Association between sarcopenia and daily living dependency among middle-aged and older adults: findings from three prospective cohort studies

Background Sarcopenia is a prevalent, potentially modifiable geriatric syndrome that may accelerate functional decline. Prospective evidence connecting sarcopenia to subsequent dependency in activities of daily living (ADLs) across different countries remains limited. Methods This study analyzed data from three prospective ageing cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Survey of Health, Ageing and Retirement in Europe (SHARE). Sarcopenia classification was based on the Asian Working Group for Sarcopenia 2019 for CHARLS and the European Working Group on Sarcopenia in Older People 2 for ELSA/SHARE, categorizing participants into no sarcopenia, possible sarcopenia, or sarcopenia. The outcome was incident ADL inability. Cox proportional hazards models were employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustments for potential confounders. Results The final analysis included 31,094 participants: 8204 from CHARLS (49.0% female, mean age 61.4 years), 5155 from ELSA (54.0% female, mean age 65.2 years), and 17,735 from SHARE (52.7% female, mean age 62.2 years). In fully adjusted models, possible sarcopenia predicted ADL inability in CHARLS (HR 1.40, 95%CI: 1.29–1.51), ELSA (HR 1.52, 95%CI: 1.33–1.74), and SHARE (HR 1.33, 95%CI: 1.21–1.46). Sarcopenia showed similarly elevated risks in CHARLS (HR 1.44, 95%CI: 1.28–1.61), ELSA (HR 1.47, 95%CI: 1.25–1.73), and SHARE (HR 1.50, 95%CI: 1.34–1.68), all showing significant dose-response trends ( P for trend <0.001). Sensitivity analyses supported these findings. Conclusions Sarcopenia and even possible sarcopenia were associated with higher risks of incident ADL inability.