Elsevier

Archives of Gerontology and Geriatrics

Volume 86, January–February 2020, 103961
Archives of Gerontology and Geriatrics

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

https://doi.org/10.1016/j.archger.2019.103961Get rights and content

Highlights

  • First study to report the association of annual change in hand grip strength (HGS) with mortality in an Asian setting.

  • Higher (lower) baseline HGS and annual increase (decrease) in HGS were associated with lower (higher) mortality likelihood.

  • Cross-sectional as well as longitudinal HGS evaluation has value in terms of predicting mortality risk among older people.

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

Introduction

Hand grip strength (HGS) is an easy to measure indicator of muscle function, nutritional status and physical health. It is a reliable general health indicator in population-based studies (Andersen-Ranberg, Petersen, Frederiksen, Mackenbach, & Christensen, 2009). HGS is often a component of tools/scales used for assessing physical frailty (Bautista & Malhotra, 2018; Dudzińska-Griszek, Szuster, & Szewieczek, 2017; Reeve et al., 2018; Velghe, De Buyser, Noens, Demuynck, & Petrovic, 2016) and is used for diagnosis of sarcopenia (Cruz-Jentoft et al., 2010; Fielding et al., 2011), important health conditions that are increasingly being assessed among older people. Thus, healthcare professionals would have data on HGS for their older patients or clients not only at a single point in time (i.e. cross-sectional) but also over time (i.e. longitudinal), allowing assessment of change in HGS. It is therefore informative and imperative to assess if there is value, in terms of its link with adverse health outcomes, of not only cross-sectional but also longitudinal HGS assessment.

HGS assessed at a single point in time is reported to predict a variety of adverse health outcomes (Celis-Morales et al., 2018; Hamasaki et al., 2017; Prasitsiriphon & Pothisiri, 2018; Strand et al., 2016; Wu, Wang, Liu, & Zhang, 2017), including cause-specific (Celis-Morales et al., 2018; Prasitsiriphon & Pothisiri, 2018; Strand et al., 2016) and all-cause mortality (Celis-Morales et al., 2018; Prasitsiriphon & Pothisiri, 2018; Wu et al., 2017). The inverse association of HGS assessed at a single point in time with subsequent mortality ‒ higher values are associated with lower mortality risk ‒ is established among older people (Gale, Martyn, Cooper, & Sayer, 2007; Rantanen et al., 2000). However, evidence on the association of change in HGS and mortality among older people is both inconclusive and has limited geographical representation.

In a study from the United States, annual change in HGS was not associated with mortality over a 40-year period among men aged ≥60 years (Metter, Talbot, Schrager, & Conwit, 2002). In contrast, reduction in HGS over 1-year was associated with higher mortality risk among adults aged ≥85 years in the United Kingdom (UK) over a 9.6-year period (Granic et al., 2017) and among adults aged ≥50 years in 10 European countries over a 7-year period (Prasitsiriphon & Pothisiri, 2018). Further, no study has assessed the association of change in HGS with mortality in an Asian population. Previously, we have shown that the age-gender-hand specific average values for HGS are lower among older people in Singapore, a Southeast Asian nation, relative to older people in Western populations, and defined normative values of HGS for older Singaporeans (Malhotra et al., 2016). Other studies from Asian populations also report their average HGS values to be lower than those for Western populations (Shim et al., 2013; Wu, Wu, Liang, Wu, & Huang, 2009). Thus, it is of interest to assess the association of change in HGS and mortality is present in an Asian setting, where, on average, HGS is lower than Western settings, where this association has been studied till date.

Our primary aim, therefore, is to investigate the association of baseline (cross-sectional) HGS and annual change in (longitudinal) HGS with all-cause mortality among community-dwelling older people, aged ≥60 years, in Singapore. A previous study linking cross-sectional and longitudinal HGS with mortality among older people has reported the association to vary by age or gender (Granic et al., 2017). It is also of interest to determine if the effect of change in HGS on mortality varies by lower or higher values of baseline HGS. Thus, our secondary aim is to assess if the association of baseline HGS with all-cause mortality varies by age and gender, and of annual change in HGS with all-cause mortality varies by age, gender and baseline HGS.

Section snippets

Study design and participants

Data from a nationally representative longitudinal survey of community-dwelling Singapore citizens and permanent residents aged ≥60 years, Panel on Health and Aging of Singaporean Elderly (PHASE), was utilized. Details on its sampling approach and design, and flow of participants across waves, are available elsewhere (Chan et al., 2019). Briefly, utilizing single-stage stratified random sampling, a total of 4990 older people (or their proxy respondent, if they were unable to respond due to

Basic characteristics

Distribution of hand grip strength, socio-demographic and health-related variables in Dataset 1 and 2 is provided in Appendix B (see Supplementary material). The baseline HGS was 21.2 kg and 21.7 kg respectively in the two datasets. HGS declined by 0.4 kg, on average, annually.

Baseline HGS and all-cause mortality

The mean (95% CI) follow-up time in Dataset 1 was 6.3 (6.2–6.3) years, with a maximum of 7 years. A total of 835 (18.8%) participants died; the mean survival time was 3.6 (3.5–3.7) years. The unadjusted and adjusted HRs

Discussion

Our study provides evidence for the linear association of both HGS assessed at a single point in time (i.e. cross-sectional) and change in HGS over a 1-year period (i.e. longitudinal) with all-cause mortality among community-dwelling older people from an Asian population. It suggests that the association between baseline HGS and all-cause mortality is slightly stronger among women relative to men, but does not vary by age. The association between change in HGS and all-cause mortality is

Conclusions

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

Author contributions

Rahul Malhotra conceptualized the research questions, co-wrote the first draft and revised the manuscript. Md. Ismail Tareque ran the statistical analyses, co-wrote the first draft and revised the manuscript. Ngiap Chuan Tan and Stefan Ma assisted in refining the research questions and analysis plan, and revised the manuscript. All authors approved the final version of the manuscript.

Funding

Waves 1, 2 and 3 of the Panel on Health and Ageing of Singaporean Elderly (PHASE) were funded or supported by the following sources: Ministry of Social and Family Development, Singapore; Singapore Ministry of Health’s National Medical Research Council under its Singapore Translational Research Investigator Award “Establishing a Practical and Theoretical Foundation for Comprehensive and Integrated Community, Policy and Academic Efforts to Improve Dementia Care in Singapore” (NMRC-STAR-0005-2009

Declaration of Competing Interest

None.

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