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Jan 2026 DOI 10.14302/issn.2474-7785.jarh-25-5940
Marks RayCorresponding author
Lower limb osteoarthritis, a widespread age related chronic condition is often accompanied by an increased tendency to fall and thereby various degrees of intrinsic and extrinsic injury. Falls, in turn may provoke the disease alone and in turn a high falls risk and cycle of recurrent falls and heightened disability. This report which updates what is known about falls in the context of disabling osteoarthritis argues for a possible future ecological orientation rather than a focal uni dimensional approach to addressing this costly health problem. It examines osteoarthritis falls risk factors, falls injury prevention attempts, and recommendations to advance research and practice using an ecological analytic approach in this regard. Using the PUBMED data base and others, lower limb osteoarthritis linkages and falls interaction studies were sought and examined. The data revealed osteoarthritis can lead to the chances of incurring one or more falls and further health and disability challenges, while falling can provoke the onset of osteoarthritis in its own right. Although many factors appear to be involved, these are rarely viewed through a broad multi dimensional ecological perspective, thus are confusing or overwhelming to apply to the active community dwelling elderly subject.
Dec 2021 DOI 10.14302/issn.2474-7785.jarh-21-4041
Marks RayCorresponding author
Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA.
Background Many older adults are vulnerable to becoming frail. They are also often at risk for falling and serious injuries and poor health outcomes. Aim This exploratory review examines the correlates of frailty, and fear of falling and their association insofar as older adults wellbeing may be jeopardized. Methods and Procedures Articles extracted from major electronic data bases that addressed the current topic of interest were used. Key findings regarding the syndromes of frailty and fear of falling were duly downloaded, analyzed and summarized in narrative form. Results A high proportion of older adults can be expected to exhibit frailty or become frail as they age. Many too are at risk for falls and fear of future falls, regardless of frailty status. A persistent fear of falls may however, heighten frailty risk or manifestations if not duly addressed in a timely manner. Conclusion Prompt comprehensive assessment of at risk older adults, as well as the frail and pre frail older adult, plus those who have fallen may avert serious injury and long term disability plus excess frailty and its deleterious impacts this syndrome has on aging older adults as well as societies.
Feb 2021 DOI 10.14302/issn.2474-7785.jarh-21-3752
Marks RayCorresponding author
Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA.
Background Falls injuries continue to contribute to numerous premature deaths as well as high disability levels, and excess morbidity rates among older adults, worldwide. But can vitamin D account for excess falls injuries among older adults? This review specifically focuses on what is known about vitamin D in the context of postural stability or balance control, both fairly consistent independent predictors of falls among older adults. Methods and Procedures Drawn largely from a review of current relevant English language peer reviewed research publications published over the last 10 years detailing the relationship between vitamin D levels and balance control among the elderly, as this relates to falls injuries, evidence for any emerging consensus on this controversial topic was sought. Used to conduct the search were various key word combinations including: falls injuries and older adults, vitamin D or vitamin D deficiency and balance or postural control. The database used predominantly to provide input into this largely descriptive assessment and narrative overview was PUBMED. Results The prevailing data show falls injuries currently constitute a widespread costly major impediment to successful aging and longevity for many older adults, despite numerous efforts to prevent this disabling set of events over the past two to three decades. However, no consistent association appears to exist between the variables of vitamin D, falls, and balance attributes in the older population-despite years of research, regardless of study approach, and a strong rationale for hypothesizing a clinically meaningful relationahip. Conclusion It is not possible to arrive at any universal recommendation concerning the value of vitamin D supplementation as regards its possible influence on balance capacity among older adults in the realm of falls prevention efforts, as has been frequently proposed. However, until more definitive research is conducted, there still appears sufficient justification for considering the screening of vulnerable aging adults for serum vitamin D levels, along with balance impairments, and intervening as required in the case of deficits in either or both of these possible falls determinants.
Aug 2020 DOI 10.14302/issn.2474-7785.jarh-20-3496
Marks RayCorresponding author
Department of Health and Behavior Studies, Teachers College, Columbia University, NY 10027, United States
Osteoarthritis, a widespread joint disease, commonly results in considerable pain and functional disability, especially among older adults. At the same time, falls and fall injuries, also common among the older population, may not only contribute to the onset of osteoarthritis, but once established, to falls that lead to fractures and disability in their own right. But what does the research show specifically? Objective This report aimed to examine what is known about the interrelationship between falls and osteoarthritis and the implications that can be drawn from this information. Methods Using the PUBMED data base, studies describing an association between osteoarthritis and falls were sought. Those fulfilling the eligibility criteria were reviewed and summarized in narrative form. Results Consistent support for an osteoarthritis-falls associated linkage is limited and not as robust as one would predict. Whether the observed associations between these health determinants are a cause of osteoarthritis, a consequence or both, or simply spurious findings is hard to decipher. Conclusion More numerous and carefully designed research to examine this issue is warranted and may be extremely helpful in preventing, as well as ameliorating a high degree of excess disability and associated fiscal costs due to both falls as well as osteoarthritis among the elderly.
Jun 2026 DOI 10.14302/issn.2474-7785.jarh-26-6358
Marks RayCorresponding author
Hip fractures, which remain an immense public health concern, have been subject to study and prevention efforts for many decades, but with limited success in averting either incident, second or subsequent hip fractures, commonly attributed to a combination of age related proclivity to fall, low bone and muscle mass. This review examines second hip fracture incidence rates and determinants of this serious functionally debilitating injury as observed over time remains a current 2026 public health concern. It specifically explores if more preventive efforts are currently warranted in this regard, and in what respect, if indeed, more frail older adults are living longer, but may be in excessively poor health, fearful of moving or falling, malnourished, weak with poor balance, or depressed. Based on what is published, it is concluded 1) second hip fracture incidence rates remain considerable, especially among those who are frail with osteoporotic bone disease, poor vision, heart/or cognitive conditions, plus those with muscle deficits of the lower limb, live alone and have a falls history; 2) studies to identify possible mitigation approaches appear promising in this regard, along with more routine efforts to minimize falls risk and bone attrition.
Oct 2025 DOI 10.14302/issn.2693-1176.ijgh-25-5729
Collins Adeyanju GbadeboCorresponding author
Background In sub-Saharan Africa, where many countries continue to experience high burdens of vaccine-preventable diseases, increasing immunization access have been a priority for the governments and international organizations such as Gavi, the Vaccine Alliance. Over 40 Gavi-supported African countries have been impacted, with 364 million children reached and over US$5.7 billion disbursed, averting over 8.9 million child deaths. Despite this progress, the African region has struggled with immunization coverage due to various factors. Nevertheless, some African countries are transitioning out of Gavi support due to economic growth. However, many require strong political will to increase their expenditure on immunization. This study therefore aims to understand the factors influencing immunization performance and its relationship to public expenditure. Methods Data on 37 Gavi-eligible sub-Saharan African countries between 2006 and 2019 was obtained from the World Bank’s World Development Indicators, the WHO and UNICEF Joint Reporting Form and the Transparency International’s Corruption Perception Index. Descriptive immunization and health expenditure were analyzed using a panel regression of variables. DPT3 was used as an indicator of immunization uptake. The indicator for public expenditure on immunization per child was based on government spending on immunization divided by the number of children in the birth cohort. Results The average gross national income increased from US$639 to US$1,192 per capita, while government spending on immunization increased from US$1.7 to about US$4.5 per child. The findings show that there is a correlation between improved immunization financing, increased gross national income, reduced corruption, and improved immunization coverage. However, performance declines beyond a certain threshold when gross national income per capita increases. In addition, an English-speaking country effect was observed. Conclusions While improved immunization financing increases immunization coverage and constitutes an advocacy talking point, there is a need to understand why an increase in gross national income per capita does not translate into an improved immunization coverage. Key highlights Increasing national spending on immunization drives up the uptake of childhood vaccines. There is a threshold beyond which immunization coverage falls despite increased GNI. Controlling corruption increases immunization coverage tendency. French- and English-speaking countries’ immunization coverage differs. Immunization and health system financing have separate outcomes.
Nov 2024 DOI 10.14302/issn.2470-0436.jos-24-5321
Daxer AlbertCorresponding author
Purpose The conventional irradiation technique in corneal crosslinking for keratoconus is characterized by a free irradiation path and parallel light rays directed to the corneal surface. This can cause treatment failures resulting from the steep and irregular corneal curvature as well as from eye and head movement. Here we present a a new and improved irradiation technology for corneal crosslinking (CXL) in keratoconus to avoid such treatment failures. Materials and Methods The presented technology is characterized by a closed irradiation channel which is lined inside with a diffusely reflecting layer and which is mounted to the eye via a suction ring. The effective intensity transferred to a curved photodetector representing the curved cornea of some 7 mm radius was measured for both, the conventional and the new technology. The results were compared with related calculations. Results The UV-A irradiation transferred to a curved cornea of some 7 mm central radius varies across the irradiated area by a factor of 2 for the conventional technology. At a distance of already 2 mm from the vertex the transferred UV-A intensity falls below 2/3 of the central intensity which might affect the effectivity of the treatment. The new technology can keep the intensity transferred to the cornea at a constant level across the entire irradiated area. Conclusion The new irradiation technology can considerably improve the energy transfer to the cornea since the effective intensity at the cornea becomes independent from the corneal shape, the eye movement and the head movement, respectively. This may probably reduce the failure rate of corneal crosslinking in the future.
May 2024 DOI 10.14302/issn.3066-8042.jac-24-4991
Samantaray SoumyashreeCorresponding author
Attention deficit hyperactive disorder is characterised by set of neurological based symptoms in children which falls into broadly two categories; inattention and hyperactive impulsive behaviour. It adversely affect child in various areas like social skill, communication, routine of daily life, academic performance and many.It not only affects the child but also other family members. ADHD often creates unproductive pattern, spouse conflict and poor quality of life. Because of executive function issue, ADHD child face difficulty in establishing and maintaining routines from morning to night which increase demands on parents. As a result parents becomes more exhausted ,emotionally triggered and breakdown.This study shows establishing consistent mindfulness routine make daily life simpler and easier for both the parent and children with ADHD.
Jan 2024 DOI 10.14302/issn.2474-7785.jarh-24-4890
Marks RayCorresponding author
Knee joint osteoarthritis, a chronic condition resulting in considerable disability, particularly in later life, not only impacts life quality significantly and severely, but is also strongly associated with the persistence of intractable pain, depression, helplessness, and a high falls injury risk. This narrative overview synthesizes the knowledge base regarding painful knee osteoarthritis and what is known about Tai Chi exercise participation in the context of reducing knee joint disability and its associated risk of one or more injurious falls, as well as pain and depression. To this end, all relevant articles published in the English language on the topic were sought. While most reports rely on Eastern observations, rather than Western medicine studies, collectively, these data reveal that Tai Chi practiced widely in Asia for many centuries may have an enormous positive impact on reducing distress and increasing function and autonomy among older adults living in the community and diagnosed as having knee osteoarthritis. They specifically suggest the increasing numbers of older adults diagnosed as having knee osteoarthritis can safely practice selected Tai Chi exercises with the expectation that consistent applications will enhance mobility, reduce pain and depression, plus instability and possible injurious falls, while reducing fatigue, even if surgery is forthcoming.
Aug 2023 DOI 10.14302/issn.2574-4496.jtc-23-4674
Almegbe MaysanCorresponding author
A case report of primary thyroid leiomyosarcoma with literature review. It discusses diagnostic pitfalls, histologic criteria, and management options.
Aug 2020 DOI 10.14302/issn.2474-7785.jarh-20-3461
Bhatt TanviCorresponding author
Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612
Background and Purpose The ability to respond effectively to perturbations is a key element of reactive postural control and is a crucial mediator of falls. Several studies exist in the literature that determine older adults’ responses to perturbations, however those studies typically involve procedures that lack objectivity or applicability outside a laboratory. A study involving waist-pull perturbations with a spring-scale (SS) is an exception. In that study, fall history was most accurately differentiated by a reactive stepping response to a perturbing force of 10% total body weight. Using data from that study, we retrospectively examined the association between fall history and the number of steps accompanying a SS perturbing force of 10% total body weight in older adults. For perspective, the association of fall history with Timed-Up-and-Go (TUG) and single limb stance (SLS) times was also determined. Methods Fifty-eight healthy older adults (mean age = 80.7 years) participated in the study. Their 2-year fall history (yes, no) was recorded. All participants underwent SS testing with one-pound incremental, horizontal sagittal plane manual waist-pull perturbations. The number of steps in response to perturbation with 10% total body weight was recorded; TUG and SLS tests were performed. Associations between variables were examined using Spearman (rank-biserial) correlations. Results The median number of steps for fallers was 5 in both anterior and posterior directions. For non-fallers, the median number of steps was 1 and 2 in the anterior and posterior directions, respectively. The significant correlations between fall status and number of steps were 0.772 and 0.813 for the anterior and posterior directions, respectively. Similarly, the significant correlations between fall status and balance tests were 0.722 and -0.456 for the TUG and the SLS, respectively. Conclusions The number of steps accompanying waist-pull perturbations with forces of 10% of body weight were highly explanatory of experiencing a fall during the preceding 2 years.
Mar 2020 DOI 10.14302/issn.2694-1198.jge-20-3206
Volobuev A.N.Corresponding author
Samara State Medical University. Department of Medical Physics. Samara, Russia
On the basis of Hardy – Weinberg’s law the problem of inbreeding in a family tree and a population was investigated. With use of an inbreeding factor are received the discrete equation for a family tree and differential equation for a population. The numerical solution of the differential equation for a population was found and analyzed at various values of the inbreeding factor. Migration of inbred population is investigated in view of natural selection. It was shown that velocity of migration falls with increase of the inbreeding factor. Interrelation of the recessive allele frequency at woman for a migrating population with inbreeding factor and standard parameter of selection was found.
Oct 2019 DOI 10.14302/issn.2641-7669.ject-19-3040
Kader Mohiuddin AbdulCorresponding author
Secretary & Treasurer, Dr. M. Nasirullah Memorial Trust, Tejgaon, Dhaka 1215
Many lay people along with some so called “key opinion leaders” have a common slogan “There's no answer for cancer”. Again, mistake delays proper treatment and make situation worse, more often. Compliance is crucial to obtain optimal health outcomes, such as cure or improvement in QoL. Patients may delay treatment or fail to seek care because of high out-of- pocket expenditures. Despite phenomenal development, conventional therapy falls short in cancer management. There are two major hurdles in anticancer drug development: dose-limiting toxic side effects that reduce either drug effectiveness or the QoL of patients and complicated drug development processes that are costly and time consuming. Cancer patients are increasingly seeking out alternative medicine and might be reluctant to disclose its use to their oncology treatment physicians. But there is limited available information on patterns of utilization and efficacy of alternative medicine for patients with cancer. As adjuvant therapy, many traditional medicines shown efficacy against brain, head and neck, skin, breast, liver, pancreas, kidney, bladder, prostate, colon and blood cancers. The literature reviews non-pharmacological interventions used against cancer, published trials, systematic reviews and meta-analyses.
May 2019 DOI 10.14302/issn.2328-0182.japst-19-2738
BARON AuroreCorresponding author
USMP Fleury Merogis, CH Sud Francilien
Rationale Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Prevalence of viral hepatitis C (HCV) is higher in prison environment in France than in the general population and is estimated to be 4,8%. The impact in prison environment is little-known as based on local studies. Inmate health care falls under USMP (prison setting medical unit), hospital specific units as by the january 18, 1994 law. Access to antiviral c treatment for inmates has always been difficult in France, would it be for interferon and ribavirin or use of protease inhibitors, with less than 20% of treated patients. French recommendations for HCV screening recommend systematic screening of inmates. The arrival of all oral therapies by direct antiviral agents (DAA) with shorter treatment times was an opportunity for doctors to propose a treatment and the patient to accept it. In 2014, the French guidelines recommended that HCV carriers in prison should systematically be treated independently of the stage of fibrosis. Objective of the Study PH8 Our objective was to evaluate the completion rate of an 8-week antiviral C treatment by sofosbuvir / ledipasvir regimen in non-cirrhotic genotype 1 patients in deprivation of liberty and achieve sustained virological response (SVR) and to measure the effectiveness of an 8-week treatment (by protocol analysis). Methodology prospective non-interventional multicenter trial among inmates with chronic hepatitis C genotype 1 with METAVIR fibrosis score F0 to F2 and who will receive a daily combination of sofosbuvir / ledipasvir for 8 weeks. Results 6 prison medical units included 115 consenting patients: there were 81% men, mean age 41 years (21 to 64 years). Route contamination was drug injection for 85%. HCV genotype was 1a for 74%, 1b for 24% and 2% none differenciated 1. Fibroscan mesure was available in 89 patients (mean score 3,5 KPa). Fibrotest was available in 37 patients with mean value 0.21. Eleven patients had Fibroscan and Fibrotest; 69% of patients were F0, 22% F1 and 9% F2. Average time between diagnosis and start of treatment was 3 weeks. We are sure that 109 patients (95%) completed DAA 8 weeks treatment; only 2 stopped DAA treatment before 8 weeks and 4 had no follow up after end of detention. HCV viral load was measured at W2 for 90 patients (78%), at W4 for 92 patients (78%), at end of treatment for 92 patients (78%), one month after treatment for 90 patients (78%) and 3 months after for 95 patients (93%). Only one viral load was positive, one month after treatment. Patient was retreated by sofosbuvir / velpastasvir. All HCV viral load 3 months after treatment negative; one patient took DAA only 6 weeks was cured. Conclusions In these study PH8, we observed completion rate of 94% for included patients in patient with 8 weeks ledipasvir/sofosbuvir regimen; data missed for only 4 patients and one relapsed. Short DAA treatment was efficient in prisoners and could be preferred in specific population.
Oct 2018 DOI 10.14302/issn.2641-4538.jphi-18-2426
P ChastonayCorresponding author
Department of Medicine, University of Fribourg, Fribourg, Switzerland.
Over the past century, the proportion of Swiss residents aged 65 or older rose from 5.8% to 17.8%; during the same period, the proportion aged over 80 rose from 0.5% to 5.0%. Although the majority of older people in Switzerland enjoy good health, disease prevalence rises with age. Almost half (49%) of people over 65 living at home report at least one chronic illness. Among the 65- to 79-year-olds living at home, 25.2% suffer from several chronic diseases; among people in the 80s, this figure reaches 41.3%. People aged over 80 are also particularly at risk for falls (30%). In addition, between 15% and 25% of the elderly suffer from at least one mental illness. Close to 30% of healthcare costs are attributable to people over the age of 75, who make up only 8% of the total population. Given the public health importance of the issue a health promotion project targeting the elderly – the VIA Project -, based on successful local programs, is being implemented throughout the country. The overall goal of the VIA project is to promote the health of older people and to strengthen their self-determination and independence.
Jul 2018 DOI 10.14302/issn.2576-9383.jhhr-18-2120
Gaurav DhawanCorresponding author
A myeloma case is described with laboratory artifacts including increased anion gap, pseudohyperphosphatemia, and pseudohyponatremia. The report explains mechanisms behind paraprotein‑related assay interference and diagnostic pitfalls.
Mar 2018 DOI 10.14302/issn.2574-4518.jsdr-17-1785
W Chang-LitCorresponding author
Mount Sinai Beth Israel
Sleep is vital for the maintenance of physical health and mental wellbeing. Sleep also plays a cardinal role in the process of healing. It is estimated that 50 to 70 million Americans suffer chronically from sleep disturbances and insufficiency, which not only hinders daily functioning but also adversely affects health, quality of life and longevity.1 Deficient sleep is associated with an increased risk of developing chronic diseases such as hypertension, diabetes, obesity, heart disease, stroke, depression, frequent mental distress, as well as increased mortality, and reduced quality of life and productivity.1,2Aging, medical conditions, pain, and mental illness further aggravate sleep disturbances such as insomnia, sleep fragmentation and daytime sleepiness.3, 4, 5, 6, 7, 8 The a common treatment for sleep disturbances and insomnia is pharmacological therapy. Benzodiazepines may have negative long-term side effects including residual daytime sedation and tolerance development. Withdrawal difficulties may increase dependency. In the older patient there are safety issues related to daytime sedation including increase risk of falls. With the importance of sleep in hospital recovery and the side effects of sleep medication becoming more widely recognized, there has been an impetus to s use nonpharmacological alternatives , such as music.. This pilot study builds on the potential impact of music’s effectivity by introducing music therapy as a safe, cost effective and culturally sensitive intervention.
Jan 2018 DOI 10.14302/issn.2474-7785.jarh-17-1911
K. Chesser AmyCorresponding author
Department of Public Health Sciences, Wichita State University
Falls continue to be a health concern for older adults. Gender and age are key predictors of falls, particularly for those with low health literacy. Data were collected by a State Health Department using the state-led supplemental question option for the Centers for Disease Control and Prevention (CDC) Behavior Risk Factor Surveillance System (BRFSS) survey. Specifically, trend data for respondents were examined by gender, geographic location and health literacy rate. Results indicated the highest mean number falls occurred with men for those within the metropolitan statistical area (MSA) city code, lowest in suburban areas. Females reported to have a higher estimated mean number of falls and injuries than males. For males, the number of falls and injuries tended to decrease with higher health literacy. The findings support the importance of addressing fall prevention for older adults. Long term implications for improving fall prevention and health literacy for older adults include impact on individual outcomes.
Sep 2017 DOI 10.14302/issn.2474-7785.jarh-17-1724
Wanby PärCorresponding author
Section of Endocrinology, Department of Internal Medicine, Kalmar County Hospital, Kalmar, Sweden
Hypovitaminosis D is common among older people and treatment with vitamin D is associated with reduced risk of falls and fractures. This paper provides a cost analysis of assessing the vitamin D status of and providing the pharmaceuticals for elderly citizens in Kalmar County, Sweden (population approximately 230,000). Four hypothetical interventions were analyzed: (a) systematic vitamin D/calcium supplementation to all elderly (≥75 years), (b) assessment of vitamin D status in elderly and supplementation to those with insufficient levels, (c) systematic vitamin D/calcium supplementation to all nursing-home residents, and (d) assessment of vitamin D status in nursing-home residents and supplementation to those with insufficient levels. The calculations were based on an estimated reduction in overall costs due to the assessed number of hip fractures after vitamin D/calcium supplementation. The annual net economic benefit of vitamin D/calcium supplementation was estimated at (a) €304,000, (b) €860,000, (c) €755,000, and (d) €740,000. The provision of systematic vitamin D supplementation to nursing-home residents would provide a substantial net economic benefit to society and assessment of the vitamin D status before starting supplementation does not seem to be necessary. Although assessment of all elderly citizens would be more comprehensive, the true proportion with insufficient vitamin D levels in the general population is uncertain and to reaching consensus on the most advantageous daily vitamin D intake, vitamin D blood levels are necessary. Also, systematic supplementation to all elderly would result in other outcomes that could be worth the cost, but that remains to be evaluated.
Apr 2017 DOI 10.14302/issn.2474-3585.jpmc-16-1213
Wood-Nartker JeanneaneCorresponding author
Department of Human Environmental Studies, Central Michigan University
As people age, environments supporting changing needs can potentially impact their quality of life. The purpose of this exploratory study was to develop and assess the validity of a checklist instrument used to evaluate senior-supportive environmental risk factors within assisted living facilities (ALFs). Aging often leads to a decrease in the ability of a person to interpret sensory cues within his or her environment. This checklist instrument examined the relationship between sensory cue frequency and the influence on fall incidence within ALFs to maximize safety and quality of life. Observers visited 140 ALFs, utilizing the checklist instrument to document the presence or non-presence of 110 sensory cues. Contrary to the original hypothesis, a positive correlation was found between sensory cues and reported falls in each space. As the number of cues increased, the number of falls also increased. Additionally, the frequency of sensory cues within each room increased as facility size increased. Lastly, data revealed that more sensory cues were present in ALFs designed or renovated by design professionals. Although the results were contrary to expectations, the checklist instrument demonstrated face and predictive validity as a future research tool.
Sep 2016 DOI 10.14302/issn.2474-7785.jarh-16-1177
J Whiting SusanCorresponding author
College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon Canada
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.