The hidden cost of hospitalization: muscle loss and functional decline in older adults

Lee Eun-ju, professor of geriatrics / Courtesy of Asan Medical Center

Many older adults fear leaving the hospital more than entering it. That’s because they know what often comes next: not a return to independent living, but a move to a care facility or a new reliance on family caregivers.

For elderly patients, hospitalization is often a necessary part of treating illness — but it can also become a serious threat to quality of life and long-term recovery. One of the greatest yet most overlooked risks is sarcopenia, or the accelerated loss of muscle mass and strength that frequently occurs during a hospital stay.

Muscle loss in older adults doesn’t require weeks or months — it can happen in just days. When a patient over 70 is confined to bed, even for just 10 days, the synthesis rate of muscle protein in the legs drops by around 30 percent, and overall muscle mass decreases by more than 1 kilogram.

Another study found that healthy elderly individuals lost 6 percent of their muscle mass and 16 percent of their lower-body strength simply from 10 days of bed rest. In many cases, this loss is irreversible. Patients who could walk on their own before admission may find themselves dependent on a cane — or unable to walk at all — by the time they’re discharged.

This physical decline has serious ripple effects. Muscle weakness and poor balance significantly increase the risk of falls, which can result in fractures, particularly of the hip. Delirium, which affects 20 to 40 percent of hospitalized older adults, further limits movement and contributes to a vicious cycle of immobility and accelerated decline.

Other complications such as pressure sores, aspiration pneumonia, deep vein thrombosis and urinary incontinence are also more likely in bedbound patients. These conditions not only extend hospital stays but also raise the risk of mortality.

What’s needed is a shift in mindset: from a disease-centered approach to a function-centered, integrated model of care. As our population ages, elderly-friendly systems must become the standard — not the exception. Four strategies are particularly important:

First, hospitals should implement Comprehensive Geriatric Assessment (CGA) for all older inpatients. This approach assesses function, cognition, nutrition, medication and social support to create a tailored treatment plan. It helps predict and prevent functional decline and guides care both during hospitalization and after discharge.

Second, early movement is essential. Elderly patients must be encouraged to get out of bed, and rehabilitation programs should begin as soon as possible. Physical therapists should intervene early to help maintain balance and lower-limb strength, reducing the risk of falls and sarcopenia.

Third, nutritional support must begin at admission. For adults aged 65 and older, a daily protein intake of 1.2 to 1.5 grams per kilogram of body weight is recommended. Early dietary intervention and protein supplementation are key to preserving muscle mass.

Fourth, families and caregivers need to be educated. They should be made aware that mobility and nutrition are directly tied to recovery. Their engagement during hospitalization — and preparation for post-discharge care — can prevent unnecessary long-term stays and help ensure a smoother recovery at home.

Hospitalization for elderly patients carries serious and often invisible risks. Sarcopenia and functional decline are not just clinical concerns, they’re deeply personal and life-altering. The goal of medical care must expand beyond treating disease — it must include preserving function from day one. Early intervention and multidisciplinary collaboration are not optional in an aging society; they are essential.

This article from the Hankook Ilbo, the sister publication of The Korea Times, is translated by a generative AI system and edited by The Korea Times.