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

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

• 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)

Background

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

Low GS Increased morbidities such as coronary heart disease and stroke Increased falls Increased risk

• f osteoporosis

and fracture Longer LOS Higher hospitalization costs Risk of malnutrition Reduced health related QoL Increased all-cause mortality

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) 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.

Aim of the study

• This was a mixed method study
• It was conducted in five MOP wards at

Southampton General Hospital.

• Patients aged 80 years and over.

Training Implementation

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

Educational leaflet Practical demonstration Competency check Feedback

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)

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

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

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
• ther 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)

0% 20% 40% 60% 80% 100% 120% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Weekly coverage of grip strength measurment

ward 1 ward 2 ward 3 ward 4 ward 5 0% 20% 40% 60% 80% 100% february march april may june july august september

• ctober

Monthly coverage of grip strength measurment

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

Facilitators and barriers of implementation

Facilitators

• Buy-in and support.
• Keen and highly motivated ward

champions.

• Shared commitment by staff

members.

• Understanding the rationale of the

test

• Engagement strategies.
• Simplicity of the test
• Self-monitoring of implementation

Barriers

• Lack of buy-in and support.
• Less keen and enthusiastic

champions

• Lack of shared commitment and

support from other staff members.

• Inability to see the end results
• High staff turnover.
• Lack of perceived responsibility

With 8 patients and 15 healthcare staff across the study wards including: 7 nurses, 4 therapy staff, 2 dieticians, 2 consultants

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)

Acceptability of implementation

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)

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

Costs of implementation

The total cost of 5 dynamometers and training 155 staff across 5 wards

• ver 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