The journal of nutrition, health & aging

, Volume 22, Issue 4, pp 501–507 | Cite as

Muscle Weakness and Physical Disability in Older Americans: Longitudinal Findings from the U.S. Health and Retirement Study

  • Kate A. Duchowny
  • P. J. Clarke
  • M. D. Peterson



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.


To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+.


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.


General community, nationally representative sample of older Americans.


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.


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).


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.

Key words

Dynapenia ADLs muscle weakness disability 


  1. 1.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–423. doi:10.1093/ageing/afq034.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249–256. doi:10.1016/j.jamda.2011.01.003.Google Scholar
  3. 3.
    Sallinen J, Stenholm S, Rantanen T, Heliövaara M, Sainio P, Koskinen S. Hand-grip strength cut points to screen older persons at risk for mobility limitation. J Am Geriatr Soc. 2010;58(9):1721–1726. doi:10.1111/j.1532-5415.2010.03035.x.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Hicks GE, Shardell M, Alley DE, et al. Absolute strength and loss of strength as predictors of mobility decline in older adults: the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2012;67(1):66–73. doi:10.1093/gerona/glr055.CrossRefPubMedGoogle Scholar
  5. 5.
    Rantanen T. Midlife Hand Grip Strength as a Predictor of Old Age Disability. JAMA. 1999;281(6):558. doi:10.1001/jama.281.6.558.CrossRefPubMedGoogle Scholar
  6. 6.
    Leong DP, Teo KK, Rangarajan S, et al. Epidemiology (PURE) study. Lancet. 2015;386(9990):266–273. doi:10.1016/S0140-6736(14)62000-6.CrossRefPubMedGoogle Scholar
  7. 7.
    Cooper R, Kuh D, Hardy R. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. 2010;341(sep09_1):c4467. doi:10.1136/bmj.c4467.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Wind AE, Takken T, Helders PJM, Engelbert RHH. Is grip strength a predictor for total muscle strength in healthy children, adolescents, and young adults? Eur J Pediatr. 2010;169(3):281–287. doi:10.1007/s00431-009-1010-4.CrossRefPubMedGoogle Scholar
  9. 9.
    Lauretani F, Russo CR, Bandinelli S, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95(5). Accessed May 31, 2017.Google Scholar
  10. 10.
    Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266–273. doi:10.1016/S0140-6736(14)62000-6.CrossRefPubMedGoogle Scholar
  11. 11.
    Giampaoli S, Ferrucci L, Cecchi F. Hand-grip strength predicts incident disability in non-disabled older men.Google Scholar
  12. 12.
    Snih S Al, Markides KS, Ottenbacher KJ, Raji MA. Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period. Aging Clin Exp Res. 2004;16(6):481–486. doi:10.1007/BF03327406.CrossRefPubMedGoogle Scholar
  13. 13.
    Rantanen T, Guralnik JM, Foley D, et al. Midlife Hand Grip Strength as a Predictor of Old Age Disability. JAMA. 1999;281(6):558. doi:10.1001/jama.281.6.558.CrossRefPubMedGoogle Scholar
  14. 14.
    Batsis JA, Germain CM, Vásquez E, Bartels SJ. Prevalence of weakness and its relationship with limitations based on the Foundations for the National Institutes for Health project: data from the Health and Retirement Study. Eur J Clin Nutr. 2016. doi:10.1038/ejcn.2016.90.Google Scholar
  15. 15.
    Rantanen T. Muscle strength, disability and mortality. Scand J Med Sci Sport. 2003;13(1):3–8. doi:10.1034/j.1600-0838.2003.00298.x.CrossRefGoogle Scholar
  16. 16.
    Peterson MD, Zhang P, Choksi P, Markides KS, Al Snih S. Muscle Weakness Thresholds for Prediction of Diabetes in Adults. Sports Med. 2016. doi:10.1007/s40279-015-0463-z.Google Scholar
  17. 17.
    Di Monaco M, Castiglioni C. Weakness and Low Lean Mass in Women With Hip Fracture: Prevalence According to the FNIH Criteria and Association With the Short-Term Functional Recovery. J Geriatr Phys Ther. 2015. doi:10.1519/JPT.0000000000000075.Google Scholar
  18. 18.
    Alley DE, Shardell MD, Peters KW, et al. Grip strength cutpoints for the identification of clinically relevant weakness. J Gerontol A Biol Sci Med Sci. 2014;69(5):559–566. doi:10.1093/gerona/glu011.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Duchowny K, Peterson MD, Clarke P. Cutpoints for Clinical Muscle Weakness Among Older Americans. Am J Prev Med. 2016;In Press.Google Scholar
  20. 20.
    Clark BC, Manini TM. What is dynapenia? Nutrition. 2012;28(5):495–503. doi:10.1016/j.nut.2011.12.002.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Yang M, Jiang J, Hao Q, Luo L, Dong B. Dynapenic obesity and lower extremity function in elderly adults. J Am Med Dir Assoc. 2015;16(1):31–36. doi:10.1016/j. jamda.2014.06.019.CrossRefPubMedGoogle Scholar
  22. 22.
    Yang M, Ding X, Luo L, Hao Q, Dong B. Disability Associated With Obesity, Dynapenia and Dynapenic-Obesity in Chinese Older Adults. J Am Med Dir Assoc. 2014;15(2):150.e11–150.e16. doi:10.1016/j.jamda.2013.10.009.CrossRefGoogle Scholar
  23. 23.
    Rossi AP, Fantin F, Caliari C, et al. Dynapenic abdominal obesity as predictor of mortality and disability worsening in older adults: A 10-year prospective study. Clin Nutr. 2015. doi:10.1016/j.clnu.2015.02.005.Google Scholar
  24. 24.
    Batsis JA, Mackenzie TA, Barre LK, Lopez-Jimenez F, Bartels SJ. Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr. 2014;68(9):1001–1007. doi:10.1038/ejcn.2014.117.CrossRefPubMedGoogle Scholar
  25. 25.
    da Silva Alexandre T, De Oliveira Duarte YA, Ferreira Santos JL, Wong R, Lebrão ML. Sarcopenia according to the European Working Group on Sarcopenia in older people (EWGSOP) versus dynapenia as a risk factor for disability in the elderly. J Nutr Heal aging. 2014;18(5):547–553. doi:10.1007/s12603-014-0465-9.CrossRefGoogle Scholar
  26. 26.
    Growing Older in America: The Health and Retirement Study. Accessed December 15, 2015.Google Scholar
  27. 27.
    Crimmins EM, Guyer H, Langa KM, Ofstedal MB, Wallace RB, Weir DR. Documentation of Physical Measures, Anthropometrics and Blood Pressure in the Health and Retirement Study. Hrs. 2008;(February).Google Scholar
  28. 28.
    “An aging nation: the older population in the United States.” Washington, DC: US Census Bureau (2014): 25-1140. Accessed December 7, 2015.Google Scholar
  29. 29.
    SAS Institute I. SAS® 9.3. 2011.Google Scholar
  30. 30.
    Baumgartner R. Epidemiology of Sarcopenia among the Elderly in New Mexico. file:///Users/kateduchowny/Downloads/0912f505b91ff4e34a000000 (1).pdf. Accessed April 4,2015.Google Scholar
  31. 31.
    Ferrucci L, Guralnik JM, Simonsick E, Salive ME, Corti C, Langlois J. Progressive versus catastrophic disability: a longitudinal view of the disablement process. J Gerontol A Biol Sci Med Sci. 1996;51(3):M123–30. Accessed July 29, 2016.CrossRefPubMedGoogle Scholar
  32. 32.
    Ferrucci L, Guralnik JM, Buchner D, et al. Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities: the Women’s Health and Aging Study. J Gerontol A Biol Sci Med Sci. 1997;52(5):M275–85. Accessed December 15, 2015.CrossRefPubMedGoogle Scholar
  33. 33.
    Latham K. Nursing Home Stays and the Pace of Severe Disability Onset. Res Aging. 2011;33(6):637–660. doi:10.1177/0164027511403160.CrossRefGoogle Scholar
  34. 34.
    Batsis JA, Zbehlik AJ, Pidgeon D, Bartels SJ. Dynapenic obesity and the effect on longterm physical function and quality of life: data from the osteoarthritis initiative. BMC Geriatr. 2015;15(1):118. doi:10.1186/s12877-015-0118-9.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Clarke P, Latham K. Life course health and socioeconomic profiles of Americans aging with disability. Disabil Health J. 2014;7(1 Suppl):S15–23. doi:10.1016/j. dhjo.2013.08.008.CrossRefPubMedGoogle Scholar
  36. 36.
    Verbrugge LM, Reoma JM, Gruber-Baldini AL. Short-Term Dynamics of Disability and Well-Being. J Health Soc Behav. 1994;35(2):97. doi:10.2307/2137359.CrossRefPubMedGoogle Scholar
  37. 37.
    Gill T, Allore Ã, Hardy Ã. The Dynamic Nature of Mobility Disabilityin. Older Persons. 2006:248–254. doi:10.1111/j.1532-5415.2005.00586.x.Google Scholar
  38. 38.
    Germain CM, Vasquez E, Batsis JA, Mcquoid DR. Sex, race and age differences in muscle strength and limitations in community dwelling older adults: Data from the Health and Retirement Survey (HRS). 2016. doi:10.1016/j.archger.2016.03.007.Google Scholar
  39. 39.
    Onder G, Penninx BWJH, Ferrucci L, Fried LP, Guralnik JM, Pahor M. Measures of physical performance and risk for progressive and catastrophic disability: results from the Women’s Health and Aging Study. J Gerontol A Biol Sci Med Sci. 2005;60(1):74–79. doi:10.1093/gerona/60.1.74.CrossRefPubMedGoogle Scholar
  40. 40.
    Femia EE, Zarit SH, Johansson B. Predicting change in activities of daily living: a longitudinal study of the oldest old in Sweden. J Gerontol B Psychol Sci Soc Sci. 1997;52(6):P294–302. Accessed July 26, 2016.CrossRefPubMedGoogle Scholar
  41. 41.
    Murtagh KN, Hubert HB. Gender differences in physical disability among an elderly cohort. Am J Public Health. 2004;94(8):1406–1411. doi:10.2105/AJPH.94.8.1406.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Tseng LA, Delmonico MJ, Visser M, et al. Body Composition Explains Sex Differential in Physical Performance Among Older Adults. Journals Gerontol Ser A Biol Sci Med Sci. 2014;69(1):93–100. doi:10.1093/gerona/glt027.CrossRefGoogle Scholar
  43. 43.
    Latham K, Clarke PJ. The Role of Neighborhood Safety in Recovery from Mobility Limitations: Findings from a National Sample of Older Americans (1996-2008). Res Aging. 2013;35(4):481–502. doi:10.1177/0164027512454887.CrossRefPubMedGoogle Scholar
  44. 44.
    Latham K. Progressive and Accelerated Disability Onset by Race/Ethnicity and Education among Late Midlife and Older Adults. J Aging Health. 2012;24(8):1320–1345. doi:10.1177/0898264312459345.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Williams JS, Egede LE. The Association Between Multimorbidity and Quality of Life, Health Status and Functional Disability. Am J Med Sci. 2016;352(1):45–52. doi:10.1016/j.amjms.2016.03.004.CrossRefPubMedGoogle Scholar
  46. 46.
    Freedman VA, Spillman BC, Andreski PM, et al. Trends in Late-Life Activity Limitations in the United States: An Update From Five National Surveys. Demography. 2013;50(2):661–671. doi:10.1007/s13524-012-0167-z.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Bassey EJ. Measurement of muscle strength and power. Muscle Nerve. 1997;20(S5):44–46. doi:10.1002/(SICI)1097-4598(1997)5+<44::AIDMUS11>3.0.CO;2-Z.CrossRefGoogle Scholar
  48. 48.
    Bohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care. 2015;18(5):465–470. doi:10.1097/MCO.0000000000000202.CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  • Kate A. Duchowny
    • 1
  • P. J. Clarke
    • 1
    • 2
  • M. D. Peterson
    • 3
  1. 1.University of Michigan School of Public Health, Department of Epidemiology, Center for Social Epidemiology and Population healthAnn ArborUSA
  2. 2.Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  3. 3.Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborUSA

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