Handgrip strength as a health screening tool Dr Kinda Ibrahim, - PowerPoint PPT Presentation

Handgrip strength as a health screening tool Dr Kinda Ibrahim, Research Fellow in Geriatric Medicine. K.Ibrahim@soton.ac.uk

Background • Nearly two thirds of people admitted to hospital in the UK are aged over 65 years old. • It is estimated that 25-40 % of hospitalised older patients are frail and up to 25% have sarcopenia ( Loss of skeletal muscle mass and function associated with increasing age). • Grip strength is a marker of frailty (Fried Frailty Score) and sarcopenia (the EWGSOP) Collaboration for Leadership in Applied Health Research and Care (Wessex)

Increased morbidities such as coronary heart disease and stroke Increased all-cause Increased falls mortality Increased risk of osteoporosis and fracture Reduced health related QoL Low GS Risk of malnutrition Longer LOS Higher hospitalization costs Grip strength is a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure. Collaboration for Leadership in Applied Health Research and Care (Wessex)

Collaboration for Leadership in Applied Health Research and Care (Wessex)

Management of low Grip Strength  Exercise - progressive resistance training.  Dietary supplementation: higher protein intake, oral nutritional supplementation (ONS) + Vitamin D. Collaboration for Leadership in Applied Health Research and Care (Wessex)

Aim of the study The aim was to assess the feasibility and acceptability of routine measurement of grip strength among older inpatients admitted to Medicine for Older People (MOP) wards. • This was a mixed method study • It was conducted in five MOP wards at Southampton General Hospital. • Patients aged 80 years and over. Implementation Training Collaboration for Leadership in Applied Health Research and Care (Wessex)

Educational Practical leaflet demonstration Competency Feedback check Collaboration for Leadership in Applied Health Research and Care (Wessex)

 155 staff were trained • First block of training occurred in 3 weeks period. (n=98) Collaboration for Leadership in Applied Health Research and Care (Wessex)

Maximum grip strength is <27 kg for men or <16 kg for women Report at handover Follow the ONS Refer the patient to and use the grip care pathway physiotherapy strength magnet

Implementation strategies • Study Steering Group/ Grip strength ward champion. • Regular timely audit and feedback to ward staff and managers about coverage. • Regular formal and informal meetings with ward managers • MOP monthly newsletter/the employee of the month • Include the grip strength test in the routine admission documentation and handover list. Collaboration for Leadership in Applied Health Research and Care (Wessex)

• Review of patients’ nursing and medical notes at regular intervals (weekly / or every other week) • All patients on the ward were eligible with the exception of palliative patients (end of life) or those who had been on the ward for less than 3 days. The mean weekly coverage of grip strength measurement varied across the wards and ranged between 25% and 80% Collaboration for Leadership in Applied Health Research and Care (Wessex)

Weekly coverage of grip strength measurment 120% 100% 80% 60% 40% 20% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ward 1 ward 2 ward 3 ward 4 ward 5 Monthly coverage of grip strength measurment 100% 80% 60% 40% 20% 0% february march april may june july august september october ward 1 ward 2 ward 3 ward 4 ward 5 Collaboration for Leadership in Applied Health Research and Care (Wessex)

811 patients had grip strength care plan completed and filed 655 (81%) performed the grip test 156 (19%) were unable to do the test (severe dementia, confused, patient refused, aggressive patients, patients unable to follow instructions, severe arthritis, and patients who did not speak English). Among those who had performed the test: • 81% of female patients had low grip strength (<16 kg), Median=11kg • 75% of male patients had low grip strength (<27 kg), Median= 20kg Collaboration for Leadership in Applied Health Research and Care (Wessex)

Facilitators and barriers of implementation With 8 patients and 15 healthcare staff across the study wards including: 7 nurses, 4 therapy staff, 2 dieticians, 2 consultants Facilitators Barriers • Buy-in and support. • Lack of buy-in and support. • Keen and highly motivated ward • Less keen and enthusiastic champions. champions • Shared commitment by staff • Lack of shared commitment and members. support from other staff members. • Understanding the rationale of the • Inability to see the end results test • High staff turnover. • Engagement strategies. • Lack of perceived responsibility • Simplicity of the test • Self-monitoring of implementation

Acceptability of implementation Well providing it provides long term information to help find out how strong people are normally and if they can manage on their own then it seems a good idea. (P8, M, GS=20) I think it’s an interesting screening tool. It’s a really simple easy thing to do. So if we were to show that was a really good marker of frailty which is the thing about, it would be a really cheap simple thing to do (yeah) which would be fantastic. (consultant 1)

Costs of implementation The total cost of 5 dynamometers and training 155 staff across 5 wards over 1 year = £2,257 The implementation provisional costs per patient (Mean = £5.80). Collaboration for Leadership in Applied Health Research and Care (Wessex)

Conclusions • It was feasible, cheap and acceptable to train a large number of staff and to routinely measuring grip strength of older patients on admission. • A high percentage of patients were found to be frail and at high risk of poor healthcare outcomes and sarcopenia. • Staff across MOP have recognised the urgent need to offer high-protein oral nutritional supplements and encourage mobility and exercises to their patients. • We have decided that routine use of grip strength among this group of patients (over 80 years old) is not necessary. Instead, routine use of fortisips compact and exercises will be adopted. • Grip strength measurement could be used in younger populations (65 years and above) or with specific patients such as those with fragility fractures. Collaboration for Leadership in Applied Health Research and Care (Wessex)

Collaboration for Leadership in Applied Health Research and Care (Wessex)

Acknowledgment • All staff and ward managers across MOP for their hard work and support of the study. • MOP departmental education team. • All patients and staff participants who took part in the interviews/focus groups. • Rosanna Orlando and Tom Monks Collaboration for Leadership in Applied Health Research and Care (Wessex)