Handgrip Strength in Old and Very Old Adults: Mood, Cognition, Function, and Mortality

Objectives: To determine the trajectory of handgrip strength (HGS) from age 70 to 90 and its association with mood, cognition, functional status, and mortality.

Design: Prospective follow-up of an age-homogenous representative community-dwelling cohort (born 1920-21) in the Jerusalem Longitudinal Cohort Study (1990-2015).

Setting: Home-based assessment.

Participants: Subjects aged 70 (n = 327), 78 (n = 384), 85 (n = 1187), and 90 (n = 406), examined in 1990, 1998, 2005, and 2010, respectively.

Measurements: Handgrip strength (kg) (dynamometer), low HGS defined as sex-specific lowest quartile grip; geriatric assessment; all-cause mortality (1990-2015).

Results: Mean HGS declined between age 70 and 90 from 21.3 ± 7.2 to 11.5 ± 5.6 kg in women and from 35.3 ± 8.4 to 19.5 ± 8.2 kg in men. Cross-sectional associations were observed between low HGS and poor functional measures (age 70-90), lower educational and financial status, smoking, and diabetes mellitus (ages 78-90). After adjustment for baseline education, self-rated health, physical activity, diabetes mellitus, depression, and cognition, low HGS predicted subsequent activity of daily living dependence from age 78 to 85 (odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.04-6.89) and 85 to 90 (OR = 2.31, 95% CI = 1.01-5.30), whereas the adjusted ORs for activities of daily living difficulty and depression failed to achieve significance. HGS did not predict subsequent cognitive decline. Survival rates were significantly lower in participants with low HGS (Quartile 1) than in those with normal HGS (Quartiles 2, 3, 4) throughout follow-up from ages 78 to 85, 85 to 90, and 90 to 95. Similarly, after adjusting for sex, education, self-rated health, body mass index, hypertension, diabetes mellitus, ischemic heart disease, and smoking, a low HGS was associated with significantly higher mortality.

Conclusions: Mean HGS declined progressively with age, and participants in the lowest age-specific quartile of HGS had a higher risk of subsequent functional decline and mortality.