Dudzińska-Griszek Joanna, Szuster Karolina, Szewieczek Jan
Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Clin Interv Aging. 2017 Jul 26;12:1151-1157. doi: 10.2147/CIA.S140192. eCollection 2017.
Frailty has emerged as a key medical syndrome predictive of comorbidity, disability, institutionalization and death. As a component of the five frailty phenotype diagnostic criteria, patient grip strength deserves attention as a simple and objective measure of the frailty syndrome. The aim of this study was to assess conditions that influence grip strength in geriatric inpatients.
The study group consisted of 80 patients aged 78.6±7.0 years [Formula: see text], with 68.8% women, admitted to the Department of Geriatrics. A comprehensive geriatric assessment was complemented with assessment for the frailty phenotype as described by Fried et al for all patients in the study group. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale and Mini-Mental State Examination.
Three or more frailty criteria were positive in 32 patients (40%), while 56 subjects (70%) fulfilled the frailty criterion of weakness (grip strength test). Multivariate linear regression analysis revealed that two independent measures showed positive association with grip strength - Mini-Mental State Examination score (β=0.239; =0.001) and statin use (β=0.213; =0.002) - and four independent measures were negatively associated with grip strength - female sex (β=-0.671; <0.001), C-reactive protein (β=-0.253; <0.001), prior myocardial infarction (β=-0.190; =0.006) and use of an antidepressant (β=-0.163; =0.018). Low physical activity was identified as the only independent qualitative frailty component associated with 2-year mortality in multivariate logistic regression analysis after adjustment for age and sex (odds ratio =6.000; 95% CI =1.357-26.536; =0.018).
Cognitive function, somatic comorbidity and medical treatment affect grip strength as a measure of physical frailty in geriatric inpatients. Grip strength was not predictive of 2-year mortality in this group.
衰弱已成为一种关键的医学综合征，可预测合并症、残疾、机构化和死亡。作为衰弱表型五项诊断标准的一个组成部分，患者握力作为衰弱综合征的一种简单客观的测量方法值得关注。本研究的目的是评估影响老年住院患者握力的因素。
研究组由80例年龄为78.6±7.0岁[公式：见正文]的患者组成，其中68.8%为女性，均入住老年医学科。对研究组所有患者进行全面的老年综合评估，并补充Fried等人描述的衰弱表型评估。功能评估包括日常生活活动能力巴氏指数（巴氏指数）、日常生活活动能力量表和简易精神状态检查表。
32例患者（40%）有三项或更多衰弱标准呈阳性，而56例受试者（70%）符合虚弱（握力测试）的衰弱标准。多变量线性回归分析显示，两项独立指标与握力呈正相关——简易精神状态检查表评分（β=0.239；P=0.001）和他汀类药物使用（β=0.213；P=0.002）——四项独立指标与握力呈负相关——女性（β=-0.671；P<0.001）、C反应蛋白（β=-0.253；P<0.001）、既往心肌梗死（β=-0.190；P=0.006）和使用抗抑郁药（β=-0.163；P=0.018）。在对年龄和性别进行调整后的多变量逻辑回归分析中，低体力活动被确定为与2年死亡率相关的唯一独立定性衰弱成分（比值比=6.000；95%置信区间=1.357-26.536；P=0.018）。
认知功能、躯体合并症和药物治疗会影响握力，而握力可作为老年住院患者身体衰弱的一项指标。在该组患者中，握力不能预测2年死亡率。
