Lino Valéria Teresa Saraiva, Rodrigues Nádia Cristina Pinheiro, O'Dwyer Gisele, Andrade Mônica Kramer de Noronha, Mattos Inês Echenique, Portela Margareth Crisóstomo
Department of Primary Care, National Public Health School, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Epidemiology, National Public Health School, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil.
PLoS One. 2016 Nov 10;11(11):e0166373. doi: 10.1371/journal.pone.0166373. eCollection 2016.
Sarcopenia is a condition diagnosed when the patient presents low muscle mass, plus low muscle strength or low physical performance. Muscle weakness in the oldest (dynapenia) is a major public health concern because it predicts future all-cause mortality and is associated with falls, disability, cardiovascular mortality and morbidity. Grip strength is a simple method for assessment of muscle function in clinical practice.
To estimate the grip strength and identify factors associated with handgrip strength variation in elderly people with low socioeconomic status.
Cross-sectional study based on a multidimensional assessment of primary care users that were 60 years or older. The sample size was calculated using an estimated prevalence of depression in older adults of 20%. A kappa coefficient of 0.6 with a 95% confidence interval was used to generate a conservative sample size of 180 individuals. Procedures: tests and scales to assess humor, cognition (MMSE), basic (ADL) and instrumental activities (IADL) of daily living, mobility (Timed Up and Go), strength, height, Body Mass Index (BMI) and social support were applied. Questions about falls, chronic diseases and self-rated health (SRH) were also included. Statistical Analysis: Mean, standard deviation and statistical tests were used to compare grip strength means by demographic and health factors. A multivariate linear model was used to explain the relationship of the predictors with grip strength.
The group was composed predominantly by women (73%) with a very low level of education (mean 3 years of schooling), mean age of 73.09 (± 7.05) years old, good mobility and without IADL impairment. Mean grip strength of male and female were 31.86Kg (SD 5.55) and 21.69Kg (SD 4.48) [p- 0.0001], respectively. Low grip strength was present in 27.7% of women and 39.6% of men. As expected, men and younger participants had higher grip strength than women and older individuals. In the adjusted model, age (p- 0.03), female sex (p- 0.0001), mobility (p- 0.05), height (p- 0.03) and depression (p- 0.03) were independently associated with low grip strength. For every second more in the mobility test, there was a mean decrease of 0.08 Kg in the grip strength. Elders with depression had a mean reduction of 1.74Kg in the grip strength in relation to those in the comparison groups. There was an average reduction of 8.36Kg in the grip strength of elderly females relative to males. For each year of age after 60 years, it was expected an average reduction of 0.11 Kg in the grip strength.
our results suggest that low grip strength is associated with age, female sex, height, depression and mobility problems in poor elderly. Grip strength can be a simple, quick and inexpensive means of stratifying elders' risk of sarcopenia in the primary care setting. Efforts should be made to recognize weaker persons and the conditions associated to low grip strength in order to target early interventions to prevent frailty and disability.
肌肉减少症是指患者出现肌肉量低，同时伴有肌肉力量低或身体机能低的一种病症。老年人的肌肉无力（动态肌力减退）是一个主要的公共卫生问题，因为它预示着未来全因死亡率，且与跌倒、残疾、心血管疾病死亡率及发病率相关。握力是临床实践中评估肌肉功能的一种简单方法。
评估社会经济地位低下的老年人的握力，并确定与握力变化相关的因素。
基于对60岁及以上初级保健服务使用者的多维评估进行横断面研究。样本量根据老年人中抑郁症估计患病率为20%来计算。使用kappa系数0.6及95%置信区间来得出保守样本量为180人。程序：应用测试和量表来评估幽默感、认知能力（简易精神状态检查表）、日常生活基本活动（ADL）和工具性活动（IADL）、活动能力（定时起立行走测试）、力量、身高、体重指数（BMI）和社会支持。还包括关于跌倒、慢性病和自评健康状况（SRH）的问题。统计分析：使用均值、标准差和统计检验按人口统计学和健康因素比较握力均值。采用多元线性模型来解释预测因素与握力之间的关系。
该组主要由女性（73%）组成，教育水平极低（平均受教育年限3年）,平均年龄73.09（±7.05）岁，活动能力良好且无IADL受损情况。男性和女性的平均握力分别为31.86千克（标准差5.55）和21.69千克（标准差4.48）[p值 = 0.0001]。27.7%的女性和39.6%的男性握力较低。正如预期那样，男性和较年轻参与者的握力高于女性和年长者个体在调整后的模型中，年龄（p值 = 0.03）、女性性别（p值 = 0.0001）、活动能力（p值 = 0.05）、身高（p值 = 0.03）和抑郁症（p值 = 0.03）与低握力独立相关在活动能力测试中每多一秒，握力平均下降0.08千克与对照组相比，患有抑郁症的老年人握力平均降低1.74千克老年女性相对于男性的握力平均降低8.36千克60岁之后每增加一岁，预计握力平均降低0.11千克。
我们的结果表明，在贫困老年人中，低握力与年龄、女性性别、身高、抑郁症和活动能力问题相关。握力可以作为在初级保健环境中对老年人肌肉减少症风险进行分层的一种简单、快速且廉价的方法。应努力识别较弱个体以及与低握力相关的状况，以便针对早期干预措施来预防衰弱和残疾。
