Unidad de Investigación Epidemiológica y en Servicios de Salud, Area de Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, Distrito Federal, México.
PLoS One. 2013 Jul 25;8(7):e69849. doi: 10.1371/journal.pone.0069849. Print 2013.
Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79-0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and intervene consequently.
住院后功能下降是老年人常见的不良后果。一种易于使用、可重复且准确的工具来识别那些处于危险中的人，将有助于将干预措施集中在那些风险较高的人身上。握力已被证明可以预测其他环境中的不良后果。本研究的目的是确定在急性护理机构入院时测量的握力是否可以预测墨西哥老年人出院时的功能下降（无论是新发还是原有功能恶化），并按性别分层。此外，还将确定作为特异性函数的截止点。在墨西哥城的两家医院进行了一项队列研究。主要终点是出院时的功能下降，定义为从基线评分下降 30 分的巴氏量表评分。在初始评估时测量了握力以及其他变量，包括：日常生活活动的工具、认知、抑郁症状、谵妄、住院时间和生活质量。所有分析均按性别分层。进行逻辑回归以测试握力与功能下降之间的独立关联，并估计握力测试值（特异性、敏感性、曲线下面积等）。2007 年至 2009 年期间共招募了 223 名入住急性护理机构的患者。共有 55 名患者（24.7%）出现功能下降，男性为 23.46%，女性为 25.6%。多变量分析显示，只有握力低的男性出院时功能下降的风险增加（OR 0.88，95%CI 0.79-0.98，p = 0.01），特异性为 91.3%，握力强度的截止点为 20.65 千克。女性握力与功能下降之间无显著相关性。在入住急性护理机构时测量握力可能会识别出有功能下降风险的男性老年患者，并进行相应干预。
