Abstract: Objective To explore the differences in the risk of sarcopenia between home-based and institutional elder care models. Methods A convenience sampling method was employed to select 174 older adults from a nursing home and two communities in Shanghai between November 2023 and September 2024. The sample comprised 74 individuals in the institutional care group and 93 in the home-based care group. Propensity score matching (PSM) was utilized to balance baseline characteristics, resulting in 60 participants per group post-matching. The effects of the care model on the prevalence of sarcopenia, decline in muscle strength, and reduced physical performance were analyzed using t-tests, χ² tests, and a multivariate logistic regression model. The correlation between physical activity level, protein intake, and sarcopenia was also examined. Results The prevalence of sarcopenia was 15.00% in the institutional care group and 10.00% in the home-based care group, with no statistically significant difference observed between the two groups (P>0.05). After adjusting for covariates including gender, age, BMI, monthly income, chronic diseases (including cardiovascular disease, diabetes, and cerebrovascular disease), and degree of disability, the logistic regression analysis indicated a change in the odds ratio (OR) for sarcopenia risk in the institutional care model compared to the home-based model, from an original OR (95% CI) of 1.344 (0.789-2.291) to 1.261 (0.777-2.047). However, the care model did not have a significant effect on the risk of sarcopenia (P>0.05). The rates of decreased muscle strength and diminished physical performance were significantly higher in the institutional care group (51.67% and 56.67%, respectively) compared to the home-based care group (31.67% and 35.00%, respectively) (P<0.05). Following covariate adjustment, the logistic regression analysis revealed that the institutional care model was associated with an increased risk of decline in muscle strength and physical performance, with ORs (95% CI) of 1.444 (1.068-1.953) and 2.126 (1.423-3.175), respectively. Correlation analysis demonstrated a negative correlation between the level of physical activity and sarcopenia (r=-0.327, P<0.01), as well as between protein intake and sarcopenia (r=-0.284, P<0.01). Conclusion The institutional elder care model does not significantly increase the risk of sarcopenia among older adults but may exacerbate the decline in their muscle strength and physical performance. Insufficient physical activity and low protein intake are identified as risk factors for sarcopenia. These findings suggest that institutional care services should prioritize the maintenance and improvement of older adults' muscle function and physical activity capabilities, alongside enhanced nutritional support, to delay functional decline and improve quality of life.

Key words: Sarcopenia, Elder care model, Muscle function, Physical activity, Nutritional intake