Is Muscle Mass Enough? Rethinking Physical Assessment Priorities in Community-Dwelling Older Adults

Objective: Current geriatric assessments emphasize muscle mass; however, its relationship with functional performance in community-dwelling older people remains unclear. This study examined whether muscle mass alone sufficiently predicts physical function and aimed to identify complementary assessment parameters. Design: Cross-sectional study following Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methods: Forty-nine people aged ≥65 years were enrolled. Body composition was assessed using bioelectrical impedance measurements. Physical performance included handgrip strength, muscle tone and stiffness, balance via single-leg stance, and the Short Physical Performance Battery (SPPB). Sarcopenia, cognitive decline, and frailty were assessed using the Physical performance was assessed through measures of muscle strength, muscle tone, balance, and overall functional performance. Sarcopenia, cognitive decline, and frailty were evaluated using standardized questionnaires. Pearson’s correlations and group comparisons were performed. Results: Muscle mass and functional performance were not associated. The skeletal muscle index was strongly correlated with handgrip strength (r=0.584, p<0.001) but not with balance. Body mass index was positively correlated with handgrip strength (r=0.370, p<0.01) and negatively with balance (r=-0.438, p<0.01). Visceral fat area independently predicted frailty (r=0.436, p<0.01). The vastus medialis oblique to vastus lateralis tone ratios had strong bilateral correlations (r=0.817–0.929, p<0.001), suggesting that neuromuscular symmetry was preserved despite aging. Conclusions: Muscle mass alone is insufficient for evaluating the physical health of older people. Comprehensive assessments that incorporate balance, body composition, and muscle quality parameters can provide more accurate insights into functional capacity. These findings highlight the requirementfor multidimensional evaluation strategies to guide geriatric health-management practices.