Handgrip Strength Asymmetry Is Associated With Limitations in Individual Basic Self-Care Tasks.

This investigation sought to determine the associations between handgrip strength (HGS) asymmetries and limitations in individual activities of daily living (ADL). The analytic sample included 18,468 participants from the 2006 to 2016 waves of the Health and Retirement Study. Those with HGS >10% stronger on either hand had any HGS asymmetry. Individuals with HGS >10% stronger on their dominant or non-dominant hand had dominant or non-dominant HGS asymmetry, respectively. ADL abilities were self-reported. Those with any HGS asymmetry had 1.21 (95% confidence interval [CI] = [1.01-1.46]) greater odds for a toileting limitation and 1.25 (CI = [1.03-1.52]) greater odds for a transferring limitation. Individuals with dominant HGS asymmetry had 1.24 (CI = [1.01-1.53]) greater odds for a transferring limitation. Those with non-dominant HGS asymmetry had 1.39 (CI = [1.01-1.93]) and 1.44 (CI = [1.05-1.96]) greater odds for a bathing and toileting limitation, respectively. HGS asymmetries could help to identify future limitations in specific ADLs.

Handgrip Strength Asymmetry and Weakness Are Associated With Future Morbidity Accumulation in Americans.

ABSTRACT: Klawitter, L, Vincent, BM, Choi, BJ, Smith, J, Hammer, KD, Jurivich, DA, Dahl, LJ, and McGrath, R. Handgrip strength asymmetry and weakness are associated with future morbidity accumulation in americans. J Strength Cond Res 36(1): 106-112, 2022-Identifying strength asymmetries in physically deconditioned populations may help in screening and treating persons at risk for morbidities linked to muscle dysfunction. Our investigation sought to examine the associations between handgrip strength (HGS) asymmetry and weakness on accumulating morbidities in aging Americans. The analytic sample included 18,506 Americans aged ≥50 years from the 2006-2016 Health and Retirement Study. Handgrip strength was measured on each hand with a handgrip dynamometer, and persons with an imbalance in strength >10% between hands had HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered as weak. Subjects reported the presence of healthcare provider-diagnosed morbidities: hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems. Covariate-adjusted ordinal generalized estimating equations analyzed the associations for each HGS asymmetry and weakness group on future accumulating morbidities. Of those included in our study, subjects at baseline were aged 65.0 ± 10.2 years, 9,570 (51.7%) had asymmetric HGS, and 996 (5.4%) were weak. Asymmetry alone and weakness alone were associated with 1.09 (95% confidence interval [CI]: 1.04-1.14) and 1.27 (CI: 1.11-1.45) greater odds for future accumulating morbidities, respectively. Having both HGS asymmetry and weakness was associated with 1.46 (CI: 1.29-1.65) greater odds for future accumulating morbidities. Handgrip-strength asymmetry, as another potential indicator of impaired muscle function, is associated with future morbidity status during aging. Exercise professionals and related practitioners should consider examining asymmetry and weakness with handgrip dynamometers as a simple and noninvasive screening method for helping to determine muscle dysfunction and future chronic disease risk.

Handgrip Strength Asymmetry and Weakness Together Are Associated With Functional Disability in Aging Americans.

BACKGROUND: Evaluating handgrip strength (HGS) asymmetry may help to improve the prognostic value of HGS. This study sought to determine the associations of HGS asymmetry and weakness on future activities of daily living (ADL) disability in a national sample of aging Americans. METHODS: The analytic sample included 18,468 Americans aged ≥50 years from the 2006-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS. Those with HGS >10% stronger on either hand were considered as having any HGS asymmetry. Individuals with HGS >10% stronger on their dominant hand were considered as having dominant HGS asymmetry, while those with HGS >10% stronger on their nondominant hand were classified as having nondominant HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered weak. ADLs were self-reported. Generalized estimating equations were used for analyses. RESULTS: Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had increased odds for future ADL disability: 1.11 (95% confidence interval [CI]: 1.02-1.20) for any HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, and 1.81 (CI: 1.52-2.16) for both any HGS asymmetry and weakness. Most weakness and HGS asymmetry dominance groups had increased odds for future ADL disability: 1.30 (CI: 1.13-1.50) for nondominant HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, 1.72 (CI: 1.29-2.29) for both weakness and nondominant HGS asymmetry, and 1.86 (CI: 1.52-2.28) for both weakness and dominant HGS asymmetry. CONCLUSIONS: HGS asymmetry and weakness together may increase the predictive utility of handgrip dynamometers.

Weakness May Have a Causal Association With Early Mortality in Older Americans: A Matched Cohort Analysis.

OBJECTIVES: Quantifying the association between muscle weakness and mortality with carefully matched cohorts will help to better establish the impact of weakness on premature death. We used a matched cohort analysis in a national sample of older Americans to determine if those who were weak had a higher risk for mortality compared with control groups with incrementally higher strength capacities. DESIGN: Longitudinal panel. SETTING: Detailed interviews that included physical measures were conducted in person, whereas core interviews were often performed over the telephone. PARTICIPANTS: Data from 19,729 Americans aged at least 50 years from the 2006-2014 waves of the Health and Retirement Study were analyzed. MEASURES: A handgrip dynamometer was used to assess handgrip strength (HGS) in each participant. Men with HGS <26 kg were considered weak, ≥26 kg were considered not weak, and ≥32 kg were considered strong. Women with HGS <16 kg were classified as weak, ≥16 kg were classified as not-weak, and ≥20 kg were classified as strong. The National Death Index and postmortem interviews determined the date of death. The greedy matching algorithm was used to match cohorts. RESULTS: Of the 1077 weak and not-weak matched pairs, 401 weak (37.2%) and 296 not-weak (27.4%) older Americans died over an average 4.4 ± 2.5-year follow-up. There were 392 weak (37.0%) and 243 strong (22.9%) persons who died over a mean 4.5 ± 2.5-year follow-up from the 1057 weak and strong matched pairs. Those in the weak cohort had a 1.40 [95% confidence interval (CI) 1.19, 1.64] and 1.54 (CI 1.30, 1.83) higher hazard for mortality relative to persons in the not-weak and strong control cohorts, respectively. CONCLUSIONS AND IMPLICATIONS: Our findings may indicate a causal association between muscle weakness and mortality in older Americans. Health care providers should include measures of HGS as part of routine health assessments and discuss the health risks of muscle weakness with their patients.

Quality improvement in long term care: the psychotropic assessment tool (PAT).

BACKGROUND: There are already a substantial number of individuals with dementia in long-term care. Many nursing home patients have difficult behaviors and are currently managed with psychotropic medications. Medications for behavior need to be titrated and monitored over time for efficacy and safety, and subsequently tapered if ineffective. Some of these medications are not without risk, and that risk-benefit ratio should be discussed and documented with the family. Currently, we are not aware of any quality improvement process that has been developed in long-term care to address these issues. OBJECTIVES: To describe the process of a novel quality improvement intervention that was designed to improve documentation in the medical record and interdisciplinary communication of the usefulness and possible side effects of psychotropic agents used in the management of difficult behaviors for dementia. DESIGN: Retrospective review of the chart and quality improvement records in a long-term care facility. SETTING: An academic long-term care facility that specializes in dementia care in St. Louis, MO. METHODS: The quality improvement team created a process and a form named the Psychotropic Assessment Tool (PAT) to document current behavioral symptoms of the residents; determine whether the resident was on psychotropic agents; identify whether agents had been initiated, titrated, and/or tapered if appropriate; and whether there were any side effects related to the behavioral medications. A letter was created and provided to the surrogate decision maker that described the risk-benefit ratio of the use of antipsychotic agents when these drugs were prescribed. Recommendations from the quality improvement team were provided to the primary care physician. After 1 year of this process, we reviewed the medical charts and quality improvement PAT forms of all residents. We documented the use of psychotropic agents before and after initiating the PAT process, the presence of current behavioral symptoms, the presence of possible side effects, and the recommendations of the interdisciplinary team that met after the monthly quality improvement meetings. RESULTS: A total of 110 patients were included in this study, which reviewed psychotropic drug use between July 2005 and July 2006. The mean age of the residents was 83.8 +/- 7.5 years. All residents had a diagnosis of dementia. Mean MMSE score was 13.5 +/- 7.3. The prevalence of potential problems that could have been associated with psychotropic drug use was not insignificant and included falls (45%), weight loss (16%), weight gain (7%), dizziness (9%), and sedation (5%). However, behaviors that might warrant psychotropic drug use were not uncommon and included active depression (12%), anxiety (24%), hallucinations (11%), disruptive behavior (21%) and delusions (21%). The percentage of residents on antipsychotics changed from 26.5% pre-PAT process to 25.2% post-PAT process; those on anxiolytics changed from 6.0% to 4.0%. There was a change in hypnotics from 2.6% to 3.4%. Antidepressant usage remained the same at 55%. The PAT CHAT discussion resulted in recommendation of medication changes in 25% of residents. CONCLUSIONS: The initiation of this quality improvement process using the PAT led to improved chart documentation and interdisciplinary communication between the team, primary care physicians, and families. Further studies are needed to determine whether this process can impact use of psychotropic agents, improve quality of life, decrease adverse drug events, and/or reduce medical-legal risk.