Grip Strength and Frailty Among Older Adults Presenting to the Emergency Department After a Fall

Frailty is a major contributor to falls and adverse outcomes among older adults presenting to the emergency department (ED). The Clinical Frailty Scale (CFS) is widely used but includes subjective assessment. Grip strength is an objective measure of muscle strength and sarcopenia and may serve as a practical screening tool in the ED. The aim of our study was to evaluate the association between grip strength and clinical frailty in older ED patients presenting after a fall.

This was a secondary analysis of a prospective randomized trial conducted at a Level I trauma center ED, the GREAT FALL study. We included adults aged ≥65 years presenting to the ED after a fall who had completed both CFS and grip strength assessments. Frailty was defined as CFS 4–9 (Living with Mild Frailty to Terminally Ill). Grip strength was measured using a standardized dynamometer and categorized as low or normal based on sex-specific cutoffs (<20 kg for women, <30 kg for men). Associations between grip strength and frailty were assessed using chi-square testing, with effect estimates reported as odds ratios (ORs) and 95% confidence intervals (CIs).

Of 3,913 patients screened, 687 met inclusion criteria. The mean age was 81.9 years (SD = 8.1) with 62% being female. In the low versus normal group strength there were 116 (16.9%) and 571 (83.1%) patients respectively. When comparing frailty among groups in the low versus normal grip strength 64.7% (95% CI: 61.1-68.3%) versus 57.6% (95% CI: 53.9%-61.3%) were frail (OR 1.35, 95% CI 0.89–2.04; p = 0.16), not statistically significant. However, when comparing the grip strength groups, they differed in rates of age, gender and several co-morbidities.

Among older adults presenting to the ED after a fall, low grip strength was not associated with clinical frailty using the Clinical Frailty Score. While grip strength is an objective and feasible measure in the ED, it may not useful in isolation to identify frailty and may be best utilized as an adjunct to comprehensive frailty assessment.