Academic Editor: Maryam Tajvar
Affilation: Tehran University of Medical Sciences
Loss of muscle mass and functionality leads to increased risk for falls and onset of frailty, especially residents of long term care (LTC) homes. Hand grip strength (HGS) is emerging as a promising tool to measure muscle strength and a proxy for functionality. Given its promise as a screening tool, several studies report cut-offs below which measured strength was predictive of risk of poor mobility in older subjects. A scoping review was conducted to examine whether HGS was currently being used in LTC, as studies demonstrate hand grip strength as positively correlated with activities of daily living, implying increased dependence on caregivers including mealtimes. Of 19 published studies in 2015, only two report HGS use. As there is an association of grip strength with nutrition-related outcomes, hand grip strength should be used as part of nutritional assessment by dietitians in LTC, as poor muscle strength adversely affects activities of daily living that may impact intake.
Aging is associated with loss of muscle mass and strength. Poor muscle strength, due to sarcopenia or frailty, results in deficits in physical activities of daily living (PADL) scores and possibly a poor quality of life.
We used two methods for this review. In the first, we provide a critical examination of definitions for frailty, sarcopenia, with a focus on older adults and when possible, on adults living in long-term care (also called nursing homes). In the second method, we employ the scoping review methodology as defined by Grant and Booth
Measurement of the physical activities of daily living (PADL) is based on descriptive questions on how well one can manage day-to-day actions.
Frailty is prevalent in older adults and a significant contributor of fall incidence.15,16 The most commonly cited definition of frailty
Sarcopenia contributes to frailty. The European Working Group on Sarcopenia in Older People has defined it as a loss of muscle mass and muscle strength or performance resulting in adverse outcomes and poor quality of life.
The use of hand grip strength is recommended to evaluate an individual’s muscle strength.
The generally accepted gold standard for hand grip strength measurement is the Jamar hand dynamometer with high test-retest reproducibility and inter-rater reliability.
In healthy individuals (age 5-95+ y) measured across the life course using normative data from twelve British studies,
Hand grip strength is closely related to PADL and functional limitations. Community-dwelling older adults with lower hand grip strength were 1.3-2.3 times more likely to develop PADL dependence after a 5-year period.
Hand grip strength threshold values for diagnosis of clinical weakness have recently been published by the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project group.
|Organization||Males (kg)||Females (kg)|
|CHS: Cardiovascular risk
||≤ 30||≤ 17-18|
||< 30||< 20|
||< 26||< 16|
||< 30||< 20|
Based on definition of frailty; CHS: Cardiovascular Health Study
Based on walking speed <0.8 m/s and difficulty walking 1 km; InCHIANTI: Invecchiare in Chianti
Based on walking speed <0.8 m/s; FNIH: Foundation for the National Institutes of Health Sarcopenia Project
Based on “statistical analysis”; EWGS: European Working Group of Sarcopenia.
The criteria between defining frailty
To determine if hand grip strength was currently in use in long term care homes, we reviewed all studies published (or epub) in 2015 that used nutrition assessment (including food behavior and functional assessments) in long term care. As shown in Table 2, of the 19 studies located, 38-
|Study first author and reference number||Country||Nutrition Assessment Methodology||Nutrition Assessment Indicators||Use of Hand Grip (yes/No)|
||Turkey||MNA||Waist, hip, calf||No|
|mid-upper arm circumference|
||Canada, Denmark||Food intake||--||no|
||USA||GNRI, MNA, MNASF, MUST, NRS, SNAQ||BMI||No|
||France||MNA||Weight change, BMI, calf circumference,||No|
||Finland||BMI||BMI, Berg balance||Yes|
|Timed up and go|
|Hand grip strength|
||USA||Oral intake||Eating performance (self-feeding)||No|
||United Kingdom||Serum albumin||Pressure sores||No|
||France||Diet history or food frequency questionnaires; MNA||BMI||No|
BMI, body mass index; GNRI, Geriatric Nutritional Risk Index; MNA, Mini-Nutritional Assessment; MNA-SF, mini-nutritional assessment – short form; MUST, malnutrition universal screening tool; NRS, nutritional risk screening; SNAQ, Short Nutritional Assessment Questionnaire
Current best practice for nutrition assessment in Canada is described in working paper as including the following elements: current height and weight status, and historical weight data if available; current diet, food texture, fluid consistency needs; dietary history and current documented food and fluid intake; use of supplements; review of relevant conditions and diagnoses, including those known to be of particular risk to this population; review of physical and cognitive functioning; review of eating ability and need for assistance; examination for skin integrity; review of gastrointestinal/bowel function/issues; review of significant lab values; review of medications and potential food-drug interactions; review of intake of vitamins/minerals; dentition; allergies and/or food intolerances; daily nutritional requirements.
In clinical practice the use of handgrip strength has important limitations. No study or guideline has published measurement protocols.
Clinical studies usually report the highest value achieved after triplicate measures
This work has been supported in part through a Health Research Team Grant from the Saskatchewan Health Research Foundation (SHRF).