Sarcopenia in Tenerife: Prevalence, Multidimensional Vulnerability, and the Socio-Economic Case for Prevention and Treatment

1. Introduction

Sarcopenia—operationally defined by reduced muscle mass combined with low muscle strength and/or diminished physical performance—has been increasingly recognised as one of the defining geriatric syndromes of the twenty-first century [1,2]. First formally described by Rosenberg [3] and subsequently standardised by the European Working Group on Sarcopenia in Older People (EWGSOP2; Cruz-Jentoft et al. [1]), the condition affects an estimated 10–27% of community-dwelling older adults globally, with prevalence rising sharply beyond the age of 80. A recent systematic review and meta-analysis of 35 studies estimated global sarcopenia prevalence at 10.0% in community-dwelling adults [4]. In Spain, national epidemiological surveys—including the ELES (Longitudinal Study on Ageing in Spain) cohort—estimate prevalence between 14.7% and 33.6% depending on diagnostic criteria, setting, and age structure [5].

Ageing island populations present particular epidemiological and socio-economic challenges that are not fully captured by mainland-calibrated models. The Canary Islands, classified as an ultraperipheral region under Article 349 of the Treaty on the Functioning of the European Union (TFEU), combine an ageing demographic structure, structural dependence on tourism, geographic isolation, and a fragmented territorial health infrastructure [6]. Tenerife—the most populous island of the archipelago, with approximately 930,000 inhabitants—is thus a critical site for understanding how sarcopenia intersects with social vulnerability, health system capacity, and economic sustainability.

Beyond its clinical dimensions, sarcopenia imposes a substantial socio-economic burden through multiple pathways: elevated rates of falls and fractures leading to hospital admission, progressive functional dependence and institutionalisation, increased demand for informal caregiving, heightened use of primary and specialist care, and premature mortality [7,8]. Global estimates of the annual economic burden of sarcopenia range from USD 18.5 billion in the United States [9] to over EUR 50 billion across the European Union [10], though subnational and island-specific estimates remain poorly characterised.

The socio-economic case for sarcopenia prevention is equally compelling from a cost-effectiveness standpoint. Evidence from randomised controlled trials and meta-analyses consistently demonstrates that resistance exercise training, protein supplementation, and combined multicomponent interventions can reduce sarcopenia incidence by 25–55%, with cost-per-quality-adjusted life year (QALY) ratios far below standard willingness-to-pay thresholds [11,12]. Yet these interventions remain systematically under-deployed in primary care settings, particularly in peripheral and island territories where health service provision is structurally constrained [6].

This study addresses four interrelated objectives: (i) to characterise the prevalence of sarcopenia risk in community-dwelling older adults in Tenerife using the validated SARC-F screening tool, stratified by sex, age group, comorbidity, and health zone; (ii) to map the multidimensional vulnerability profile of the affected population; (iii) to estimate the direct and indirect economic costs of sarcopenia at island and national levels; and (iv) to evaluate the cost-effectiveness of available prevention and treatment strategies and derive policy implications for the Canarian and Spanish health systems.

2. Materials and Methods

2.1. Study Design and Setting

This cross-sectional epidemiological study was conducted in Tenerife, Canary Islands, Spain, within primary care health centres across three health zones (Zonas de Salud 1, 2, and 3). Data collection was carried out under the framework of the BLUMI-Med project's integrated sustainability assessment protocol for local health systems.

2.2. Participants

A total of 374 community-dwelling older adults aged 75 years and above were enrolled. Participants were recruited through their affiliated primary care centres and stratified into two study arms: Group 1 (control; n = 274), comprising individuals without a prior diagnosis of chronic disease-related functional decline, and Group 3 (case; n = 100), comprising individuals with established multimorbidity and functional limitations. Group numbering follows the original BLUMI-Med project protocol; Group 2 was allocated to a separate arm not included in the present analysis. Exclusion criteria included acute illness at time of assessment, cognitive impairment severe enough to preclude informed consent, and inability to complete the physical assessment battery. The mean age of the total sample was 80.4 years (SD 4.8; range: 75–97 years); 51.1% were female. Body mass index (BMI) was calculated as weight in kilograms divided by height in metres squared; mean BMI was 24.7 kg/m².

2.3. Sarcopenia Screening: SARC-F Questionnaire

Sarcopenia risk was assessed using the SARC-F questionnaire [13], a validated five-item self-report screening tool covering Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls. Each item is scored 0–2, yielding a maximum total score of 10; scores ≥4 indicate sarcopenia risk. The SARC-F has demonstrated high specificity (>75%) and acceptable sensitivity (>60%) for sarcopenia diagnosis confirmed by muscle mass measurement, and is recommended for population-level screening by EWGSOP2 [1].

2.4. Complementary Clinical Assessments

A multi-domain geriatric assessment battery was administered to all participants. Frailty was evaluated using the FRAIL scale [14] (five components: fatigue, resistance, ambulation, illness, and loss of weight; scores: 0 = robust, 1–2 = pre-frail, ≥3 = frail). Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF [15]; scores: 12–14 = normal, 8–11 = at nutritional risk, 0–7 = malnourished). Functional independence was measured with the Barthel Index [16] (0–100; categorised as independent ≥90, mild dependence 60–89, moderate dependence 40–59, severe dependence <40). Cognitive function was evaluated using the Pfeiffer Short Portable Mental Status Questionnaire [17] (0–2 errors = no impairment, 3–4 = mild, 5–7 = moderate, ≥8 = severe). Physical performance was measured with the Short Physical Performance Battery (SPPB [18]; 0–12, four performance categories). Grip strength was measured bilaterally using a hand-held dynamometer, with sex-specific cut-offs consistent with EWGSOP2 criteria [1] (women: <16 kg; men: <27 kg). Physical activity was assessed using the short form of the International Physical Activity Questionnaire (IPAQ [19]), yielding metabolic equivalent (MET)-minutes per week and categorical activity levels (inactive, low, moderate, and high).

2.5. Economic Cost Estimation

Direct healthcare costs attributable to sarcopenia were estimated by multiplying sarcopenia-attributable healthcare utilisation rates (from published systematic reviews and Spanish health administrative data) by unit costs derived from the Ministerio de Sanidad's 2022 health accounts [20] and IMSERSO's 2022 long-term care expenditure report [21]. Indirect costs—including informal care burden and productivity losses among working-age caregivers—were estimated using replacement cost and human capital methodologies, respectively. Tenerife-specific extrapolations applied island-level population denominators for the over-75 age group (approximately 65,000 individuals; INE 2023 [22]). All monetary values are expressed in 2023 euros.

2.6. Cost-Effectiveness Modelling

Intervention cost-effectiveness was assessed using published meta-analytic data on the efficacy and per-patient costs of seven categories of sarcopenia prevention and treatment. Cost-per-QALY ratios were estimated using a simplified decision-analytic framework assuming a 5-year time horizon, a 3% annual discount rate, and utility weights derived from EQ-5D-based mapping from sarcopenia severity categories [10,11]. Interventions were graded: A (≤EUR 10,000/QALY, strong evidence), B (EUR 10,001–20,000/QALY, moderate evidence), or C (EUR 20,001–25,000/QALY, limited evidence).

2.7. Statistical Analysis

Descriptive statistics are reported as frequencies and percentages for categorical variables, and means with standard deviations for continuous variables. Between-group comparisons used chi-squared tests for categorical variables and independent-samples t-tests or Mann–Whitney U tests for continuous variables as appropriate. Odds ratios with 95% confidence intervals were calculated for key risk factors. Binary logistic regression was used to explore independent predictors of sarcopenia risk, adjusting for diabetes status, sex, age group, and health zone simultaneously. All analyses were conducted in R (version 4.3.1; R Core Team, Vienna, Austria [23]). Statistical significance was set at p < 0.05.

3. Results

3.1. Participant Characteristics

Table 1 presents the socio-demographic and clinical characteristics of the 374 participants. The case group (Group 3) was significantly older than controls (82.3 vs. 79.7 years, p < 0.001) and had a higher proportion of males (58.0% vs. 45.6%, p = 0.045). Diabetes mellitus was present in 43.6% of all participants. Mean BMI was 24.7 kg/m². Multidimensional vulnerability was pervasive: 71.4% were classified as frail, 56.6% had nutritional compromise, 89.8% reported low or inactive physical activity, and 54.5% exhibited moderate-to-severe functional dependence on the Barthel Index.

3.2. Sarcopenia Prevalence: Overall and Subgroup Analyses

Overall, 136 participants (36.4%) screened positive for sarcopenia risk (SARC-F ≥4). The distribution of SARC-F total scores showed progressive accumulation at higher score ranges; 34.3% of all participants scored ≥6 points. Prevalence differed markedly across analytical subgroups (Table 2).

The most striking finding was the divergence between study groups: 83.0% of case participants (Group 3) exceeded the sarcopenia risk threshold compared with only 19.3% of controls (Group 1), yielding a crude odds ratio of approximately 21.5 (p < 0.001). Within the case group, Group 3 males had the highest prevalence at 87.9% (51/58), while Group 3 females showed 76.2% (32/42); corresponding figures in the control group were 20.8% (26/125) and 18.1% (27/149) for males and females, respectively. Across the overall sample, prevalence was higher among males (42.1%) than females (30.9%), with grip strength dynamometry confirming that 63.9% of men and 24.1% of women exhibited low grip strength.

Diabetes mellitus was associated with significantly elevated sarcopenia risk (44.8% vs. 29.9%; OR 1.90, 95% CI 1.23–2.92; p = 0.003). Territorial heterogeneity was pronounced: Health Zone 1 exhibited a prevalence of 63.0%, compared with 23.5% in Zone 2 and 32.8% in Zone 3. Age-stratified analysis showed broadly consistent prevalence across age bands—34.4% in the 71–75 year group, 36.1% in 76–80 years, 38.1% in 81–85 years, 34.8% in 86–90 years, and 42.9% in participants aged ≥91 years (n = 14), though small cell sizes limit interpretation in the oldest group.

3.3. Multidimensional Vulnerability Profile

Frailty co-occurrence was near-universal: 71.4% of participants were classified as frail (FRAIL score ≥3), 27.0% as pre-frail, and only 1.6% as robust. Nutritional compromise was widespread: 55.3% screened positive for malnutrition risk on MNA-SF (score 8–11) and a further 1.3% were malnourished (score 0–7); only 43.3% had normal nutritional status. Cognitive impairment was present in 58.8% (Pfeiffer 5–7 errors), with clinical significance for adherence to self-managed exercise and dietary prescriptions. Physical inactivity was the most prevalent modifiable risk factor: 89.8% of participants fell below recommended physical activity thresholds, with 4.5% completely sedentary. The SPPB revealed that 12.6% (n = 47) showed severe physical limitation (Category 1) and 26.2% (n = 98) showed moderate limitation (Category 2), together indicating that 38.8% of participants had clinically meaningful gait, balance, and lower-limb strength impairments.

3.4. Economic Burden of Sarcopenia in Tenerife

Applying the study's overall prevalence estimate (36.4%) to Tenerife's population aged ≥75 years (approximately 65,000 individuals; INE 2023 [22]), we estimate approximately 23,660 individuals are currently living with sarcopenia risk in Tenerife. Table 3 presents the estimated annual economic burden. The total annual socio-economic cost reaches approximately EUR 88.9 million for the island and EUR 12.1 billion nationally. Direct costs (primary care, hospitalisations, rehabilitation, nutritional supplementation, and long-term care) account for approximately 55.7% of the total burden (EUR 49.5 million in Tenerife). Indirect costs (informal care burden and productivity losses) contribute a further 44.3% (EUR 39.3 million). Long-term care and institutionalisation represents the single largest cost category (EUR 31.0 million in Tenerife; EUR 4.20 billion nationally). Applying a conservative 60% reducibility estimate consistent with multicomponent intervention evidence [24], approximately EUR 53.3 million annually in Tenerife could theoretically be averted through widespread evidence-based prevention.

3.5. Cost-Effectiveness of Prevention and Treatment

Table 4 summarises the cost-effectiveness profiles of eight intervention categories. Multicomponent exercise–nutrition programmes demonstrated the most favourable cost-per-QALY ratios (EUR 3,800–7,000), with break-even horizons of one to two years. Primary care-based SARC-F screening (EUR 18–35 per screen) achieved cost-per-QALY ratios below EUR 2,800. Resistance exercise training alone (EUR 480–820/patient/year) yielded ratios of EUR 4,200–8,500/QALY, while protein supplementation programmes (EUR 290–550/year) achieved EUR 5,100–9,200/QALY. All Grade A interventions fall substantially below Spain's conventional cost-effectiveness threshold of EUR 25,000/QALY.

4. Discussion

4.1. Prevalence in Context

The 36.4% overall sarcopenia risk prevalence observed in this Tenerife sample substantially exceeds estimates from most comparable European community-based studies. Population-level SARC-F-based estimates from the SHARE study range from 7.3% to 27.4% across European nations [25], while Spanish-specific estimates from the ELES cohort approximate 25–30% in the over-75 age group [5]. Our higher estimate likely reflects the composition of our sample—including a case group with established multimorbidity—as well as the advanced mean age of 80.4 years and structural socio-economic characteristics of the Canarian population. The 83.0% prevalence in Group 3 is particularly striking and consistent with the known relationship between multimorbidity burden and sarcopenia risk, forming a self-reinforcing cycle of malnutrition, physical inactivity, metabolic dysregulation, and functional decline.

4.2. Territorial Inequalities and the Health Zone Effect

The three-fold difference in sarcopenia risk prevalence between Health Zone 1 (63.0%) and Zone 2 (23.5%) is one of the study's most policy-relevant findings. This territorial gradient reflects the well-documented relationship between place-based socio-economic deprivation and accelerated biological ageing [26], operating through cumulative disadvantages in nutrition quality, access to physical activity infrastructure, and healthcare utilisation. Within the Canarian health system, Zone 1 health centres typically serve urban-peripheral or rural populations with lower median income and more limited access to community exercise facilities, underscoring the need for place-based health equity interventions.

4.3. The Compound Geriatric Vulnerability Nexus

A distinctive contribution of this study is its simultaneous documentation of sarcopenia risk within a multi-domain vulnerability profile. The constellation observed—sarcopenia risk (36.4%), frailty (71.4%), nutritional compromise (56.6%), cognitive impairment (58.8%), physical inactivity (89.8%), and functional dependence (54.5%)—constitutes a mutually reinforcing compound geriatric vulnerability nexus with significant implications for clinical management and economic modelling. Standard cost-of-illness models that treat sarcopenia as a single-disease entity underestimate the full economic burden by failing to account for interaction effects that compound care needs and accelerate institutionalisation. The 58.8% prevalence of moderate cognitive impairment is particularly important: individuals with cognitive limitations require supervised rather than self-managed exercise and dietary prescriptions, substantially increasing per-patient costs and constraining intervention reach.

4.4. The Economic Case for Prevention

The economic argument for sarcopenia prevention is robust across multiple analytical frameworks. From a health economics perspective, all Grade A interventions identified meet cost-effectiveness thresholds by a wide margin, with break-even horizons of one to two years. The estimated EUR 53.3 million annual preventable burden in Tenerife alone—against an investment requirement of perhaps EUR 10–15 million for broad intervention coverage—implies a return on investment of three to five times within a five-year window. These findings align with European multicomponent intervention programmes such as SPRINTT [27] and with evidence-based advocacy analyses demonstrating high returns from prevention investment [28]. The long-term care and informal care burden estimated here (EUR 53 million combined in Tenerife) also represents a form of socio-economic cost systematically underestimated in GDP-based accounting, predominantly borne by female family members outside formal healthcare expenditure tracking.

4.5. Policy Implications

Five concrete policy recommendations emerge: (i) universal SARC-F screening should be integrated into annual over-75 health checks in the Canarian primary care system at an annual cost of approximately EUR 1.2–2.3 million—less than 3% of the estimated annual sarcopenia burden; (ii) multicomponent exercise–nutrition programmes should be systematically commissioned through Zone 1 health centres with subsidised access to overcome socio-economic barriers; (iii) diabetes management protocols should explicitly incorporate musculoskeletal health monitoring given the nearly two-fold higher sarcopenia risk in diabetic participants; (iv) care pathways for the 71.4% classified as frail should integrate sarcopenia management alongside falls prevention, nutritional support, and cognitive stimulation; and (v) territorial burden gradients call for differentiated resource allocation formulas within the Canarian health funding distribution rather than per-capita allocations that ignore compound Zone 1 vulnerability.

4.6. Strengths and Limitations

Strengths of this study include its comprehensive multi-domain assessment battery, reasonable sample size for an island-specific context, use of validated internationally standardised instruments, and integration of economic burden estimation with epidemiological findings. Limitations include: (i) SARC-F-based estimates reflect sarcopenia risk rather than confirmed sarcopenia diagnosis—the gold standard of low muscle mass (measured by DXA or BIA) combined with low grip strength or poor physical performance [1] was not available for all participants, and SARC-F has lower sensitivity than diagnostic algorithms; (ii) the cross-sectional design precludes causal inference; (iii) the sample composition—including a high-multimorbidity case group—produces higher overall prevalence than a purely population-representative sample would (users should apply Group 1's 19.3% as a conservative lower bound for general population planning); (iv) economic cost estimates involve extrapolation uncertainties and rely on average unit costs that may not reflect island-specific resource utilisation patterns; and (v) the BLUMI-Med project protocol did not include a formal Group 2 arm, limiting comparisons across a full health-functional status spectrum. Future studies should incorporate longitudinal follow-up, objective muscle mass measurement, island-specific unit cost surveys, and caregiver burden data.

5. Conclusions

This study establishes that sarcopenia risk affects more than one in three community-dwelling older adults in Tenerife, rising to four in five among those with established multimorbidity. It is systematically co-embedded within a nexus of frailty, malnutrition, cognitive impairment, physical inactivity, and functional dependence that collectively define a compound geriatric vulnerability of major public health significance. The estimated annual socio-economic burden of nearly EUR 89 million for Tenerife confirms that sarcopenia is among the most economically costly under-addressed conditions in Spanish ageing policy.

The economic case for prevention is unambiguous: multicomponent exercise–nutrition programmes achieve cost-per-QALY ratios of EUR 3,800–7,000 against a national threshold of EUR 25,000, with break-even horizons of one to two years. Primary care SARC-F screening—at under EUR 35 per screen—represents one of the most cost-effective health investments available in this population. The territorial concentration of burden in Health Zone 1 calls for place-sensitive, equity-oriented resource allocation within the Canarian health system. These findings underscore the importance of integrating sarcopenia prevention within broader healthy-ageing frameworks for ageing island societies, where the fiscal and demographic stresses of population ageing intersect with structural constraints on public expenditure.