Journal of Aging and Physical Activity, 2008, 16, 24-41

© 2008 Human Kinetics, Inc.

Hand Force of Men and Women Over 65

Years of Age as Measured by Maximum
Pinch and Grip Force
Caroline W. Stegink Jansen, Bruce R. Niebuhr,
Daniel J. Coussirat, Dana Hawthorne,
Laura Moreno, and Melissa Phillip

This cross-sectional study aimed to assess the impact of age and gender on 4 mea-
sures of grip and pinch force of well elderly community dwellers and to provide
normative values. The hypotheses were that age and gender affect pinch and grip
force and that these 2 factors might interact. Hand strength of 224 seniors 65–92
years old was tested. Grip and pinch force decreased in successively older age
groups past 65 years. Men’s grip force exceeded that of women in all age groups.
Men’s hand-force decline was steeper than that of women over successive age
groups, suggesting that gender differences in force decreased with age. Trends
were the same for all 4 types of grip- and pinch-force measurement but were most
clearly visible in grip and key-pinch force. Norms were provided for seniors age
65–85+ years in 5-yr increments.

Keywords: hand strength, aging hand, normative values, older adults

The American population is aging, meaning that more and more elderly are
living longer and enjoying life, yet they often do so hindered by diseases such as
arthritis that limit their capacity to maintain independence (Blackman, Kamimoto,
& Smith, 1999). Impairment of hand strength (Boyd, Xue, Simpson, Guralnik, &
Fried, 2005; Rantanen et al., 1999) and hand movement (Jette, Branch, & Berlin,
1990) are important predictors of older adults’ capability to perform basic activities
of daily living (e.g., bathing, dressing, eating, toileting), which in turn serves as a
marker of independence. Changes in hand function over the life span, however, are
neither fully understood (Carmeli, Patish, & Coleman, 2003) nor well described,
and normative data for commonly used measures such as grip force, and even
more so for pinch force, are lacking. Thus, health-care professionals do not have
pinch- and grip-force estimates for older patients. The goals of this study were to
describe maximum voluntary pinch and grip forces and provide normative data
for a group of well men and women older than 65 years, an age range that is most
often absent in existing normative data sets.

Jansen and Phillip are with the Dept. of Physical Therapy, and Niebuhr, Coussirat, Hawthorne, and
Moreno, the Dept. of Physician Assistant Studies, University of Texas Medical Branch–SAHS, Galves-
ton, TX 77555-1144.

24
 Hand Forces of Adults Over 65 Years of Age   25

Assessment of hand function, and specifically assessment of pinch and grip

forces, allows us to identify seniors who might be unable to perform basic activi-
ties of daily living. These data are also needed to measure treatment effectiveness
in a population with a high incidence of pathological processes (e.g., neurological
ailments) and degenerative disorders (e.g., osteoarthritis) that affect hand function
(Blackman et al., 1999). For example, Shechtman, Mann, Justiss, and Tomita (2004)
reported a decrease in grip strength for a group of 832 frail elderly, with the pathol-
ogy type affecting the maximum-strength measurements of the study group. In a
study by Vliet Vlieland, van der Wijk, Jolie, Zwinderman, and Hazes (1996), pinch
force was found to explain 74% of loss of hand function in a sample of 50 elderly
participants with rheumatoid arthritis. Similarly, Bagis, Sahin, Yapici, Cimen, and
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Erdogan (2003) found a decrease in hand function, bilateral grip, and right-hand
pinch force in a group 170 women in their 60s with osteoarthritis as compared with
a control group of 70 age- and weight-matched women without osteoarthritis. In
both the well elderly and the not-well elderly, hand strength is an important aspect
of hand function, because different tasks require different patterns of hand force
(Shiffman, 1992). The decline in pinch force, for example, can lead to difficulties
in performing such tasks as buttoning a shirt, tying a shoelace, holding a pen, or
manipulating small objects (Grabiner & Enoka, 1995; Ranganathan, Siemionow,
Sahgal, & Yue, 2001).
The effects of aging on hand prehension and grip force have been investigated,
but the findings are inconsistent and often do not include individuals older than
80 years. Age-related decline of hand strength is believed to be caused by a com-
bination of factors, including a decline in hand sensation, loss of finger dexterity,
muscle-fiber deterioration, and central-nervous-system degeneration (Carmeli et
al., 2003; Grabiner & Enoka, 1995). Several studies have documented normative
values of grip force in healthy older adults (Agnew & Maas, 1982; Brown & Miller,
1998; Crosby, Wehbe, & Mawr, 1994; Desrosiers, Bravo, Hebert, & Dutil, 1995;
Hanten et al., 1999; Horowitz, Tollin, & Cassidy, 1997; Mathiowetz et al., 1985;
Rice, Cunningham, Paterson, & Rechnitzer, 1989; Schmidt & Toews, 1970; Sinaki,
Nwaogwugwu, Phillips, & Mokri, 2001; Sperling, 1980), but fewer studies have
reported the effects of aging on pinch force (Mathiowetz et al., 1985; Sperling; Su,
Chien, Cheng, & Su, 1995).
Findings between studies differ in their descriptions of hand-strength changes
in advancing age groups of adults. Schmidt and Toews (1970) observed that grip
force increased from 18 years of age and peaked around 30 years of age, declining
gradually over the life span in a sample of 1,128 male and 80 female applicants at
a steel-manufacturing plant with ages ranging from 18 to 62 years. Hanten et al.
(1999), in a cross-sectional study, noted that age might not affect the hand force of
men and women equally. In their sample of 1,182 volunteers ranging from 20 to 64
years of age, a decline in grip force was noticed for men starting in the 55–59 age
range and for women in the 60–64 age range. People 62 years of age are currently
seen as the “young old” (Blackman et al., 1999). The study by Hanten et al. lacked
data for more elderly, healthy individuals. In one of the few longitudinal studies of
hand strength, Kallman, Plato, and Tobin (1990) observed a curvilinear progression
of hand strength for a group of 847 participants whose ages ranged from 20 to 100
years and who were followed for 9 years. They warned that cross-sectional data
might not be able to accurately predict longitudinal changes in individual hand
 26   Jansen et al.

strength. This observation was confirmed by Bassey and Harries (1993), who, using
a sample of 920 men and women with a 4-year follow-up of 620 survivors, found
that the longitudinal decline in hand grip of women was steeper than one would
expect based on cross-sectional data.
Some studies investigated the effects of aging on pinch force (Mathiowetz et al.,
1985; Shiffman, 1992; Su et al., 1995). For example, Su et al. found that in a sample
of older adults from Taiwan, pinch force decreased with age but did not decline
as rapidly as grip force. Furthermore, this study demonstrated that the decline in
hand force was most pronounced after the age of 70. The study did not stratify age
groups over 70 years in further detail because of a lack of study participants in the
higher age ranges. Mathiowetz et al. (1985), using a study sample of 310 male and
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328 female participants, reported that pinch force remained fairly stable between
the ages of 20 and 59, with a gradual decline occurring between the ages of 60 and
79. Shiffman reported a decline in pinch force in 40 participants across four age
groups, ranging from 24 to 87 years of age. These studies therefore suggest that
hand strength decreases in older age, but the nature of this decline warrants further
investigation, especially for the very old.
There is reason to believe that the changes in hand strength of advanced age
groups differ between men and women (Agnew & Maas, 1982; Bassey & Harries,
1993; Desrosiers et al., 1995; Ranganathan et al., 2001). Conflicting findings, how-
ever, have been presented in the literature. In a cross-sectional study, Desrosiers
et al. reported that declines in grip force are greater for men than for women. In
contrast, Ranganathan et al. observed that decreases in pinch and grip force were
more pronounced in women than in men when compared with their respective
younger counterparts. In addition to the decline of hand strength, Jette et al. (1990),
in a large sample of community-dwelling participants in Massachusetts, reported
that the incidence of hand and wrist impairments was greater in older men than in
older women and that the impairments worsened over time in a larger percentage
of men than women. Bassey and Harries sketched a more complicated picture: In
a group of elderly adults, they reported contrasting findings for grip force between
the cross-sectional comparisons in the first phase of their study and the longitudinal
comparisons 4 years later. Cross-sectionally, the rate of decline was steeper in men
than in women in absolute terms, but in longitudinal comparisons, the decline was
12% in men and 19% in women. Moreover, the longitudinal declines were larger
than predictions based on the cross-sectional data collected 4 years earlier.
Findings regarding the impact of gender differences on the level of muscle
force, muscle mass, and muscle physiology are conflicting, as well. Hughes et al.
(2001) found that changes in strength over time between men and women depended
on the muscles being tested in the upper and lower extremities. Women showed a
decline of 2% per decade in the strength of elbow flexors and extensors, whereas
men showed a decline of 12% per decade for elbow flexors. Both genders showed
similar strength changes for knee flexors and extensors, ranging from 11.1% to
16.7%. The decline in overall muscle-mass estimates observed in a subset of par-
ticipants was smaller for women than for men. Frontera et al. (2000) noted that
there are gender differences in muscle-force production and in muscle fiber type
based on comparisons of the quadriceps muscle of older and younger groups of
men and women. Sarcopenia, defined as the age-associated loss of muscle mass
(Roubenoff, 2003), was found to be functionally related to poor balance and the
 Hand Forces of Adults Over 65 Years of Age   27

need to use a cane or walker in men; in women, however, sarcopenia was associated
with the ability to carry out instrumental activities of daily living. Iannuzzi-Sucich,
Prestwood, and Kenny (2002) reported that the prevalence of sarcopenia in a sample
of older adults over 80 years of age was higher in men than in women.
Based on the available literature, it appears that age and gender affect the
decrease of upper extremity strength in later years, but there is a dearth of data to
assess hand-strength changes in older adults. Pinch force is an important component
of hand function, but it is not known whether changes in strength occur similarly
to other strength measures of the upper extremity or whether these changes are
similar for men and women. Additional data are therefore needed to elucidate the
impact of mediating factors in various samples of elderly participants.
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The overall goals of this cross-sectional study were to provide normative

values for four measures of hand strength for well elderly men and women. The
three measurements of pinch force are of primary interest to this study. Grip force
was included as a second dependent variable to contrast our findings with a larger
pool of publications. The hypotheses were that (a) age and gender affect pinch
and grip force in well elderly adults; (b) the rate of hand-strength decrease will be
similar for men and women, meaning that there would be no interaction between
age and gender; and (c) there is an inverse relationship between pinch and grip
force and age.

Methods
Study Design
This normative research had a cross-sectional design measuring maximum pinch
and grip forces of the right and left hands in a convenience sample of healthy elderly
over 65 years old. The sample was stratified into the following age groups: 65–69,
70–74, 75–79, 80–85, and 85+ years. Measurements were completed in one ses-
sion by five raters: one physician assistant, three physician assistant students, and
one physical therapy student. All raters were thoroughly trained by the principal
investigator, a physical therapist with more than 20 years of experience in rehabili-
tation of patients with hand injuries. Interrater reliability for the measure of pinch
and grip force is reported as very high in the literature, allowing us to use multiple
raters (Bohannon & Schaubert, 2005; MacDermid, Kramer, Woodbury, McFarlane,
& Roth, 1994; Mathiowetz, Weber, Volland, & Kashman, 1984; Schreuders et
al., 2003). Four measures of hand strength were included in the study: maximum
voluntary key pinch, three-jaw-chuck pinch, fingertip pinch, and grip force. The
order of testing was randomized in a Latin-square approach.

Participants
The sample consisted of 224 participants from the Galveston County area in
Texas who were recruited from local health fairs, a geriatric primary-care clinic,
and senior-citizen community events, with ages ranging from 65 to 92 years
(M = 75.4, SD = 6.8). During the health fairs participants were tested in an area
removed from the visitor traffic flow. The sample included 140 women and 84
men; 174 were right-hand dominant, 5 left-hand dominant, and 4 ambidextrous;
 28   Jansen et al.

41 participants were missing data on hand dominance. Demographically, 2 Asian,

11 African American, 16 Hispanic, and 194 White participants participated in the
study. The number of participants in each age group is listed in Tables 1–4. Inclu-
sion criteria were that participants reported general good health with normal hand
function. Exclusion criteria were acute pain in the arms or hands, being less than
6 months posthospitalization for surgery or a heart condition, restricted or limited
upper extremity function because of any medical condition such as neurological
or systemic diseases, or pain during the measurement.

Table 1 Normative Grip Force (in Pounds)

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Men Women
Age Hand n M SD n M SD
65–69 19 33
right 91.5 15.5 54.9 10.1
left 88.2 14.4 51.5 9.5
70–74 19 37
right 84.2 17.2 52.5 9.5
left 81.4 18.4 48.3 10.5
75–79 17 39
right 81.9 9.94 48.2 10.3
left 77.3 10.2 43.6 10.7
80–84 15 17
right 70.6 14.6 44.5 11.1
left 63.1 16.2 41.0 9.3
85+ 14 14
right 54.2 14.2 40.4 11.6
left 50.3 13.8 37.7 8.6

Table 2 Normative Key-Pinch Force (in Pounds)

Men Women
Age Hand n M SD n M SD
65–69 19 33
right 22.3 4.3 13.4 2.8
left 20.9 5.0 12.6 2.5
70–74 19 37
right 19.4 4.7 13.4 2.7
left 18.4 4.5 12.1 2.7
75–79 16 38
right 19.0 4.2 12.1 2.8
left 18.5 2.7 11.2 2.8
80–84 15 17
right 17.7 4.8 10.5 1.9
left 17.0 5.2 10.6 2.5
85+ 14 14
right 13.6 3.5 10.2 3.6
left 11.7 3.4 9.5 3.5
 Hand Forces of Adults Over 65 Years of Age   29

Table 3 Normative Three-Jaw-Chuck Pinch Force (in Pounds)

Men Women
Age Hand n M SD n M SD
65–69 19 32
right 19.5 4.7 13.5 3.2
left 19.2 4.4 12.7 2.9
70–74 19 35
right 18.4 5.2 12.6 2.7
left 17.6 4.6 12.6 2.9
75–79 17 38
right 17.9 3.5 11.7 2.5
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left 16.8 2.9 10.9 2.5

80–84 15 17
right 16.1 4.2 11.1 2.9
left 14.6 4.2 10.3 3.9
85+ 13 14
right 11.8 2.6 10.2 2.5
left 11.7 3.0 9.6 2.6

Table 4 Normative Tip-Pinch Force (in Pounds)

Men Women
Age Hand n M SD n M SD
65–69 19 32
right 15.8 4.4 10.0 3.1
left 15.4 3.9 9.7 2.2
70–74 19 35
right 15.0 4.5 10.0 2.4
left 13.9 4.1 9.2 2.3
75–79 16 39
right 14.7 2.7 9.4 2.3
left 13.0 2.9 9.1 2.2
80–84 15 17
right 14.1 4.1 *8.8 2.3
left 11.7 3.8 8.6 2.6
85+ 13 14
right 10.6 3.1 8.9 3.0
left 10.4 2.9 7.9 3.5

Procedures
Procedures for the protection of human participants were explained to the partici-
pants according to guidelines provided by the University of Texas Medical Branch.
Agreement to participate in the study consisted of verbal consent by the participants
as approved by the institutional review board. The following demographics were
obtained: height and weight by measurement and self-report, ethnicity, hand domi-
nance, gender, and age. Hand dominance was established by asking the participant
which was his or her preferred hand for writing and for throwing a ball.
 30   Jansen et al.

Instrumentation
Grip and Pinch Force. Grip-force testing was performed using two Jamar dyna-
mometers (see Figure 1[a]). The standard grip-testing position recommended by
the American Society of Hand Therapists was used (Fess, 1992). Participants were
seated with the shoulder adducted, the elbow flexed at 90° and unsupported, the
forearm positioned in a neutral position, and the wrist positioned at 30° of extension.
The guidelines provided by the American Society of Hand Therapists indicate that
a position between 0° and 30° of wrist extension is acceptable, but a goniometer is
usually not used to standardize the wrist position. The dynamometer handle was
set in the second position for all participants.
Three B&L Engineering pinch gauges were used to measure tip, key, and three-
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jaw-chuck pinch forces (see Figure 1[b–d]). The B&L pinch gauge was held at the
distal end of the instrument. Standardized verbal instructions were given to each
participant (Mathiowetz et al., 1984) as follows: “I want you to hold this instrument
like this, and when I say ready, squeeze as hard as you can until I say stop.” The
examiner demonstrated the grip or the correct placement of fingers and then gave
the dynamometer or pinch gauge to the participant. The rater steadied the pinch and
grip meters for the participant and placed a goniometer set at 30° of extension to
maintain a standard angle of wrist extension for all participants. The angle was set
at 30° of wrist extension after some pilot testing indicated that participants tended
to extend the wrist beyond the functional wrist extension of 20° when applying
maximum force. After correct positioning was verified, the examiner said, “Are
you ready? Squeeze as hard as you can.” As the participant began to squeeze, the
examiner then said, “Harder! . . . Harder! . . . Stop.” Participants performed three
submaximal pinch warm-ups (Marion & Niebuhr, 1992) on the type of pinch force

(a) (b)

(c) (d)

Figure 1 — The experimental setup to measure (a) grip, (b) key-pinch, (c) three-jaw-chuck-
pinch, and (d) tip-pinch force. The goniometer was placed over the dorsum of the hand as
a reference for the participant to maintain 30° of extension.
 Hand Forces of Adults Over 65 Years of Age   31

first tested. Three trials were collected, alternating between hands to minimize the
effects of fatigue, and the mean of the recorded force readings (in pounds) of the
three trials was used for further data analysis. The experimental setup is shown in
Figure 1. All raters were thoroughly trained in the data-collection procedures. High
reliability with correlation coefficients of .8 or higher for pinch and grip measure-
ment has been reported in the literature in healthy and hand-injured populations
(Bohannon et al., 2005; MacDermid et al., 1994; Mathiowetz et al., 1984; Schreud-
ers et al., 2003). Reliability studies were not repeated to confirm the reliability
between participating raters.
Jamar dynamometers and B&L Engineering pinch meters that had been initially
calibrated by the companies were used. After completion of the study, the pinch and
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grip meters were sent back to B&L Engineering to test accuracy of measurement,
and the reports were obtained from the company. Correlation coefficients between
known force values and measured values were .99 for the Jamar dynamometers,
with a difference between mean values ranging between 0 and 3.1 lb lower than
the known weight and with less than 1% difference for the pinch gauges.

Data Analysis
Descriptive Statistics. The Statistical Package for Social Studies (SPSS) was used
to analyze the data. Ms and SDs were calculated for all dependent variables for all
age groups and both genders for the right and left hands. Scatter plots were drawn
for all correlations to assess the linearity of the correlation before the application
of Pearson’s correlation coefficients.
Inferential Statistics. Four 5 × 2 × 2 ANOVAs were used to analyze differences
of grip and pinch force among five age groups (65–69 years, 70–74 years, 75–79
years, 80–84 years, and 85+ years), two genders (male, female), and two sides
(right and left hand). Effect sizes were calculated for all comparisons. The level
of significance was adjusted to .0125 (.05/4) to accommodate for testing multiple
variables of the same sample. Pearson’s correlation coefficients were calculated
between grip and pinch force and age.

Results
Ms and SDs for grip, key-, three-jaw-chuck-, and tip-pinch force are given in
Tables 1, 2, 3, and 4, respectively. The absolute force is presented in pounds. For
conversion to metrics, the values need to be multiplied by 0.45 to obtain kilograms
and by 0.91 to obtain English pounds. The results of the ANOVAs for grip, key-,
three-jaw-chuck-, and tip-pinch force with gender, age, and hand as factors are
given in Tables 5, 6, 7, and 8, respectively.
The significant main effects (Tables 5 and 6) suggest the following general
inferences: Men showed greater grip and pinch force at all age ranges than women,
the right hand showed greater grip and pinch force than the left hand for both
genders at all age ranges, and younger participants showed greater grip and pinch
force than older participants for both genders. The significant gender-versus-age
interaction (Tables 5 and 6) indicates that the difference between genders in grip
and key pinch decreased as a function of age. In tip and three-jaw-chuck pinch,
the gender-versus-age interaction was not statistically significant at the .01 level.
 Table 5 Summary of Analysis of Variance for Grip Force
Source df F η2 p
Between participants
gender 1 298.74* .58 .01
age group 4 28.72* .35 .01
Gender × Age Group 4 5.97* .10 .01
participants within-group error 214 (254.40)
Within participants
hand 1 43.71* .17 .01
Hand × Gender 1 0.32 .01 .57
Hand × Age Group 4 0.48 .01 .75
Hand × Gender × Age Group 4 0.55 .01 .70
Hand × Participants within-group error
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214 (36.85)
Note. Values enclosed in parentheses represent mean square errors.
*p < .0125.

Table 6 Summary of Analysis of Variance for Key Pinch Force

Source df F η2 p
Between participants
gender 1 180.94* .46 .01
age group 4 17.02* .24 .01
Gender × Age Group 4 3.76* .07 .01
participants within-group error 212 (21.24)
Within participants
hand 1 38.62* .15 .01
Hand × Gender 1 1.88 .01 .17
Hand × Age Group 4 1.29 .02 .28
Hand × Gender × Age Group 4 1.07 .02 .37
Hand × Participants within-group error 212 (2.10)
Note. Values enclosed in parentheses represent mean square errors.
*p < .0125.

Table 7 Summary of Analysis of Variance for Three-Jaw-Chuck

Pinch Force
Source df F η2 p
Between participants
gender 1 113.64* .35 .01
age group 4 15.42* .23 .01
Gender × Age Group 4 2.54 .04 .05
participants within-group error 209 (19.71)
Within participants
hand 1 14.00* .06 .01
Hand × Gender 1 0.09 .01 .72
Hand × Age Group 4 0.69 .01 .57
Hand × Gender × Age Group 4 0.64 .01 .66
Hand × Participants within-group error 209 (19.71)
Note. Values enclosed in parentheses represent mean square errors.
*p < .0125.

32
 Hand Forces of Adults Over 65 Years of Age   33

Table 8 Summary of Analysis of Variance for Tip Pinch

Source df F η2 p
Between participants
gender 1 105.98* .34 .01
age group 4 6.55* .11 .01
Gender × Age Group 4 1.81 .04 .13
participants within-group error 209 (16.49)
Within participants
hand 1 34.47* .14 .01
Hand × Gender 1 5.25 .02 .02
Hand × Age Group 4 1.44 .03 .22
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Hand × Gender × Age Group 4 2.76 .05 .03

Hand × Participants within-group error 209 (2.00)
Note. Values enclosed in parentheses represent mean square errors.
*p < .0125.

The listed effect sizes reflected the inferential findings. The effect sizes calculated
for hand were the smallest, ranging from 0.06 to 0.17, followed by the effect
sizes calculated for age, ranging from 0.11 to 0.35. The effect sizes were largest
for gender, ranging from 0.34 to 0.58. The effect size for the gender-versus-age
interaction was highest for grip force, followed by key-, three-jaw-chuck-, and,
last, fingertip-pinch force.
The general findings are best visualized in Figures 1 and 2. Grip and three-jaw-
chuck force were selected for graphical display as representative of the results in
Tables 1–4. The most striking finding is the degree to which gender difference has
virtually disappeared for the oldest (85+ years) group. Pearson’s r correlations also
support the inference that declines in strength in successive age groups are more
striking for men than for women. The inverse correlations between age and grip
and pinch forces were statistically significant (p < .01). The level of correlation
was higher for men (from –.68 for left grip to –.41 for right fingertip pinch, n =
84) than for women (from –.45 for right grip to –.23 for right fingertip pinch, n =
140). On inspection of scatter plots of age versus force, no evidence of a systematic,
nonlinear correlation was observed.

Discussion
This study investigated the effects of age and gender on the decrease of hand strength
in a sample of healthy, older, community-dwelling adults in a cross-sectional study.
Our hypothesis that age would affect grip and pinch force was supported. Groups
of healthy older adults in successive age ranges demonstrated decreasing pinch
and grip force progressively after the age of 65. Our hypothesis that there would
be no interaction between age and gender was not supported, because significant
interaction effects between age and gender were found. Men were stronger than
women, but gender differences in forces decreased with age. All four measures of
hand strength (grip, key, three-jaw-chuck, and fingertip pinch) showed the same
age and gender trends, but trends were most strongly seen in grip and key-pinch
force. The hypothesis that there would be inverse correlations between age and
grip and pinch was supported. The correlations between age and grip and pinch
 34   Jansen et al.
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(a)

(b)

Figure 2 — Mean grip force (± SD) of healthy older men and women over five successive
age ranges from 65 years old for (a) right hand and (b) left hand.

forces were inverse and statistically significant from zero, and the level of cor-
relation was higher for men (from –.68 for left grip to –.41 for right fingertip
pinch) than for women (from –.45 for right grip to –.23 for right fingertip pinch).
The results from the statistical analyses supported the hypothesis that hand force
declines more steeply in men than in women, with the end result being that in the
older age groups the genders displayed nearly identical forces. Normative values
were provided for men and women for the five age groups (65–69, 70–74, 75–79,
80–84, and 85+ years).
 Hand Forces of Adults Over 65 Years of Age   35
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(a)

(b)

Figure 3 — Mean three-jaw-chuck pinch force (± SD) of healthy older men and women
over five successive age ranges from 65 years old for (a) right hand and (b) left hand.

Values for grip and pinch forces can be found in Tables 1–4. In comparing the
results of our study with those of the normative study of Mathiowetz et al. (1985),
we found many similarities and some discrepancies. Both studies include the age
ranges of 65–69 years and 70–74 years. Grip forces from our sample were higher
than those reported by Mathiowetz et al. (1985), but the pinch forces were similar.
Other studies have corroborated higher grip-force values than those reported by
Mathiowetz et al. (1985; Desrosiers et al., 1995; Hanten et al., 1999; Horowitz
et al., 1997). The differences in grip forces between Mathiowetz et al.’s (1985)
 36   Jansen et al.

sample and our sample ranged from 0.4 to 8.9 lb for men and from 2.9 to 5.3 lb
for women. These differences are well under the 13.2 lb that Nitschke, McMeeken,
Burry, and Matyas (1999) assert is needed to detect a genuine change in grip force.
Thus, we are confident that our norms can be used in conjunction with those of
Mathiowetz et al. (1985).
To explain contrasts between our results and those found in the literature, we
will first address the factor of gender difference, followed by the age factor as it
pertains to men and women. To place our findings in the context of other published
reports, we calculated percent grip and pinch values in two ways: a cross-sectional
gender difference percentage for each age group, calculated as a ratio between
women’s and men’s scores expressed as a percentage (mean women’s score/mean
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men’s score × 100), and a longitudinal relative percentage for each gender to
describe the change relative to the youngest group ([mean Group 5 – mean Group
1]/mean Group 1). The first relative percentage expresses differences between
men and women, and the second relative percentage expresses how well force was
maintained in successively older age ranges in the men’s and women’s groups.
The gender percentage calculated by age groups confirms results reported in
other studies. In our sample, the hand strength of women age 65–70 ranged from
60% (grip and key pinch) to 67% (three-jaw-chuck pinch) of the men’s values. In
the 85+ age group, the ratio between women’s and men’s hand strength ranged from
76.9% (tip left) to 90% (left key pinch). When contrasting our female:male ratio
data with the literature, we found that our 65–70 age group female:male ratio values
are similar to those calculated from the normative data published by Mathiowetz
et al. (1985), which range from 54% (left grip) to 68% (left tip pinch). Our 75–80
age-group values (60–76%) are similar to the female:male ratio calculated for the
75+ age group by Mathiowetz et al. (1985; 60–68%) and Horowitz et al. (1997;
61%) and are slightly higher than values reported by Bassey and Harries (1993;
55–57%). On the other hand, grip-force and pinch-force ratio for our 80–84 age
group (81% right and left grip and 59% to 72% pinch force) are higher than the
58% ratio calculated from the normative values presented for the 80+ age group of
Desrosiers et al. (1995). The study sample from Desrosiers et al. was drawn from
an electoral list in Quebec and might represent the general population better than
our sample of participants who attended educational settings such as health fairs in
Texas. Our study confirms that the grip and pinch force of women is weaker than
that of men, although the difference is almost negligible for the very old. When
assessing reports in the literature, it appears that a preponderance of studies support
the finding that men experience a larger percent strength loss than women. Our
results lend credence to that assumption.
Our sample confirmed, in a cross-sectional way, that women appear to maintain
strength better than men. The 85+ age group’s hand strength relative to the 65–70
age group’s baseline hand strength decreased from 33% (fingertip pinch) to 41%
(grip) in men and from 13% (fingertip pinch) to 28% (grip) in women. Our results
also are in line with findings that indicate a greater loss in muscle mass in men than
in women (Gallagher et al., 1997; Hughes et al., 2001; Newman et al., 2003) with
advancing age, but they do not support the 2% decline for men and women alike in
the cross-sectional data by Bassey and Harries (1993). The results observed in our
cross-sectional study cannot be compared with findings in longitudinal studies in
which the same participants were followed over time. Future studies are needed to
 Hand Forces of Adults Over 65 Years of Age   37

confirm the pinch-force observations of Bassey and Harries, who reported a greater
decline of handgrip strength in women (19%) than in men (12%), and of Su et al.
(1995), who reported a decline of 10–16% in men and 10–19% in women.
We did study the force application in grip and pinch measures as representa-
tive of muscle performance, but we did not assess muscle-tissue characteristics.
Nonetheless, our results in muscle-force application seem to mirror others’ findings
on the level of muscle-tissue assessment. The female:male ratio in the force applied
by well elderly in our and the cited comparison studies for groups around 70 years
of age is similar to the female:male ratio in skeletal-muscle-mass measurement
in the study by Janssen, Baumgartner, Ross, Rosenberg, and Roubenoff (2004),
who reported that the skeletal-muscle mass of men was 40% higher than that of
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women for participants in the 70-year age group. Other studies support the greater
loss observed of strength and muscle quality in the upper extremity for men than
for women over time (Hughes et al., 2001; Newman et al., 2003). The female:male
ratio for our oldest groups was quite different from that of the 70-year age group.
The ratio of our 85+ age group exceeded 77% for left tip pinch and ranged from
84% to 91% for all other hand-strength measures. Future studies are needed on a
muscular level, as well as on an applied force-production level, to contrast with
our data for the very old.
Our study does not provide cutoff points in grip and pinch force that can be used
to determine whether a person is at risk of developing a disability to perform basic
activities of daily living analogous to skeletal-muscle cutoff points presented by
Janssen et al. (2004). Nonetheless, we can compare our scores with those obtained
in elderly patients. Shechtman et al. (2004) provided grip-force values for a group
of frail elderly as part of a larger study, the University at Buffalo Assessment
Study. Participants were recruited from various sources, such as home-health-care
centers or rehabilitation hospitals, where patients sought medical and rehabilitative
care to improve their functioning. Four patient groups were defined (minimally
impaired, visually impaired, motor impaired, and cognitively impaired), and three
age categories designated (60–69, 70–79, and >80 years). We calculated the ratio
between the mean frail grip force per age group and gender and the mean scores
of our sample for each patient-type group. In comparison with our sample, the
frail elderly grip ratio for women ranged from 97% for minimally impaired to
58% for the maximally impaired group for the oldest participants; the younger
group’s ratio ranged from 84% to 63%. Frail elderly ratios for men ranged from
97% for the minimally impaired to 87% for the oldest participants and from 83%
to 55% in the younger participants. These scores cannot be used as cutoff points,
but they demonstrate that the mean grip force of our sample of well elderly came
very close to the force of minimally impaired persons. It has been stated that based
on muscle distribution, women have a smaller percentage of muscle in their arms
than do men and therefore have less available to lose (Hughes et al., 2001). Hand
strength of the women in our sample was indeed less than men’s, but based on our
comparisons with this impaired population, it cannot be confirmed that healthy
women have less to lose, because percentage differences between the healthy and
impaired groups’ means were similar in men and women. Future studies are needed
to establish cutoff points of grip and pinch force that are related to the capability
of elderly patients to resume an independent lifestyle or decrease their level of
dependency on caregivers.
 38   Jansen et al.

Our study had its limitations. We had hoped to have a broader representation
of major racial and ethnic groups, but we ended up with mostly White participants,
thus limiting generalizability of the data. Ethnic differences in muscle characteristics
have been found in previous studies (Gallagher et al., 1997; Newman et al., 2003).
We found no studies that assessed ethnic differences for grip and pinch force, and
future studies are definitely needed to see whether potential differences are clini-
cally relevant. In addition, we had wanted a more even number of participants in
each age group, and future studies should be sure to include a larger number of
very old participants.
Another factor of note is that our study had missing data on reported hand
dominance (41 participants). The proportion of the recorded hand dominance of our
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sample was similar to other reported samples (Sperling, 1980; Su et al., 1995), with
174 right-hand-dominant and 5 left-hand-dominant participants (3%). We defined
handedness by the preference of the participant to use the hand for writing and to
throw a ball. As reviewed by Clerke and Clerke (2001), handedness is a nuanced
concept and might include not only hand preference but also skillfulness. We opted
to present our data for the right and left hands to be able to contrast our data with
those of other studies and also because the low number of left-hand-dominant
participants would not have allowed for group comparisons.
Our study did not investigate the impact of structured or habitual activity on
hand-strength measures in older adults. Reports indicate that men have a higher
activity level than women at a younger age (Chad et al., 2005; Hughes et al.,
2001) but decline their activity level more steeply in older age (Hughes et al.).
Further study of activity scales is needed to determine the most beneficial scale
for measuring impact of physical activity on strength in the upper extremity. For
instance, we do not know if a scale such as the Alumni Health Physical Activity
Questionnaire (Lee, Paffenbarger, & Hsieh, 1992), which focuses on metabolic
expenditure in a variety of sports and do-it-yourself job activities using the upper
extremities, would be more advantageous than a scale such as the Physical Activ-
ity Scale for the Elderly, which places some, but proportionally less, emphasis on
sports and proportionally more emphasis on housework. Future studies also are
needed to assess whether activity scales target men and women of different ethnic
backgrounds equally.
The data in our study were collected by trained students in physical therapy
and physician assistant studies, not by experienced clinicians, and this might have
affected the results. We also measured pinch and grip force only once. Even though
we provided some warm-up opportunity by applying three submaximal forces before
measuring maximum voluntary force, it might be that repeating the measurements
over a few days could result in higher values. Clinicians or researchers who want to
use our data as normative data are therefore encouraged to use the same standard
of testing when measuring grip and pinch force.

Conclusion
This cross-sectional study has extended our understanding of grip and pinch force
in older men and women between the ages of 65 and 92 years. Our most exciting
finding is that the gap between men’s and women’s grip and pinch force narrowed
 Hand Forces of Adults Over 65 Years of Age   39

and virtually disappeared in successively older age groups. When comparing our
hand-strength values with published reports of hand strength in frail elderly, we
observed that frail elderly hand strength approached scores of our healthy sample
for minimally impaired persons in men and women alike.
Additional normative data are needed to cover the broad racial and ethnic
scope of patients who present to hand therapists throughout the world. Further
research is needed to assess factors that affect hand strength in the elderly and
explore the implications of hand-strength loss for daily functioning. It is important
that researchers and clinicians include measurements of hand strength of older
individuals, such as grip and pinch force.
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