A Pragmatic Two-Step Screening Algorithm for Sarcopenia and Frailty in Community-Dwelling Older Adults: A Cross-Sectional Population-Based Study

Sarcopenia and physical frailty are interconnected geriatric syndromes that frequently coexist in older adults, sharing common pathophysiological pathways. However, their early detection in community settings is limited by resource constraints and by the lack of simplified, scalable diagnostic tools. This cross-sectional study aimed to estimate the prevalence and overlap of sarcopenia and frailty in a real-world public health screening programme and to evaluate the diagnostic performance of a pragmatic two-step algorithm. In September 2025, a total of 256 consecutive community-dwelling adults aged ≥65 years underwent standardized assessment using the SARC-F questionnaire, handgrip strength dynamometry, and selective bioelectrical impedance analysis (BIA). Sarcopenia was defined according to 2019 EWGSOP2 criteria, and frailty according to the Fried phenotype. Confirmed sarcopenia was identified in 37 participants (14.5%, 95% CI 10.7-19.1%) and frailty in 31 (12.1%, 95% CI 8.6-16.7%), with substantial overlap (77.4% of frail individuals also had sarcopenia; Cohen's κ = 0.62). The two-step algorithm (Step 1: SARC-F ≥ 4; Step 2: handgrip strength and BIA only in screen-positive participants) demonstrated excellent accuracy for confirmed sarcopenia (AUC 0.913, 95% CI 0.871-0.955), with sensitivity 91.9%, specificity 81.3%, and a 53.9% reduction in BIA use. Factors independently associated with confirmed sarcopenia included older age, BMI < 22 kg/m², physical inactivity, and higher SARC-F score. A simple, function-centered two-step approach enables efficient and scalable identification of sarcopenia and frailty in community settings, supporting early preventive strategies to preserve physical function.