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Dr. Huang observes that in the very elderly, a serial decline in grip strength may signal that something bad is about to happen. I assume he means that the patient is likely to die in the near future. Arguably, the decline in grip strength is an inevitable change that will occur in the majority of octogenarians barring sudden death (or the development of immortality). From a population health perspective, advanced age at the time of death preceded by a decline in grip strength may be the best outcome one should hope for. An obvious conclusion not stated by Dr. Huang is that in frail and failing elderly patients, palliative goals should be integrated into the care plan.
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/5/423#316127