title: Association of regional muscle strength with mortality and hospitalisation in older people.
abstract: BACKGROUND
  the association between muscular strength, mortality and hospitalisation with ageing can change depending on sex and the body region analysed (e.g. upper and lower limb muscles).
  
  
  OBJECTIVE
  to determine the effect of measuring lower and upper extremities muscular strength on the relationship between strength, mortality and hospitalisation risk in elder men and women.
  
  
  METHODS
  a population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA).
  
  
  METHODS
  a Spanish population sample of 1,755 elders aged ≥65 years participated in this study. Upper (handgrip and shoulder) and lower limbs (knee and hip) maximal voluntary isometric strength was obtained using standardised techniques and equipment. Cox proportional hazards model was used to examine mortality and hospitalisation over 5.5 and 3 years of follow-up, respectively.
  
  
  RESULTS
  after adjustment for potential confounding factors, including co-morbidities and BMI, hazard ratio of death and hospitalisation was significantly lower in the stronger women and men, but showing regional- and sex-specific differences. That is shoulder, knee and hip muscle regions in women and handgrip and shoulder in men (all P < 0.05). There was a cumulative effect of measuring several muscle strengths over the risk of health events (P < 0.05), so that mortality hazard ratio increased by 45% in women and 25% in men per muscular strength (shoulder, grip, knee and hip) in the weaker strength quartile increase (P < 0.01).
  
  
  CONCLUSIONS
  regional muscle strength is a predictor of medium-term mortality and hospitalisation in elder men and women. Multiple strength measures including lower and upper body limb muscles are better predictors than a single strength measurement.
authors.affiliation: Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain.
authors.forename: Amelia
authors.initials: A
authors.lastname: Guadalupe-Grau
authors.affiliation: Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Carnicero
authors.affiliation: Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain Centro Universitario de la Defensa, Zaragoza, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Gómez-Cabello
authors.affiliation: Servicio de Epidemiología de la Consejería de Sanidad y Bienestar Social. Junta de Comunidades de Castilla la Mancha, Toledo, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Gutiérrez Avila
authors.affiliation: Servicio de Epidemiología de la Consejería de Sanidad y Bienestar Social. Junta de Comunidades de Castilla la Mancha, Toledo, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Humanes
authors.affiliation: GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Alegre
authors.affiliation: Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Castro
authors.affiliation: Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Leocadio
authors.initials: L
authors.lastname: Rodríguez-Mañas
authors.affiliation: Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: García-García
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002423:Cause of Death; D005260:Female; D015577:Geriatric Assessment; D018737:Hand Strength; D006304:Health Status; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007537:Isometric Contraction; D008297:Male; D053580:Muscle Strength; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain; D013997:Time Factors
keywords: ageing; death; hospitalisation; older people; regional muscle strength; sex