A locally developed reference for normal hand grip strength values among the elderly is now available for use by Singapore doctors and healthcare professionals. Designed by Duke-NUS Medical School (Duke-NUS), the first such guide based on a national large-scale study of the elderly could be a predictor of future adverse health outcomes, including disability and death.
Measurement of hand grip strength, or the maximum force possible in gripping an object with one’s hand, is often done to gauge frailty and the loss of muscle mass and strength among older adults. Lower hand grip strength values have been shown to predict negative health outcomes.
Hand grip strength is associated with individual, genetic and nutritional factors, which vary across countries and populations. Currently the reference values rely on values established abroad, mainly in the West, which may not be relevant to the local elderly.
In this study, the Duke-NUS researchers analysed data from a representative survey of 4,990 community-dwelling elderly Singaporeans aged 60 years and above, who are part of the Social Isolation, Health and Lifestyles Survey conducted in 2009. Besides face-to-face interview, body measurements — including hand grip strength, determined with a popular spring-type dynamometer — were taken from 4,616 of the participants. Of these, figures from 2,664 healthy participants, aged 60 to 89 years, without existing cognitive impairment, memory problems or other health issues were used for developing the reference values.
Besides Duke-NUS, researchers from SingHealth Polyclinics in Singapore and Nihon University in Japan also contributed to the development of the reference values.
Assistant Professor Rahul Malhotra, lead author and Head of Research at the Centre for Ageing Research and Education (CARE) in Duke-NUS, said results showed locals, on average, had lesser hand grip strength than their Western counterparts. He also revealed that ethnicity played a part in men, where lower values were observed in Indians compared to Chinese or Malays.
Asst Prof Malhotra pointed out that the reference values come in simple charts for doctors to mark and map the hand grip force of their patients. A medical practitioner in Singapore measuring an older patient can thus “benchmark” the measured hand grip strength, added Associate Professor Angelique Chan, senior author and Executive Director of CARE.
Published in the September 2016 issue of Journal of the American Medical Directors Association, the reference values are ready for real-world application. The findings will help clinicians and researchers interpret hand grip strength statistics in Singapore, and potentially other Asian countries.
The team plans to further identify hand grip strength thresholds that could foresee negative health outcomes, such as development of functional limitations or mortality among the elderly in Singapore.