| Summary: | Studies assessing the grip strength of older people have typically recruited community dwelling participants, or those in acute hospital settings. There are few studies of grip strength of older people in rehabilitation or long term care. The aim of this thesis was therefore to investigate the epidemiology of grip strength in these healthcare settings. The specific objectives were to study in each setting a) the feasibility and acceptability of grip measurement; b) the grip strength values recorded in comparison with published reference ranges; c) the clinical correlates of grip strength; and d) the association of grip strength with discharge outcomes for the rehabilitation inpatients. Participants were recruited prospectively between 2007 and 2010 from four healthcare settings within the same geographical area. Data on age, anthropometry, current comorbidities and medication, physical, cognitive and nutritional status, and subsequent - discharge were recorded, and grip strength was measured. The feasibility of grip strength measurement was evaluated and its acceptability was assessed by questionnaire and by semistructured interviews with a purposive sample of participants from each setting. 305 participants were recruited. Almost all could complete the grip strength assessment and would repeat the test. Qualitative data confirmed the high level of acceptability of grip strength measurement. There were significant differences in grip strength of both men and women between settings, and the grip strength of the in-patients and the nursing home residents was far below published reference values. Age, gender, body size and Barthel Score were the characteristics most consistently associated with grip strength in these settings. Among the 101 rehabilitation in-patients higher grip strength was associated with a reduced length of stay but this was only statistically significant among the men. This thesis has demonstrated that grip strength measurement of older people in these healthcare settings is both feasible and acceptable, and has described its values as well as its clinical correlates. It has shown the need for reference ranges specific to each healthcare setting since grip strength appears to be associated with length of stay even amongst those with low grip strength.
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