Grip strength predicts outcome

Age and Ageing 2006; 35: 320–323 © The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: [email protected] Letters to the Editor Reply Sir—I was pleased to read the Research Letter of Kerr et al. in the January issue of this journal [1]. In it, they report a relationship between the grip strength and discharge disposition of elders admitted to hospital. Their research, though informative, is not the first to investigate ‘the link between grip strength and outcome in non-surgical settings’. For a primarily aged cohort of patients hospitalised with pneumonia, we have reported a significant correlation (−0.226) between the grip strength and a ‘bad acute outcome’; that is, an inhospital death or a length of stay of nine or more days [2]. We also found grip strength to correlate significantly with the length of stay (−0.269), discharge home (0.545) and 30-day survival (0.285) [3]. In a follow-up study, we showed that death within a year of hospitalisation was correlated with grip strength (−0.272) [4]. Grip strength was a stronger predictor than any other measured variable, including pneumonia severity, co-morbidity load, age or preadmission residence in an extended care facility. Considering Kerr et al.’s results in combination with our own, I would definitely agree that grip strength should be measured routinely ‘alongside the measurement of blood pressure’ [1]. Grip strength and other physical performance measures can ‘serve as easily accessible “vital signs” to screen older adults in clinical settings’ [5]. Sir—We thank Professor Bohannon for bringing to our attention his research showing a link between grip strength and a range of adverse outcomes including prolonged length of stay in a group of people hospitalised with community-acquired pneumonia. The finding that grip strength was a stronger predictor than factors such as pneumonia severity, co-morbidity or age supports growing evidence that the loss of muscle strength lies on the final common pathway of a number of adverse processes including illness, functional impairment, inadequate nutritional status and ageing. As such, it acts both as a good single marker of physical frailty and as a potentially powerful predictor of future outcome. We hope that this additional evidence will further encourage clinicians to include the measurement of grip strength in the clinical setting. RICHARD W. BOHANNON Principal, Physical Therapy Consultants, Professor, University of Connecticut, Physical Therapy Consultants, 130 Middlebrook Road, West Hartford, CT 06119, USA Tel: (+1) 860 233 1033 Fax: (+1) 860 233 0609 Email: [email protected] url: www.ptconsultants.biz 1. Kerr A, Syddall HE, Cooper C, Turner GF, Briggs RS, Sayer AA. Does admission grip strength predict length of stay in hospitalized older patients? Age Ageing 2006; 35: 82–4. 2. Bohannon RW, Ferullo J, Maljanian R. Muscle strength is impaired and related to acute outcome in patients with community acquired pneumonia. Cardiopulm Phys Ther 2002; 13: 3–6. 3. Vecchiarino P, Bohannon RW, Ferullo J, Maljanian R. Shortterm outcomes and their predictors for patients hospitalized with community-acquired pneumonia. Heart Lung 2004; 33: 301–7. 4. Bohannon RW, Maljanian R, Ferullo J. Mortality and readmission of the elderly one year after hospitalization for pneumonia. Aging Clin Exp Res 2004; 16: 22–5. 5. Studenski S, Perera S, Wallace D et al. Physical performance measures in the clinical setting. J Am Geriatr Soc 2003; 51: 314–22. doi:10.1093/ageing/afj061 Published electronically 2 March 2006 320 AVAN AIHIE SAYER*, ROGER BRIGGS, GILLIAN TURNER, CYRUS COOPER, HOLLY SYDDALL, ALASTAIR KERR *To whom correspondence should be addressed MRC Epidemiology Resource Centre, University of Southampton, Southampton SO16 6YD, UK Email: [email protected] doi:10.1093/ageing/afj062 Published electronically 13 March 2006 The future of geriatric medicine SIR—That the paying public is not as embarrassed by Geriatric Medicine as Metz and Labrooy [1] is shown by the rapid increase in private practice in the specialty. Twenty-five years ago, there were a handful of geriatricians with significant private practices in central London. Now every private hospital throughout the affluent areas of England has access to geriatricians with substantial private caseloads. Their comments, however, should not be ignored, although there is another future for the specialty in the environment that they describe. The development in the UK of most physicians as protocol-driven organ specialists leaves space for the continuation of the specialty of General Medicine. Current physicians accredited in ‘General (Internal) Medicine’ are good at managing medical emergencies but have little experience in less acute disease. Patients of all ages with nonspecific symptoms, mixed medical and psychiatric problems and multi-system disorder may have problems finding an appropriate specialist. Older people do not always benefit from care driven by protocols worked out on younger people [2]. The General Physician of the past had little or no knowledge of the most important part of General Medicine, Geriatric Medicine. The public needs a new generation of General Physicians, most of whose training and practice is in what Downloaded from https://academic.oup.com/ageing/article/35/3/320/40169 by guest on 20 August 2022 Grip strength predicts outcome