Sarcopenia and Muscle Dysfunction in Older Adults with Burn Injuries: An Integrated Clinical Perspective

Sarcopenia is a progressive skeletal muscle disorder associated with impaired physical function and adverse outcomes in older adults. Burn injury imposes profound hypermetabolic and catabolic stress that may compromise muscle mass, strength, and physical function, particularly in individuals with reduced baseline muscle reserve. This narrative review integrates current evidence on sarcopenia and muscle dysfunction in older adults with burn injuries, addressing baseline vulnerability, burn-related muscle deterioration, diagnostic challenges, clinical implications, and therapeutic strategies. Patients may present with pre-existing sarcopenia or reduced muscle reserve, develop acute sarcopenia during or after burn-related illness, or experience worsening of pre-existing sarcopenia, potentially resulting in an acute-on-chronic trajectory. However, substantial burn-related muscle wasting, weakness, and functional impairment may occur without fulfilling diagnostic criteria for sarcopenia and represent distinct, clinically relevant manifestations of impaired muscle health. Sarcopenia assessment in burn patients is challenging and should be individualized according to clinical context and stage of recovery. Preservation and recovery of muscle health should be addressed throughout burn care through individualized nutritional support, early mobilization, and progressive exercise, with pharmacological strategies playing an adjunctive role. Prospective longitudinal studies are needed to characterize muscle-health trajectories, distinguish sarcopenia from other forms of post-burn muscle dysfunction, and determine their prognostic significance and response to interventions, including effects on functional recovery, independence, and quality of life.