Establishing Prognostic Value for Gait Speed and Hand Grip Strength in Predicting Hospitalization and Mortality Risk in Older Adults With Cardiometabolic Multimorbidity

Importance Despite the high risks of hospitalization and mortality in older adults with cardiometabolic multimorbidity (CMM), risk predictions often overlook gait speed and hand-grip strength. Objective The objective was to establish cut-off points for gait speed and hand grip strength for 1-year hospitalization risk and their predictive ability for 3-year mortality among older adults with CMM. Design This was a retrospective cohort study using National Health and Aging Trends Study and linked Medicare claims data (2015 to 2018). Setting The study was conducted in community settings. Participants Participants were community-dwelling adults (N = 4157) aged 66 years and older. Main Outcomes and Measures Cut-off points for gait speed and grip strength for 1-year hospitalization were established stratified by sex and CMM group. Cox proportional hazards model was employed to estimate the probability of 3-year mortality, with gait speed and grip strength, stratified by sex and CMM groups. Results In male participants with CMM, the optimal cut-off points for 1-year hospitalization were 0.82kg/BMI for handgrip strength (sensitivity = 0.59, specificity = 0.85) and 0.58 meters/second for gait speed (sensitivity = 0.62, specificity = 0.92). In female participants, the cut-off points were 0.52kg/BMI (sensitivity = 0.61, specificity = 0.84) and 0.68 meters/second (sensitivity = 0.69, specificity = 0.71) to predict 1-year hospitalization. Among male participants, 3-year mortality rate was higher for those below cut-offs compared with those above (grip strength: 18.0% vs 13.6%; gait speed: 23.7% vs 12.6%). Among female participants, 3-year mortality rate was higher for those below cut-offs compared with those above (grip strength:15.1% vs 11.7%; gait speed: 16.1% vs 9.4%). Conclusion Validated cut-off points for gait speed and grip strength can help predict hospitalization and mortality risk. Relevance Gait speed and grip strength are quick, and reliable functional biomarkers for assessing risk in older adults. Their integration into routine clinical practice can help identify early risks and guide targeted interventions to improve outcomes.