Fatigue and recovery assessed by repetitive handgrip strength measurement as predictors of fall risk in older adults: A cross-sectional study

Design A cross-sectional study assessing the utility of repetitive handgrip strength measurements for predicting fall risk in older adults. Setting Conducted in two residential care homes in Vienna, Austria. Participants 217 older adults (mean age: 80.2 years, 65.9% female) participated. Those with significant cognitive impairments Mini-Mental State Examination <= 17, severe neuromuscular disorders, or recent hand injuries were excluded. Intervention Participants underwent a repetitive handgrip strength protocol, comprising 10 maximal grips (3-second contractions, 5-second rest intervals) performed twice, with a one-hour interval. Fatigability and recovery ratios were calculated. Functional assessments included the Short Physical Performance Battery, the Physical Activity Scale for the Elderly, the Falls Efficacy Scale-International, and the Multidimensional Fatigue Inventory. Retrospective and prospective fall data were also collected. Main Measures Handgrip strength parameters (maximum, fatigue ratio, recovery ratio) and fall events (retrospective and prospective) were analysed alongside physical and functional assessments. Results Fallers (39.6%) had higher fatigue ratios (median: 1.4 vs. 1.2) and lower recovery ratios (median: 0.9 vs. 1.0) compared to non-fallers (P < .001). Fatigue ratio was a strong predictor of prospective falls (incidence rate ratio: 1.14, 95% confidence interval: 1.09-1.41). Recovery ratio showed marginal significance. Functional measures were also strongly associated with fall risk. Conclusions Repetitive maximum handgrip strength measurements dynamically assess neuromuscular performance and offer superior predictive power for fall risk compared to standard single maximum handgrip strength. Fatigue and recovery ratios should be incorporated into fall risk assessment to improve prevention strategies in older adults.