​Pay attention if you notice an elderly relative's hand getting weaker. A local study has shown that a weak handgrip in the old is a cause for concern.

The study – the first of its kind in Singapore – spanned four years and was carried out by a team from Duke-NUS Graduate Medical School, SingHealth Polyclinics and Japan's Nihon University. They wanted to see if handgrip strength, measured at a single point in time, was associated with a risk of dying within that four-year period.

They took handgrip strength measurements (a marker for muscle strength, nutritional status and overall health) of 4,131 people aged 60 and above in 2009. In the five-minute test, participants had to grip and squeeze two bars on a dynamometer while standing. Other factors like chronic diseases, depression and cognition were taken into account when compiling results. Four years later, in 2013, they matched these measurements against data from Singapore's Registry of Births and Deaths, and found that 9.1 per cent of the participants had died.

The data showed when an old person's handgrip was weaker by 5kg compared to another old person with a similar health status and socio-demographics, the one with the weaker handgrip had a 33 per cent higher chance of dying within four years, said Assistant Professor Rahul Malhotra, Programme in Health Services and Systems Research, Duke-NUS, who led the team. But he clarified that a weak handgrip in itself was not the cause of death.

The findings were similar to those in Western studies, but one drawback here was that Western reference values for handgrip strength were not applicable to Singaporeans because of anatomical and other differences. The team is now compiling Singapore-specific reference values derived from a study of 3,000 healthy elderly people, as this will help doctors to better assess local patients.

Handgrip strength tests are not widely used in Singapore, but some doctors use it on elderly patients with cancer and in the preoperative phase. Prof Malhotra said it is too early for clinical use now, as more clarity is needed, but he is confident that it will be used in the near future.

Meanwhile, it is never too late to improve health. Dr Tan Ngiap Chuan, Senior Consultant and Director of Research, SingHealth Polyclinics and a member of the research team, said the elderly can delay frailty and sarcopenia (the loss of muscle mass with age) by maintaining a healthy lifestyle with proper diet and exercise. It is a mistaken notion that a weak handgrip – and hence mortality – can be improved with forearm exercises. A weak handgrip must be viewed and managed in the context of the overall health assessment of a patient.

Dr Tan advises the elderly to increase their daily physical activities to their best capabilities, with supervision from caregivers and periodical reviews by their family doctors.

Ref. Q15