Grip strength in a cohort of older medical inpatients in Malaysia: A pilot study to describe the range, determinants and association with length of hospital stay Victoria Keevil a,b, *, Rizah Mazzuin Razali c , Ai-Vyrn Chin c , Karen Jameson b , Avan Aihie Sayer a,b , Helen Roberts a a Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK b MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK c Division of Geriatrics, Department of Medicine, Faculty of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia 1. Introduction Sarcopenia, the decline in skeletal muscle mass and function with age, has been proposed as a new ‘Geriatric Giant’ with estimated annual healthcare costs of $18.5 billion in the USA (Janssen, Shepard, Katzmarzyk, & Roubenoff, 2004). The term sarcopenia was coined by Rosenberg in 1989, but a universally accepted operational definition has proved elusive. In 2010, the European Working Group on Sarcopenia in Older People presented a consensus definition for sarcopenia, requiring two out of three of the following criteria to be fulfilled: low muscle mass, low muscle strength and/or low physical function (Cruz-Jentoft et al., 2010). Low hand grip strength has been shown to be associated with negative outcomes in older people, such as increased mortality (Newman et al., 2006; Ruiz et al., 2008), longer hospital inpatient stay (Kerr et al., 2006), falls (Sayer et al., 2006; Wickham, Cooper, Margetts, & Barker, 1989) and disability (Giampaoli et al., 1999; Rantanen et al., 1999). Most studies to date have been conducted within Caucasian populations from high income countries limiting their generali- sability (Bohannon, Peolsson, Massy-Westropp, Desrosiers, & Bear- Lehman, 2006). Thus, the validity of proposed definitions of sarcopenia when applied to Asian populations is debated (Wen, Wang, Jiang, & Zhang, 2011). For example, body composition varies significantly with ethnicity and young Asian men and women have lower muscle mass than Caucasians. The influence of ethnicity on population norms of skeletal muscle properties, their determi- nants and associations warrants further investigation. Studies in Taiwan (Wu, Wu, Liang, Wu, & Huang, 2009) and Malaysia (Kamarul, Ahmad, & Loh, 2006) have described the mean grip strength of healthy adult Asian men and women to be up to 25% and 33% lower than the mean grip strength observed in Archives of Gerontology and Geriatrics xxx (2012) xxx–xxx A R T I C L E I N F O Article history: Received 21 May 2012 Received in revised form 1 October 2012 Accepted 5 October 2012 Available online xxx Keywords: Grip strength Ageing Sarcopenia Length of stay Older people A B S T R A C T Grip strength is a marker of sarcopenia, the age-related decline in muscle mass and function, and has been little researched in Asian populations. We aimed to describe the feasibility and acceptability of measuring grip strength in hospitalized, older people in Malaysia and to explore its range, determinants and association with length of stay. Patients admitted acutely to the geriatrics ward of a teaching hospital were consecutively recruited. Inability to consent or use the dynamometer led to exclusion. Maximum grip strength, anthropometric data, length of hospital stay, discharge destination, 3-point Barthel score, mini-mental state examination, falls history and number of co-morbidities and medications on admission were recorded. 80/153 (52%) eligible patients were recruited (52 women; age range 64–100 years). 9/153 (6%) refused to participate and 64/153 (42%) were excluded (34 too unwell, 24 unable to consent, 4 unable to use the dynamometer, 2 other reasons). 76/80 patients (95%) reported that they would undergo grip strength measurement again. Determinants were similar to those of Caucasian populations but grip strength values were lower. After adjustment for sex, age and height, stronger grip strength was associated with shorter length of stay [hazard ratio 1.05 (95% CI 1.00, 1.09; P = 0.03)]. This is the first report of grip strength measurement in hospitalized older people in Malaysia. It was feasible, acceptable to participants and associated with length of stay. Further research is warranted to elucidate the normative range in different ethnic groups and explore its potential use in clinical practice in Malaysia. ß 2012 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Present address: EPIC Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Wort’s Causeway, Cambridge CB1 8RN, UK. Tel.: +44 01223 740168; fax: +44 01223 740177. E-mail address: vlk20@cam.ac.uk (V. Keevil). G Model AGG-2784; No. of Pages 5 Please cite this article in press as: Keevil, V., et al., Grip strength in a cohort of older medical inpatients in Malaysia: A pilot study to describe the range, determinants and association with length of hospital stay. Arch. Gerontol. Geriatr. (2012), http://dx.doi.org/10.1016/ j.archger.2012.10.005 Contents lists available at SciVerse ScienceDirect Archives of Gerontology and Geriatrics jo ur n al ho mep ag e: www .elsevier .c om /lo cate/ar c hg er 0167-4943/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.archger.2012.10.005