Handgrip Strength as a Predictor of Adverse Outcomes Among Older Adults in the Emergency Department

Background Sarcopenia and frailty are prevalent geriatric syndromes associated with adverse outcomes in older adults. Despite their clinical relevance, these conditions are rarely diagnosed or managed appropriately in emergency departments (EDs), where rapid decision-making is essential. Objective To investigate the prognostic value of handgrip strength (HGS) as a marker of probable sarcopenia and frailty in older adults admitted to the ED, and its association with in-hospital mortality and length of stay. Methods We conducted a retrospective observational study on patients aged ≥ 65 years admitted to a teaching hospital ED between January and December 2024. All patients underwent Comprehensive Geriatric Assessment, including Clinical Frailty Scale (CFS) and handgrip strength testing. Probable sarcopenia was defined according to EWGSOP2 cut-offs. Primary outcomes were in-hospital mortality and length of stay. Statistical analyses included multivariate Cox regression and Kaplan–Meier survival curves. Results Among 499 patients (median age 84 years), 88.2% met criteria for probable sarcopenia. In-hospital mortality occurred in 12.4% of cases and was significantly associated with lower HGS values (Day 1: p = 0.001; Day 3: p < 0.001; Day 7: p = 0.001). Patients with lower HGS also had higher CFS scores and increased prevalence of COPD, CKD, and sepsis. A handgrip strength below 7 kg was consistently associated with an adjusted hazard ratio above 1 for mortality, indicating elevated risk. Conclusion In the ED setting, handgrip strength is a simple, objective biomarker that correlates with frailty and predicts in-hospital mortality. Rather than focusing solely on diagnosing sarcopenia, integrating HGS into routine assessment may enhance risk stratification and guide personalized care for older adults.