgrip strength has been associated with adverse functional and metabolic morbidity and mortality. Korea is one of the fastest aging countries, and the prospective relationship of handgrip strength with all-cause mortality in Korean adults has not been studied. We conducted a prospective observation study to examine whether baseline handgrip strength predicted mortality over eight years of follow-ups in Korean adults aged 45 years or older. We analyzed the nationwide survey data based on 9393 Korean adults (mean age of 61 ± 10.7 years) from the 2006–2014 Korean Longitudinal Study of Aging. The mean handgrip strength values measured using a dynamometer, and were divided into quartiles for each gender. Cox models were conducted in order to estimate the hazard ratios (HRs) of all-cause mortality with 95% confidence intervals (CIs) in relation to handgrip strength adjusting for covariates. There was a robust independent relationship between a weaker handgrip strength and higher all-cause mortality in both women and men, adjusting for selected covariates (e.g., age, income, smoking, exercise, and comorbidities). Compared to the strongest quartile (i.e., reference), women and men in the weakest group had higher HRs of mortality, 2.5 (95% CI: 1.7–3.8) vs. 2.6 (95% CI: 1.8–3.9), respectively. The robust independent relationships between weaker handgrip strength and higher all-cause mortality found in the study suggest that simply assessing and monitoring the handgrip strength during adulthood demonstrates great potentials for the public health of aging populations, and protects against premature death in Korean adults.