Long-term impact of sarcopenia on functional decline and mortality in community-dwelling older adults: a systematic review and meta-analysis

Abstract

Background: Sarcopenia is an age-related syndrome characterized by progressive loss of muscle mass and function. While it is considered a key predictor of adverse health outcomes, comprehensive evidence regarding its long-term impact on functional decline and mortality in community-dwelling older adults remains limited.

Objective: To evaluate the longitudinal association between baseline sarcopenia and risks of functional decline and all-cause mortality among community-dwelling older adults, with subgroup analyses based on methods of sarcopenia assessment and domains of functional decline.

Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 and MOOSE guidelines. Seven databases were searched from inception to September 30^th, 2025. We included cohort studies of older adults aged 60 years and above, with sarcopenia defined by recognized criteria, and reporting effect estimates for functional decline or mortality with follow-up for 1 year or longer. A meta-analysis based on heterogeneity was conducted using either common or random-effects models.

Results: A total of 39 studies involving 76151 participants were included. Sarcopenia was significantly associated with an increased risk of all-cause mortality (29 publications, OR = 1.79, 95%CI: 1.55~2.06) and functional decline (16 publications, OR = 1.90, 95%CI: 1.55~2.32). Subgroup analyses revealed consistent associations across different muscle mass assessment methods (DXA, BIA, and CT). Notably, sarcopenia was associated with both physical (OR = 1.91, 95%CI: 1.52~2.40) and cognitive/psychological functional decline (OR = 2.03, 95%CI: 1.35~3.05). Heterogeneity was moderate to high but did not substantially alter the results in sensitivity analyses.

Conclusion: This meta-analysis confirms that sarcopenia significantly predicts long-term functional decline and mortality in community-dwelling older adults, with robust associations across multiple muscle mass measurement methods and functional domains. These findings highlight the importance of standardized sarcopenia screening and early intervention to mitigate long-term functional impairment and mortality risk in aging populations.

Clinical trial registration: PROSPERO (ID CRD42024595362).

Keywords: aging; community-dwelling; functional decline; meta-analysis; mortality; sarcopenia.