A clinically relevant criterion for grip strength: relationship with falling in a sample of older adults.Abstract Objective: To develop a clinically relevant criterion for assessment of grip strength Grip strength is the force applied by the hand to pull on or suspend from objects. Optimum-sized objects permit the hand to wrap around a cylindrical shape with a diameter from one to three inches. in older adults. Design: Longitudinal cohort study A cohort study is a form of longitudinal study used in medicine and social science. It is one type of study design. In medicine, it is usually undertaken to obtain evidence to try to refute the existence of a suspected association between cause and disease; failure to refute . Subjects: 1251 persons aged [greater than or equal to] 70 years who had grip strength measured as part of the Australian Longitudinal Study longitudinal study a chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study. of Ageing (1992) and survived to a second interview 12 months later. Setting: Randomly selected sample of community-dwelling older adults residing in the Adelaide (South Australia South Australia, state (1991 pop. 1,236,623), 380,070 sq mi (984,381 sq km), S central Australia. It is bounded on the S by the Indian Ocean. Kangaroo Island and many smaller islands off the south coast are included in the state. ) Statistical Division as defined by the Australian Bureau of Statistics The Australian Bureau of Statistics (ABS) is the Australian government agency that collects and publishes statistical information about Australia and its people. Population and Housing The agency undertakes the Australian Census of Population and Housing. . Main outcome measures: Participants were asked if they had any falls in the previous 12 months and the same question was repeated in the second interview. Statistical analyses: Logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analyses were performed with faller status at 12 months as the dependent variable, grip strength [greater than or equal to] 25th percentile percentile, n the number in a frequency distribution below which a certain percentage of fees will fall. E.g., the ninetieth percentile is the number that divides the distribution of fees into the lower 90% and the upper 10%, or that fee level as the reference category and controlling for age, gender, fuller status, BMI BMI body mass index. BMI abbr. body mass index Body mass index (BMI) A measurement that has replaced weight as the preferred determinant of obesity. , exercise status and chronic disease. Results: For both genders the percentage fullers was highest for those with grip strength < 25th percentile (< 28kg males, < 15.5kg females). After controlling for potential confounders, grip strength < 25th percentile independently predicted falls 12 months later (OR = 1.41, 95% CI=1.03-1.94, P = 0.034). Conclusion: In previous studies grip strength has been shown to be positively correlated with measures of nutritional health and in this study we have shown that it is an important determinant of future falls. This knowledge could be used to help prevent falls in the elderly, in the future. Further research is warranted to determine whether nutritional support nutritional support, n the supply of foods and liquids necessary to advance healing and support health. interventions can (1) improve or maintain grip strength among older adults and (2) aid in the prevention of subsequent accidental fails. Key words: accidental falls, grip strength, nutrition, elderly ********** Background Studies have shown that approximately 30% of community-dwelling people over the age of 65 years have a fall each year (1-4) and that this incidence increases to as high as 50% in those over 80 years (5). Despite the overwhelming evidence that under-nutrition is very prevalent in frail older adults who fall and break a hip (6-9) screening and interpretation of nutritional health in this vulnerable patient group has been neglected. Furthermore, decreased muscle mass, weakness and gait abnormalities are associated with under-nutrition and impaired coordination, and hence a tendency to fall is compounded by being undernourished (10). One of the issues perhaps responsible for this omission is the perceived difficulty of assessing nutritional health. It is well known that assessment of nutritional health requires a combination of indices, most of which are either expensive, require training or simply have not been shown to be clinically relevant. There is now evidence to suggest that grip strength is positively correlated with measures of nutritional health including body mass index (11), mid-upper arm circumference (11), arm muscle area (11) and lean body mass (12). Grip strength is an ideal measurement because of this relationship and also because it is inexpensive, has been shown to be reliable (13) and is easy to perform. The major limitation however in using grip strength in nutritional assessment nutritional assessment Oncology The profiling of a Pt's current nutritional status and risk of malnutrition and cancer cachexia. See Cachexia, Malnutrition. is that there is currently no agreement on clinically relevant reference values ref·er·ence values pl.n. A set of laboratory test values obtained from an individual or from a group in a defined state of health. . The clinical relevance of grip strength has mainly been studied with elderly people from affluent societies and outcome variables investigated have included morbidity (13), mortality (22) and functional ability (23,24). Each of these studies has shown that low grip strength is predictive of poor outcome. However defining what constitutes a low grip strength has largely been ignored. The aim of this study was to establish gender-specific, clinically relevant reference values for grip strength that predict falls in older adults. Methods Study population The study population was a subset of a larger sample (n = 2087) of older Australians randomly selected to participate in a longitudinal study of ageing, Australian Longitudinal Study of Aging (ALSA ALSA Advanced Linux Sound Architecture ALSA Amyotrophic Lateral Sclerosis Association ALSA Australian Law Students' Association ALSA Alberta Land Surveyors Association ALSA Alpaca and Llama Show Association ALSA Air Land Sea Application Center ) in 1992. Details of the ALSA study are reported elsewhere (14). The sample of 1251 participants referred to in the present study were community dwelling, 70 years or older on the date of entry to the study, participated in an interview and clinical assessment at baseline, and survived to participate in a second interview 12 months later. All 1251 participants were interviewed in their own homes and underwent a clinical assessment by trained observers. Ethical approval was obtained from the Clinical Investigation Committee of Flinders Medical Centre Flinders Medical Centre is a 500 bed public teaching hospital and medical school, co-located with Flinders University and Flinders Private Hospital located at Bedford Park, South Australia. It opened in 1976. , Adelaide, South Australia. Written informed consent was obtained from each participant. Study variables For the purpose of this study, variables collected in the interview and clinical assessment were chosen for further analysis it there was some literature available supporting their association with grip strength in older adults. The variables chosen included socio-demographic and lifestyle characteristics, the presence of chronic disease and falls history. Socio-demographic and lifestyle characteristics included age (70-74; 75-79; 80-84; 85+ years), gender, body mass index (BMI: weight (kg)/height ([m.sup.2]); < 22, 22-26, >26-30, >30), self-rated health (very good excellent; good; fair-poor) and exercise status (self-reported engagement in exercise for recreation, sport or health fitness purposes or sedentary sedentary /sed·en·tary/ (sed´en-tar?e) 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. sedentary of inactive habits; pertaining to a fat, castrated or confined animal. )(15). Grip strength [to the nearest 0.5 kg using a hand-held dynamometer dynamometer /dy·na·mom·e·ter/ (di?nah-mom´e-ter) an instrument for measuring the force of muscular contraction. dy·na·mom·e·ter n. An instrument for measuring the degree of muscular power. (Smedlay's Dynamo Meter, TTM TTM Trailing 12 months. Often used with Earnings Per Share. , Tokyo, Japan) in the dominant hand] was measured. Percentage of fallers at each grip strength reading was calculated and this suggested a non-linear relationship with faller status. Grip strength was subsequently categorised into gender-specific tertiles, quartiles, quintiles Quintiles Transnational Corp. is a contract research organization which serves the pharmaceutical, biotechnology and healthcare industries. History Quintiles was founded in 1982 by Dennis Gillings and as of 2007 it has 18,000 employees. , and deciles and ROC analysis ROC analysis Clinical decision-making The analysis of the relationship between the true positive fraction of test results and the false positive fraction for a diagnostic procedure that can take on multiple values. See 4-cell decision matrix. Cf Likelihood ratio. performed to determine the most suitable classification with respect to sensitivity and specificity. The best categorisation corresponded to the quartiles, and further examination showed the greatest discrimination was at the 25th percentile for both males and females. A dichotomised grip strength value was therefore used for subsequent analyses (< 25th percentile and [greater than or equal to] 25th percentile). The presence of chronic disease was assessed via self-report and included the ten most prevalent morbid conditions (any cancer, arthritis, diabetes, heart attack, heart condition, hernia hernia, protrusion of an internal organ or part of an organ through the wall of a body cavity. The hernia is enclosed by a sac formed by the lining of the cavity. It results from a weakness or rupture in the wall, usually where there is already a natural weakness. , hypertension, respiratory disease Noun 1. respiratory disease - a disease affecting the respiratory system respiratory disorder, respiratory illness adult respiratory distress syndrome, ARDS, wet lung, white lung - acute lung injury characterized by coughing and rales; inflammation of the , ulcers, stroke). The number of chronic conditions present were summed to give a score between 0 and 10 for each participant. This was further categorised into: 0 conditions, 1-3 conditions and [greater than or equal to] 4 conditions. The outcome variable was the occurrence of falls in the year following the first interview. We used the definition of fall defined by the Kellogg International Work Group on the Prevention of Falls by the Elderly: 'A fall is an event which results in a person coming to rest inadvertently on the ground or other lower level and other than as a consequence of a violent blow; loss of consciousness or sudden onset of paralysis' (16). Participants were asked at each interview to recall whether they had fallen on at least one occasion in the previous 12 months. If a participant reported at least one fall in the previous 12 months and the description of at least one fall was consistent with the definition described above, participants were classified as fallers. If no falls were reported in the previous 12 months participants were classified as non-fallers. Faller status was reported at both the baseline and 12 month follow-up interview. Statistical analyses All statistical analyses were conducted using the SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. statistical package (SPSS Inc, Chicago, SPSS for Windows, Advanced Statistics, version 10.0 2000) and were carried out using weighted data. The sample weights were calculated to reflect the stratification of the sample by age group, gender and local government area, and were based on the probability of selection and adjusted for non-response. The sample weights were applied in all analyses so that the results could be generalised Adj. 1. generalised - not biologically differentiated or adapted to a specific function or environment; "the hedgehog is a primitive and generalized mammal" generalized biological science, biology - the science that studies living organisms to the older population resident in Adelaide at the time the study was conducted. Chi square chi square (kī), n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies. tests of association for categorical variables and independent samples t-tests for continuous variables were used to test for differences between fallers and non-fallers. Multiple logistic regression was used to examine the effect of low grip strength on subsequent falls (dependent variable), adjusting for the socio-demographic, lifestyle and morbidity characteristics of the participants already described. Odds ratios (ORs) and 95% confidence intervals (CI) are reported and statistical significance was set at P < 0.05 throughout. Results The mean age (SD) of the 1251 participants at entry into the study was 76.1 [+ or -] 5.0 years, and 44% were female. At the time of the first interview, 346 (28%) of the sample reported that they had fallen at least once in the previous 12 months. Over the 12 months of follow-up, 280 (22%) of the 1251 participants reported that they had experienced at least one fall. Differences in study variables between fallers and non-fallers at baseline are shown in Table 1. The results show fallers were older, more likely to be female, and more likely to be sedentary in comparison to non-fallers. At baseline, fallers had more chronic conditions than non-fallers. There was no difference in BMI identified between fallers and non-fallers at baseline. The mean grip strength was 32.4 ([+ or -] 7.0) kg and 19.0 ([+ or -] 5.3) kg for males and females respectively. Grip strength was subsequently classified based on quartiles for the two genders. As shown in Figure 1, the percentage of fallers at 12 months follow-up was markedly higher for participants in the lowest quartile Quartile A statistical term describing a division of observations into four defined intervals based upon the values of the data and how they compare to the entire set of observations. Notes: Each quartile contains 25% of the total observations. of grip strength (< 28 kg males, < 15.5 kg females; P < 0.001). [FIGURE 1 OMITTED] Table 2 shows the results of the final multiple logistic regression model using faller status at the second interview as the dependent variable. The results show that after controlling for variables including age, gender, exercise, chronic conditions, BMI and previous faller status, a grip strength below the 25th percentile for both males and females predicts faller status after one year of follow-up. The Nagelkerke [R.sup.2] values were 6.8% excluding grip strength and 7.3% including grip strength in the model. The odds ratio and 95% confidence interval associated with grip strength changed negligibly when BMI, chronic conditions and exercise status were excluded. Discussion We measured the prevalence of falls among older community-living adults and found that the prevalence was markedly higher for those with low grip strength. We also found that low grip strength has potential as a clinical indicator clinical indicator Patient care An objective measure of the clinical management and outcome of Pt care of falls risk, as in our sample we were able to show that even after accounting for potential confounders, low grip strength independently predicted falls 12 months later. The significance of the potential confounders may be expected but what is new is that even after adjusting for these, nutrition (as measured by grip strength) remains strongly predictive of falls. Hand-grip dynamometry dy·na·mom·e·ter n. Any of several instruments used to measure mechanical power. [French dynamomètre : Greek dunamis, power; see dynamic + -mètre, -meter. is a measure of muscle function. This protein content and the evidence that suggests hand-grip strength is positively associated with nutritional status nutritional status, n the assessment of the state of nourishment of a patient or subject. is increasing both in developed (17) and developing countries (11). There is also evidence to suggest that poor nutritional health (both overweight and underweight Underweight An situation where a portfolio does not hold a sufficient amount of securities to satisfy the accepted benchmark of the portfolio's asset allocation strategy. Notes: ) has implications in terms of falls risk (18-20). Several assessment techniques are used in the diagnosis of poor nutritional health, however none of these alone are considered adequate. In contrast, nutrition screening tools which are commonly used to identify those patients who are more likely to be 'at risk' often refer to a single variable. An example of this is the World Health Organization recommendation that mid-upper arm circumference is a useful tool to identify those older adults who might benefit from nutrition intervention (21). The measurement of grip strength is rapid, reproducible, does not require extensive training and is inexpensive. These are all important considerations when making decisions about which nutrition screening tool or nutritional assessment techniques should be used. When these measures are shown to have clinical relevance, this makes the measurement significantly more robust. The clinical relevance of grip strength has largely been studied with elderly people from affluent societies and outcome variables investigated have included morbidity (13), mortality (22) and functional ability (23,24). Each of these studies has shown that low grip strength is predictive of poor outcome. More relevant to our study are the results published in 1989 by Wickham et al. (25) which reported on grip strength and risk of falls in elderly people. The authors of this study reported on results obtained from a national survey in Britain in which 983 elderly people were asked about their falls history. These data were analysed by multiple logistic regression, after controlling for mobility, non-phenothiazine tranquillisers, number of cohabitants, recent weight loss and physical disability. The authors concluded that those who had fallen one or more times had reduced grip strength. Our study has confirmed these results in an Australian sample of older adults and further has been able to look at the predictive relationship of low grip strength and fails in a longitudinal analysis. The results of this study must be interpreted with caution if the intention is to apply the results to other populations. The study protocol was extensive and this may have favoured refusal to participate and loss to follow up among members of the study population who were in particularly poor health. The use of grip strength as a nutritional marker has also been questioned with some research suggesting that perhaps grip strength is more an indicator of general debility debility /de·bil·i·ty/ (de-bil´i-te) asthenia. de·bil·i·ty n. The state of being weak or feeble; infirmity. or frailty frailty Vox populi A state of delicacy or weakness which, which encompasses age-related fragility, in particular osteoporosis. See FICSIT, Osteoporosis. (26-27). In this study we found that grip strength was an independent predictor of falling, even after controlling for the presence of chronic diseases. In principle, analysis after stratification according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. levels of BMI might enable overt exploration of possible interactions of BMI, grip strength and falling. We did consider interactions between BMI and grip strength and found no evidence for an interaction between the two variables. The relationship of grip strength and nutritional health is becoming increasingly recognised although remains underutilised as a nutritional assessment tool, perhaps due to some literature suggesting it is merely a measure of frailty. Although analysis of the relationship between grip strength and nutritional health was beyond the scope of this study, we suggest that low grip strength is an important risk factor for falls among older adults and have provided clinically relevant reference values for use in clinical practice. Further research is warranted to determine whether nutritional support interventions can improve or maintain grip strength among older adults and aid in the prevention of subsequent accidental falls. Furthermore it would be interesting to determine whether grip strength can predict alternative clinical outcomes such as mobility and hospital admissions.
Table 1. Baseline data for the 1251 participants (680 males)
of the Australian Longitudinal Study of Ageing by faller status
Non-
fallers Fallers
Participant characteristics (n = 905) (n = 346)
Age (years)
Mean [+ or -] SD 75.8 [+ or -] 4.9 77.0 [+ or -] 5.3
Gender (%)
Female 55 68
Chronic conditions (%)
0 21 14
1-3 71 80
[greater than or equal to] 4 8 6
Self-rated health (%)
Very good - Excellent 43 35
Good 32 30
Fair-Poor 25 35
Exercise status (%)
Sedentary 32 42
BMI (kg/[m.sup.2])
Mean [+ or -] SD 26.0 [+ or -] 4.0 26.2 [+ or -] 4.0
< 22 (%) 16 12
22-26 (%) 35 39
> 26-30 (%) 34 31
> 30 (%) 15 18
Grip strength (kg)
Mean [+ or -] SD 26.3 [+ or -] 8.8 23.2 [+ or -] 8.5
p (a)
Participant characteristics
Age (years)
Mean [+ or -] SD < 0.001
Gender (%)
Female < 0.001
Chronic conditions (%)
0
1-3
[greater than or equal to] 4 0.010
Self-rated health (%)
Very good - Excellent
Good
Fair-Poor 0.002
Exercise status (%)
Sedentary 0.002
BMI (kg/[m.sup.2])
Mean [+ or -] SD 0.457
< 22 (%)
22-26 (%)
> 26-30 (%)
> 30 (%) 0.081
Grip strength (kg)
Mean [+ or -] SD < 0.001
(a) Chi square tests of association for categorical variables and
independent samples t-tests for continuous variables were used to
test differences between fallers and non-fallers.
Table 2. Multivariate logistic regression model (OR, 95%
CI) using faller status at one year follow-up as the
dependent variable for 1251 participants of the
Australian Longitudinal Study of Ageing
Study Variables OR 95% CI P
Age category (years)
70-74 1.00
75-79 1.21 0.87-1.68
80-84 1.32 0.89-1.96
85+ 2.43 1.47-4.00 0.007
Gender
Male 1.00
Female 1.55 1.16-2.09 0.003
Faller status at
baseline
Non-faller 1.00
Faller 1.78 1.32-2.38 < 0.001
BMI (kg/[m.sup.2])
22-26 1.00
< 22 1.14 0.75-1.75
> 26-30 1.11 0.79-1.56
> 30 1.41 0.94-2.13 0.437
No. chronic conditions
0 1.00
1-3 1.07 0.74-1.55
[greater than or equal to] 4 0.88 0.47-1.64 0.746
Exercise status
Regular exercise 1.00
Sedentary 1.14 0.85-1.53 0.370
Grip strength (kg) (a)
[greater than or equal to] 25th 1.00
percentile
< 25th percentile 1.41 1.03-1.94 0.034
(a) [greater than or equal to] 25th percentile:
[greater than or equal to] 28 kg males,
[greater than or equal to] 15.5 kg females.
Acknowledgments The data for this study were obtained from the Australian Longitudinal Study of Ageing data set held by the Centre for Ageing Studies, Flinders University The university has established a reputation as a leading research institution with a devotion to innovation. It is a member of Innovative Research Universities Australia and ranks among the leading universities in Australia. of South Australia. This study was supported in part by the South Australian Health Commission, the Australian Rotary Health Research Fund and by a grant from the US National Institute of Health, Grant No. AG 08523-02). References (1.) Prudham D, Evans JG. Factors associated with falls in the elderly: a community study. Age Ageing 1981;10:141-6. (2.) Campbell AJ, Reinken J, Allan BC, Martinez GS. Falls in old age: a study of frequency and related clinical factors. Age Ageing 1981;10:264-70. (3.) Perry BC. Falls among the elderly: a review of the methods and conclusions of epidemiologic studies. Journal of the Am Geriatr Soc 1982;30:367-71. (4.) Tinetti M, Speechly M, Ginter S. Risk factors for falls among elderly persons living in the community. N Eng J Med 1988;319:1701. (5.)Vellas B, Albarede J, Garry P. Diseases and aging: patterns of morbidity with age: relationship between aging and age-associated diseases. Am J Clin Nutr 1992;55:1225S-30S. (6.) Bastow M, Rawlings J, Allison S. Undernutrition Undernutrition A type of malnutrition caused by inadequate food intake or the body's inability to make use of needed nutrients. Mentioned in: Appetite-Enhancing Drugs undernutrition see malnutrition, starvation. , hypothermia hypothermia Abnormally low body temperature, with slowing of physiological activity. It is artificially induced (usually with ice baths) for certain surgical procedures and cancer treatments. , and injury in elderly women with fractured femur femur (fē`mər): see leg. , an injury response to altered metabolism. Lancet 1983;ii:143-6 (7.) Panerson B, Cornell CN, Carbone B, Levine B, Chapman D. Protein depletion and metabolic stress in elderly patients who have a fracture of the hip. J Bone Joint Surg 1992;2:251-60. (8.) McWhirter J, Pennington C. Incidence and recognition of malnutrition in hospital. Br Med J 1994;308:5-8. (9.) Miller M, Crotty M, Whitehead C, Daniels L, Finucane P. Nutritional assessment and osteoporosis treatment of patients with a femoral femoral /fem·o·ral/ (fem´or-al) pertaining to the femur or to the thigh. fem·o·ral adj. Of or relating to the femur or thigh. neck fracture: a chronicle of missed opportunities. Aust J Nutr Diet 2001;58:86-91. (10.) Vellas B, Conceicao J, Lafont CH, Fontan B, Garry PJ, Adoue D, et al. Malnutrition and falls. Lancet 1990;336:1447. (11.) Chilima D, Ismail S. Nutrition and handgrip strength of older adults in rural Malawi. Public Health Nutr 2001;4:11-7. (12.) Heimburger O, Qureshi AR, Blaner WS, Berglund L, Stenvinkel P. Hand-grip muscle strength, lean body mass and plasma proteins as markers of nutritional status in patients with chronic renal failure chronic renal failure Chronic kidney failure Nephrology A slow decline in renal function, which may be 2º to chronic HTN, DM, CHF, SLE, or sickle cell anemia and, if extreme, leads to ESRD, mandating kidney dialysis; an abrupt decline in renal function may be close to start of dialysis therapy. Am J Kid Dis 2000;36:1213-25. (13.) Klidjian AM, Foster KJ, Kammerling RM, Cooper A, Karran SJ. Relation of anthropometric an·thro·pom·e·try n. The study of human body measurement for use in anthropological classification and comparison. an and dynamometric dy·na·mom·e·ter n. Any of several instruments used to measure mechanical power. [French dynamomètre : Greek dunamis, power; see dynamic + -mètre, -meter. variables to serious post-operative complications. Br Med J 1980;281:899-901. (14.) Andrews G, Cheok F, Carr S. The Australian Longitudinal Study of Ageing. Aust J Ageing 1989;8:31-5. (15.) Finucane P, Giles LC, Withers withers the region over the backline where the neck joins the thorax and where the dorsal margins of the scapulae lie just below the skin. fistulous withers see fistulous withers. RT, Silagy CA, Sedgwick A, Hamdorf PA, et al. Exercise profile and subsequent mortality in an elderly Australian population. Aust NZ J Public Health 1997;21:155-8. (16.) Kellogg International Work Group. The prevention of falls in later life. A report of the Kellogg International Work Group on the prevention of falls in the elderly. Danish Med Bull 1987;34:1-24. (17.) Guo CB, Zhang W, Ma DQ, Zhang KH, Huang JQ. Hand grip strength hand grip strength Neurology A measure of muscle strength, evaluated with a Jamar dynamometer, often ↓ in older folks : an indicator of nutritional state and the mix of postoperative complications postoperative complications, n.pl unexpected problems that arise following surgery. The most frequent are bleeding, infection, and protracted pain. in patients with oral and maxillofacial maxillofacial /max·il·lo·fa·cial/ (-fa´sh'l) pertaining to the maxilla and the face. max·il·lo·fa·cial adj. Relating to or involving the maxilla and the face. cancers. Br J Oral and Maxillofac Surg 1996;34:325-7. (18.) Wardlaw GM. Putting body weight and osteoporosis into perspective. Am J Clin Nutr 1996;63:433S-6S. (19.) Vellas B, Baumgartner RN, Wayne SJ, Conceicao J, Lafont C, Albarede JL, et al. Relationship between malnutrition and falls in the elderly. Nutr 1992;8:105-8. (20.) Stolz D, Miller M, Bannerman E, Whitehead C, Crotty M, Daniels L. Nutrition screening and assessment of patients attending a multidisciplinary falls clinic. Nutr Diet 2002;59:234-9. (21.) World Health Organization. Physical Status: The use and interpretation of anthropometry anthropometry (ănthrəpŏm`ətrē), technique of measuring the human body in terms of dimensions, proportions, and ratios such as those provided by the cephalic index. . Report of a WHO Expert Committee Report 854. Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. : WHO; 1994. (22.) Phillips P, Grip strength, mental performance and nutritional status as indicators of mortality risk among female geriatric patients. Age Ageing 1986;15:53-6. (23.) Hyatt R, Whitelaw MN, Bhat A, Scott S, Maxwell JD. Association of muscle strength with functional status in elderly people. Age Ageing 1990;19:330-6. (24.) Hughes S, Gibbs J, Dunlop D, Edelman P, Singer R, Chang RW. Predictors of decline in manual performance in older adults. J Am Geriatr Soc 1997;45:905-10. (25.) Wickham C, Cooper C, Margetta BM, Barker DJP DJP DJ Premier DJP Department of Justice and Police DJP D'Jungle People Sdn Bhd DJP Doctor of Jurisprudence DJP Desk Jet Printer DJP Digital Jet Printer . Muscle strength, activity, housing and the risk of falls in elderly people. Age Ageing 1989;18:47-51. (26.) Whitehead C, Giles LC, Andrews GR, Finucane P. Anthropometric and laboratory markers of nutritional status in a large sample of elderly Australians: The ALSA study. Aust J Ageing 2000;19:85-90. (27.) Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype phenotype (fē`nətīp'): see genetics. phenotype All the observable characteristics of an organism, such as shape, size, colour, and behaviour, that result from the interaction of its genotype (total genetic makeup) with . J Gerontol Series A--Biol Sci and Med Sci 2001;56:146-56. Flinders University Department of Rehabilitation rehabilitation: see physical therapy. and Aged Care, Adelaide, South Australia M. Miller, BSc, MNutrDiet, PhD Candidate M. Crotty, BMed, PhD, FAFRM, Professor and Head Faculty of Health Studies, Auckland University of Technology Not to be confused with the University of Auckland. The Auckland University of Technology (AUT) (Māori: Te Wananga Aronui o Tāmaki Makau Rau) is the newest university in New Zealand. L. Giles, MPH, Biostatistician Research Centre for Injury Studies, Flinders University, Adelaide, South Australia J. Harrison, MBBS MBBS, MBChB n abbr (BRIT) (= Bachelor of Medicine and Surgery) → título universitario MBBS, MBChB n abbr (Brit) (= Bachelor of Medicine and Surgery) → , MPH, FAFPHM, Director Flinders University Centre for Ageing Studies, Adelaide, South Australia G. Andrews, MBBS, FRCP FRCP Fellow of the Royal College of Physicians. FRCP abbr. Fellow of the Royal College of Physicians , FRACP FRACP Fellow of the Royal Australasian College of Physicians , FFRM FFRM Federation of Farmers of Republic of Macedonia FFRM Friendship Force of the Rocky Mountains (Estes Park, Colorado) , FRACMA FRACMA Fellow, Royal Australian College of Medical Administrators , Director Correspondence: M. Miller, Flinders University Department of Rehabilitation and Aged Care, Repatriation Repatriation The process of converting a foreign currency into the currency of one's own country. Notes: If you are American, converting British Pounds back to U.S. dollars is an example of repatriation. General Hospital, Daws Road, Daw Park SA 5041. Email: michelle.miller@rgh.sa.gov.au |
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