Handgrip strength as a predictor of adverse outcomes among older adults in the emergency department

Abstract Methods We conducted a prospective observational study of patients aged ≥ 65 years admitted to the ED of a teaching hospital between January and December 2024. All patients underwent a Comprehensive Geriatric Assessment, including Clinical Frailty Scale (CFS) and handgrip strength testing. Probable sarcopenia was defined according to EWGSOP2 criteria, based on handgrip strength values below established sex-specific thresholds. The primary outcomes were in-hospital mortality and length of stay. Statistical analyses included multivariate Cox proportional hazards regression and Kaplan–Meier survival curves. Results Among 499 patients (median age 84 years), 88.2% met criteria for probable sarcopenia at baseline. In-hospital mortality occurred in 12.4% of cases and was significantly associated with lower HGS values at Day 1 ( p = 0.001), Day 3 ( p < 0.001), and Day 7 ( p = 0.001). Patients with lower HGS also had higher CFS scores and increased prevalence of COPD, CKD, and sepsis. Restricted cubic spline analysis demonstrated that HGS values below approximately 10 kg were associated with an exponential rise in mortality risk. Conclusions In the ED setting, handgrip strength is a simple, objective biomarker that correlates with acute dynapenia and frailty and predicts in-hospital mortality. Rather than focusing solely on diagnosing chronic sarcopenia, integrating HGS into routine assessment may enhance risk stratification and guide personalized care for older adults.