NDSU researchers working to improve health care for older adults

Like many states, the population of North Dakota is aging quickly, increasing the importance of providing effective health-care treatment methods for older adults.

A team led by Ryan McGrath, NDSU associate professor of health, nutrition and exercise science, is researching ways to address this problem by examining the role of muscle function metrics in physical functioning among older adults. One way this is measured is through handgrip strength, although it alone does not fully capture how muscles function.

Current hand-grip testing guidelines focus solely on the strongest grip from one hand, omitting other important aspects of muscle performance. These include how quickly force is produced, differences in strength between hands, how well both hands work together, control during lighter efforts, how quickly the muscles fatigue, and how steady the grip is over time. Many of these features may be more sensitive indicators of cognitive decline.

“Examining prevention and treatment mechanisms for age-related health conditions is critically important to address the healthcare needs of an aging demographic,” McGrath said.

The National Institute of Aging funds the research.

“As North Dakota’s population ages, especially in our rural communities, research like Dr. McGrath’s is essential,” said NDSU interim vice president for research and creative activity Heidi Grunwald. “By developing practical, accessible ways to assess muscle and cognitive health, this work has the potential to improve early detection, guide prevention strategies, and help older adults maintain independence and quality of life — no matter where they live. Dr. McGrath’s research reflects NDSU’s commitment to improving rural health while training the next generation of health professionals. By focusing on accessible muscle function assessments, Dr. McGrath’s team is helping ensure that older adults in rural communities receive informed, proactive care that supports aging in place.”

Handgrip strength is a long-established indicator of overall muscle strength. Low handgrip strength is associated with a wide range of adverse health conditions, including dementia and diabetes. However, because it is related to many different outcomes, handgrip strength may not clearly indicate specific health risks and offers limited guidance for targeted interventions. McGrath’s team focuses on measuring aspects of muscle function, such as how quickly force can be produced and how easily muscles fatigue, while keeping the measurements practical to perform.

“Handgrip strength is recommended to be measured across the lifespan where possible, as muscle health is relevant for all ages,” McGrath said. Despite any limitations of conventional handgrip strength procedures, implementing these tools and methods in practice may help support lifespan health.

“We hope that our work will increase the predictive utility of muscle function assessments for health and improve intervention targets,” McGrath said.

Meeting physical activity guidelines, including recommendations for muscle strengthening, can be particularly challenging for people living in rural areas. Low muscle strength, commonly assessed using a handgrip dynamometer, is strongly associated with chronic disease, mobility limitations, and difficulty performing basic self-care tasks.

“Identifying factors related to low muscle strength, and routinely measuring strength, may help with prevention and early detection of a health condition, which may allow for lifestyle interventions such as physical activity and nutrition education when possible,” McGrath said. “Community health workers could be helpful in this regard, and such strategies may help to preserve independent living and aging in place.”

All the muscle strength research was conducted on the NDSU campus. Participants in the study were generally healthy community-dwelling adults aged 65 or older. One study found that newer digital handgrip tools can provide measurements beyond grip strength alone.

New digital handgrip tools can measure more than just grip strength. They can also show how quickly force is applied, how steady the grip remains, how easily muscles tire, and how much the hand shakes. Grip tests can also be improved by comparing hand strength and measuring how both hands work together.

These updated tools and testing methods offer a more complete and practical way to assess muscle function. They may help identify age-related disability and disease earlier and better guide treatment, without making testing more complicated.

McGrath is the director of Health and Aging North Dakota, which is dedicated to advancing scientific discoveries that aim to benefit society while enriching students' educational experience.

“We have a larger student group that is engaging in this work, given that part of the project’s theme is to expose students to research,” McGrath said. “The dedicated inclusion of students in our work also richens their education experience and prepares them to address the workforce need in aging.”

“Participation in research has strengthened my critical thinking skills and helped me connect classroom topics to real-world applications,” said Jacob Kieser, an NDSU graduate student in the HAND lab. “It has made me a more engaged student by teaching me how to ask meaningful questions and approach problems thoughtfully. Research has also prepared me for a career in medicine, particularly in working with older adults. This experience has motivated me to continue contributing to research as a future healthcare professional.”

Using electronic handgrip devices and motion sensors enables the practical and efficient measurement of these additional aspects of muscle function. Collecting this broader set of measures could provide earlier and more informative warning signs of AD/ADRD that are not captured by traditional grip strength testing. It may also help guide more targeted interventions by focusing on specific muscle features that can be improved and may support cognitive health, ultimately leading to more personalized and effective patient care.

“Research in aging and health is important for all students, not just those pursuing health professions, because aging is a universal experience that affects everyone,” said Kieser. “Understanding aging helps students think critically about all the factors influencing health and well-being across a lifespan.”

“We found that our muscle function metrics were overall reliable in measurement across days,” McGrath said. “Given how new our method is for assessing muscle function, gauging reliability is important before continuing.”

The research’s future includes further examining links between brain and muscle health.

“The next phase of our work will include a greater emphasis on the link between muscle and brain health, which may provide greater insights for the role of muscle function on cognitive impairment,” McGrath said.