Getting a grip on high risk older inpatients with low grip strength -Dr Kinda Ibrahim and Dr Helen Roberts, Associate Professor in Geriatric Medicine

Our muscles play an important role in our health and grip strength is a good way of measuring how well our muscles are doing. Our grip strength builds through young adulthood to reach its peak in our 30s after which it gradually tails away. It is a reliable and valid way of evaluating someone’s hand strength, which in turns provides an objective measure of the skeletal muscle strength and function in their whole body.

Dr Kinda Ibrahim is based at University Hospital Southampton

Studies that have followed patients over a long period of time show that reduced muscular strength – as measured by grip strength – is consistently linked with early death, disability, and illness.

Given its simplicity and ability to predict health vulnerability, grip strength measurement should be considered as a vital sign useful for screening older people. A major study published in The Lancet followed 139,691 adults aged between 35 and 70 living in 17 countries, and suggests that the strength of a person’s hand-grip could predict the risk of heart attacks and strokes – and is a stronger indicator of death than blood pressure checks. The researchers suggest that grip strength test could be used as a quick, low-cost way for doctors to identify high-risk patients.

By routinely measuring grip strength in older people in hospital we may be able to identify patients with a higher risk of adverse outcomes and that in turn could allow early interventions focusing on progressive resistance training (strength building) and nutritional supplements. So, our aim is to assess the feasibility of using grip strength measurement as a routine assessment for older patients who are admitted to one of the five wards in Department of Medicine for Older People (MOP) at University Hospital Southampton. The study involves training MOP staff including nursing staff, healthcare assistants, and therapy teams on measuring grip strength. Then use a special care plan to support older patients with low grip strength.

Grip strength test is very easy and quick and can be done using a hand dynamometer (Jamar) following a standardised approach. Patients are asked to squeeze twice in each hand on the dynamometer handle as firmly as they can. The maximum value is recorded and those patients who have low grip strength (less than 16 kg for women and less than 27 kg for men) will be given a care plan according to their needs.

In November, we launched the grip strength training in MOP. Working with the MOP educational team, we developed a schedule where training sessions would be run daily for 3 weeks in the treatment rooms in each of the five MOP wards. An average of 2-3 sessions took place daily, each lasted 20 minutes. In total, we have run 36 sessions and have trained 106 staff members on measuring grip strength and using the adapted care plan. The sessions included a practical demonstration of how to measure grip strength using the hand dynamometer and an outline on how to put in place and complete the care plan. At the end of each session, we asked the trained staff to evaluate the training sessions by answering 9 simple questions using a 5–point rating scale. We gave staff the opportunity to talk and express their initial views about using grip strength test in the routine assessment of older inpatients in their wards and reveal any concerns about using it. The training sessions integrated well within the daily routine of staff and they were fun and lively as staff were competing regarding their own grip strength.

Having completed our first training sessions, we are running an on-going training programme for staff who could not attend the initial sessions. Each one of the MOP wards has received a Jamar case (handgrip tool) and the routine assessment of grip strength should start now as part of the routine assessment for all patients admitted or transferred to MOP within 24 hours of their admission. Our next steps are to monitor and reinforce the process by assessing the acceptability of grip strength test by staff and patients, the coverage of grip strength test, the use of the care plan, and the costs of implementation.

We’ve just published the protocol too

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