Department of Medicine, University of Washington, Seattle, Washington, USA.
Department of Radiology, University of Washington, Seattle, Washington, USA.
J Gerontol A Biol Sci Med Sci. 2022 Jul 5;77(7):1398-1404. doi: 10.1093/gerona/glab332.
Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with the development of hospital-associated ADL disability in older adults in the Health ABC Study.
Individuals hospitalized during the first 5 years of follow-up (n = 1 724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual-energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of prehospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability.
Each standard deviation decrement in prehospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared with not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with the development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death.
Prehospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.
老年人一半的身体残疾，包括日常生活活动（ADL）残疾，都发生在住院期间。本研究通过健康老龄化研究（Health ABC Study）检验了四肢瘦体质（ALM）和握力，这些指标通常包含在肌少症的各种定义中，与老年人住院后发生与医院相关的 ADL 残疾之间的关系。
分析了在随访的前 5 年内住院的个体（n = 1724）。通过双能 X 射线吸收法（DXA）评估四肢瘦体质与体重指数（BMI）的比值（ALMBMI），通过手持测力计评估握力，每年评估一次。在住院后的下一次年度评估时评估新的 ADL 残疾的发展情况。分别进行回归分析，以模型化住院前 ALMBMI 或握力与下一次年度评估前死亡的关系。接下来，在那些存活到下一次年度评估的人中，分别进行回归分析，以模型化 ALMBMI 或握力与 ADL 残疾发展的关系。
住院前握力每标准偏差降低与随访时新 ADL 残疾的调整后比值比（OR）为 1.80（95%CI：1.18，2.74）相关。与不低握力（根据 FNIH 定义）相比，低握力与随访时 ADL 残疾的调整后比值比（OR）为 2.36（95%CI：1.12，4.97）相关。ALM 指标与医院相关的 ADL 残疾的发展无关。ALM 和握力指标与死亡无关。
住院前较低的握力可能是住院后老年人 ADL 残疾的一个重要危险因素。
