%0 Journal Article %J Experimental Gerontology %D 2021 %T Muscle weakness is a prognostic indicator of disability and chronic disease multimorbidity. %A Mark D Peterson %A Casten, Kimberly %A Collins, Stacey %A Hassan, Halimah %A García-Hermoso, Antonio %A Jessica Faul %K Aging %K Chronic disease %K Dementia %K Disability %K Grip strength %K weakness %X

BACKGROUND: The objective of this study was to use nationally-representative data on Americans greater than 50 years of age to determine the association between grip strength and inflammation as independent predictors of incident disability, chronic multimorbidity and dementia.

METHODS: Middle age and older adults (n = 12,618) from the 2006-2008 waves of the Health and Retirement Study with 8-years of follow-up were included. Longitudinal modeling was performed to examine the association between baseline grip strength (normalized to body mass: NGS) and high sensitivity C-reactive protein (hs-CRP) (≥3.0 mg/L) with incident physical disabilities (i.e., ≥2 limitations to activities of daily living), chronic multimorbidity (≥2 of chronic conditions), and dementia.

RESULTS: The odds of incident disability were 1.25 (95% CI: 1.20-1.30) and 1.31 (95% CI: 1.26-1.36) for men and women respectively, for each 0.05-unit lower NGS. The odds of incident chronic multimorbidity were 1.14 (95% CI: 1.08-1.20) and 1.14 (95% CI: 1.07-1.21) for men and women respectively for each 0.05-unit lower NGS. The odds of incident dementia were 1.10 for men (95% CI: 1.02-1.20) for each 0.05-unit lower NGS, but there was no significant association for women. Elevated hs-CRP was only associated with chronic multimorbidity among men (OR = 1.29; 95% CI: 1.00-1.73) and women (OR = 1.60; 95% CI: 1.26-2.02).

CONCLUSIONS: Our findings indicate a robust inverse association between NGS and disability and chronic, multimorbidity in older men and women, and dementia in men. Elevated hs-CRP was only associated with chronic multimorbidity in men and women. Healthcare providers should implement measures of grip strength in routine health assessments and discuss the potential dangers of weakness as well as interventions to improve strength with their patients.

%B Experimental Gerontology %V 152 %P 111462 %G eng %R 10.1016/j.exger.2021.111462 %0 Journal Article %J The Journal of Nutrition, Health & Aging %D 2019 %T The burden of functional disabilities for middle-aged and older adults in the United States %A Ryan P McGrath %A Soham Al Snih %A Kyriakos S Markides %A Kyle J Hackney %A Bailey, R. %A Mark D Peterson %K Activities of Daily Living %K Disabilities %K IADLS %X Understanding the role of functional capacity on longevity is important as the population in the United States ages. The purpose of this study was to determine the burden of instrumental activities of daily living (IADL) and activities of daily living (ADL) disabilities for a nationally-representative sample of middle-aged and older adults in the United States. %B The Journal of Nutrition, Health & Aging %V 23 %P 172-174 %G eng %N 2 %! J Nutr Health Aging %R 10.1007/s12603-018-1133-2 %0 Journal Article %J Medicine %D 2019 %T The burden of health conditions across race and ethnicity for aging Americans: Disability-adjusted life years. %A Ryan P McGrath %A Soham Al Snih %A Kyriakos S Markides %A Jessica Faul %A Brenda Vincent %A Orman T Hall %A Mark D Peterson %K Disability %K health conditions %K race %X

Despite evidence suggesting race and ethnicity are important factors in responses to environmental exposures, drug therapies, and disease risk, few studies focus on the health needs of racially- and ethnically-diverse aging adults.The objective of this study was to determine the burden of 10 health conditions across race and ethnicity for a nationally-representative sample of aging Americans.Data from the 1998 to 2014 waves of the Health and Retirement Study, an ongoing longitudinal-panel study, were analyzed.Those aged over 50 years who identified as Black, Hispanic, or White were included. There were 5510 Blacks, 3423 Hispanics, and 21,168 Whites in the study.At each wave, participants reported if they had cancer, chronic obstructive pulmonary disease, congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Disability-adjusted life years (DALYs) were calculated for each health condition by race and ethnicity. Ranked DALYs determined how race and ethnicity was differentially impacted by the burden of each health condition. Sample weights were utilized to make DALY estimates nationally-representative.Weighted DALY estimates (in thousands) ranged from 1405 to 55,631 for Blacks, 931 to 28,442 for Hispanics, and 15,313 to 295,623 for Whites. Although the health conditions affected each race and ethnicity differently, hypertension had the largest number of DALYs, and hip fractures had the fewest across race and ethnicity. In total, there were an estimated 198,621, 101,462, and 1,187,725 DALYs for older Black, Hispanic, and White aging adults.Our findings indicate that race and ethnicity may be influential on health and disease for aging adults in the United States. Monitoring DALYs may help guide the flow of health-related expenditures, improve the impact of health interventions, advance inclusive health care for diverse aging adult populations, and prepare healthcare providers for serving the health needs of aging adults.

%B Medicine %V 98 %P e17964 %G eng %N 46 %R 10.1097/MD.0000000000017964 %0 Journal Article %J BMC Geriatrics %D 2019 %T The burden of health conditions for middle-aged and older adults in the United States: Disability-adjusted life years. %A Ryan P McGrath %A Soham Al Snih %A Kyriakos S Markides %A Orman T Hall %A Mark D Peterson %K Comorbidity %K Disabilities %K Longevity %X

BACKGROUND: Many adults are living longer with health conditions in the United States. Understanding the disability-adjusted life years (DALYs) for such health conditions may help to inform healthcare providers and their patients, guide health interventions, reduce healthcare costs, improve quality of life, and increase longevity for aging Americans. The purpose of this study was to determine the burden of 10 health conditions for a nationally-representative sample of adults aged 50 years and older in the United States.

METHODS: Data from the 1998-2014 waves of the Health and Retirement Study were analyzed. At each wave, participants indicated if they were diagnosed with the following 10 conditions: cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Years lived with a disability and years of life lost to premature mortality were summed for calculating DALYs. Sample weights were utilized in the analyses to make the DALY estimates nationally-representative. Results for the DALYs were presented in thousands.

RESULTS: There were 30,101 participants included. Sex stratified DALY estimates ranged from 4092 (fractured hip)-to-178,055 (hypertension) for men and 13,621 (fractured hip)-to-200,794 (hypertension) for women. The weighted overall DALYs were: 17,660 for hip fractures, 62,630 for congestive heart failure, 64,710 for myocardial infarction, 90,337 for COPD, 93,996 for stroke, 142,012 for cancer, 117,534 for diabetes, 186,586 for back pain, 333,420 for arthritis, and 378,849 for hypertension. In total, there were an estimated 1,487,734 years of healthy life lost from the 10 health conditions examined over the study period.

CONCLUSIONS: The burden of these health conditions accounted for over a million years of healthy life lost for middle-aged and older Americans over the 16 year study period. Our results should be used to inform healthcare providers and guide health interventions aiming to improve the health of middle-aged and older adults. Moreover, shifting health policy and resources to match DALY trends may help to improve quality of life during aging and longevity.

%B BMC Geriatrics %V 19 %P 100 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30961524?dopt=Abstract %R 10.1186/s12877-019-1110-6 %0 Journal Article %J Journal of the American Medical Directors Association %D 2019 %T Weakness May Have a Causal Association With Early Mortality in Older Americans: A Matched Cohort Analysis %A Ryan P McGrath %A Brenda Vincent %A Mark D Peterson %A Donald A Jurivich %A Lindsey J Dahl %A Kyle J Hackney %A Brian C Clark %K Aging %K Epidemiology %K Geriatrics %K Hand Strength %K Muscle Strength %K sarcopenia %X Objectives Quantifying the association between muscle weakness and mortality with carefully matched cohorts will help to better establish the impact of weakness on premature death. We used a matched cohort analysis in a national sample of older Americans to determine if those who were weak had a higher risk for mortality compared with control groups with incrementally higher strength capacities. Design Longitudinal panel. Setting Detailed interviews that included physical measures were conducted in person, whereas core interviews were often performed over the telephone. Participants Data from 19,729 Americans aged at least 50 years from the 2006-2014 waves of the Health and Retirement Study were analyzed. Measures A handgrip dynamometer was used to assess handgrip strength (HGS) in each participant. Men with HGS <26 kg were considered weak, ≥26 kg were considered not weak, and ≥32 kg were considered strong. Women with HGS <16 kg were classified as weak, ≥16 kg were classified as not-weak, and ≥20 kg were classified as strong. The National Death Index and postmortem interviews determined the date of death. The greedy matching algorithm was used to match cohorts. Results Of the 1077 weak and not-weak matched pairs, 401 weak (37.2%) and 296 not-weak (27.4%) older Americans died over an average 4.4 ± 2.5-year follow-up. There were 392 weak (37.0%) and 243 strong (22.9%) persons who died over a mean 4.5 ± 2.5-year follow-up from the 1057 weak and strong matched pairs. Those in the weak cohort had a 1.40 [95% confidence interval (CI) 1.19, 1.64] and 1.54 (CI 1.30, 1.83) higher hazard for mortality relative to persons in the not-weak and strong control cohorts, respectively. Conclusions and Implications Our findings may indicate a causal association between muscle weakness and mortality in older Americans. Health care providers should include measures of HGS as part of routine health assessments and discuss the health risks of muscle weakness with their patients. %B Journal of the American Medical Directors Association %G eng %U http://www.sciencedirect.com/science/article/pii/S152586101930756X %R https://doi.org/10.1016/j.jamda.2019.10.016 %0 Journal Article %J Medicine and Science in Sports and Exercise %D 2018 %T Handgrip Strength, Function, and Mortality in Older Adults: A Time-Varying Approach. %A Ryan P McGrath %A Brenda Vincent %A Lee, I-Min %A William J Kraemer %A Mark D Peterson %K Activities of Daily Living %K Mortality %K Physical Ability %K Physical measures %X

PURPOSE: To determine the time-varying associations between 1) decreased handgrip strength and disabilities in each activity of daily living (ADL) function, and 2) disaggregated ADL limitations and time to mortality in older adults.

METHODS: A United States nationally-representative sample of 17,747 older adults from the Health and Retirement Study were followed for eight-years. Maximal handgrip strength was measured with a hand-held dynamometer. Ability to perform ADLs were self-reported. Date of death was identified by the National Death Index and exit interviews. Separate covariate-adjusted hierarchical logit models were used to examine the time-varying associations between decreased handgrip strength and each ADL outcome. Distinct covariate-adjusted Cox models were used to analyze the time-varying associations between disaggregated ADL limitations and time to mortality.

RESULTS: Every five-kilogram decrease in handgrip strength was associated with increased odds for the following ADL limitations: 20% for eating, 14% for walking, 14% for bathing, 9% for dressing, 8% for transferring, and 6% for toileting. The presence of a bathing, walking, toileting, eating, and dressing ADL disability was associated with a 47%, 43%, 32%, 30%, and 19% higher hazard for mortality, respectively. A transferring ADL disability was not significantly associated with mortality.

CONCLUSIONS: Decreased handgrip strength was associated with increased odds for each ADL limitation, and in turn, most individual ADL impairments were associated with a higher hazard for mortality in older adults. These findings provide insights into the disabling process by identifying which ADL limitations are most impacted by decreased handgrip strength and the subsequent time to mortality for each ADL disability.

%B Medicine and Science in Sports and Exercise %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29933349?dopt=Abstract %R 10.1249/MSS.0000000000001683 %0 Journal Article %J The Journal of Nutrition, Health & Aging %D 2018 %T Muscle weakness and physical disability in older Americans: Longitudinal findings from the U.S. Health and Retirement Study %A Kate A Duchowny %A Philippa J Clarke %A Mark D Peterson %K Activities of Daily Living %K Disabilities %K Muscle Weakness %X Importance: Muscle weakness is an important indicator of disability, chronic disease and mortality. While we recently proposed sex/race specific grip strength cutpoints for clinical muscle weakness in a diverse, nationally representative sample of older Americans, the extent to which these cutpoints predict physical disability remains unknown. Objective: To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+. Design: We used data from the 2006-2010 Health and Retirement Study. Fully-adjusted, weighted multinomial logistic regression models were used to quantify the odds of experiencing the onset, progression or persistence of disability in activities of daily living (ADL) among weak versus non-weak individuals over a 2-year period. Setting: General community, nationally representative sample of older Americans. Participants: Population-based, community dwelling sample of older American adults aged 65-years+; 57 percent were women, 91% were White and the mean age was 75 years. Main Outcome(s) and Measure(s): The primary outcome of interest was disability dynamics, defined by changes in ADL status across at 2- year period. The primary exposure was clinical muscle weakness as defined by previously identified cutpoints. Hypotheses were formulated before analyses were conducted. Results: In this nationally representative sample (n= 8,725), 44% of individuals were classified as weak at baseline. At follow-up, 55% remained independent with no change in their ADL status, 11% had an onset of disability and 4% progressed in their disability status. The odds of experiencing an onset of ADL disability was 54% higher among weak individuals compared those who were not weak at baseline (OR= 1.54, 95% CI= 1.54, 1.5, p<.0001); the odds of experiencing a progression in physical disability status was 2.16 times higher among those who were weak at baseline compared to non-weak individuals (OR= 2.16, 95% CI= 2.15, 2.16, p<.0001). Conclusions: This is the first study to use grip strength weakness cut-points to identify those who may be at greatest risk for experiencing physical disability in later life. Results underscore the importance of using population-specific cutpoints for clinical weakness in order to identify individuals at greatest risk for adverse health outcomes. %B The Journal of Nutrition, Health & Aging %V 22 %8 04/2018 %G eng %U http://link.springer.com/10.1007/s12603-017-0951-yhttp://link.springer.com/content/pdf/10.1007/s12603-017-0951-y.pdfhttp://link.springer.com/content/pdf/10.1007/s12603-017-0951-y.pdfhttp://link.springer.com/article/10.1007/s12603-017-0951-y/fulltext.html %N 4 %! J Nutr Health Aging %R 10.1007/s12603-017-0951-y %0 Journal Article %J American Journal of Preventative Medicine %D 2017 %T Cut points for clinical muscle weakness among older Americans. %A Kate A Duchowny %A Mark D Peterson %A Philippa J Clarke %K Cut points %K Gender Differences %K Grip strength %K Muscle Weakness %K Older Adults %K Racial/ethnic differences %X

INTRODUCTION: Muscle weakness is an important indicator of disability, chronic disease, and early mortality. Grip strength is a simple, cost-effective measure of overall muscle strength. The Foundation of the National Institutes of Health recently proposed sex-specific grip strength cut points for clinical muscle weakness. However, these criteria were established using non-nationally representative data. This study used nationally representative data on Americans aged ≥65 years to identify race- and sex-specific cut points for clinical muscle weakness and quantify prevalence among older blacks and whites by sex.

METHODS: Classification and Regression Tree models were used to identify cut points based on individual-level grip strength associated with slow gait speed (<0.8 m/second) among 7,688 individuals (57% female; 8% black; mean age, 74.6 [SD=6.79] years) from the 2010/2012 Health and Retirement Study during January-April 2016. Identified cut points were then used to quantify the prevalence of weakness by race/sex subgroup.

RESULTS: Fifty-five percent of men (maximum grip strength <39 kg) and 47% of women (maximum grip strength <22 kg) were classified as weak. Higher cut points were identified for black men (maximum grip strength <40 kg) and women (maximum grip strength <31 kg), and the prevalence of weakness (57% and 88%, respectively) was higher compared with whites. Fifty-five percent of individuals had slow gait speed (<0.8 m/second).

CONCLUSIONS: Prevalence of weakness was substantially higher than previous reports, underscoring the importance of using population-level data to identify individuals at greatest risk for adverse health outcomes. This is the first study to establish cut points for muscle weakness in a nationally representative sample by race and sex.

%B American Journal of Preventative Medicine %V 53 %P 63-69 %G eng %N 1 %R 10.1016/j.amepre.2016.12.022