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Introduction Delirium is a common and serious complication among older adults hospitalized with acute stroke, and it is associated with increased morbidity, mortality, and prolonged hospital stays. Sarcopenia, characterized by a decline in muscle mass and strength, has emerged as a potential risk factor for delirium. However, there has been scarce research exploring this relationship in stroke populations. This study aimed to investigate the association between possible sarcopenia and the onset of delirium in older patients with acute stroke. Methods We conducted a retrospective cohort study of patients aged 65 years and older admitted to the Stroke Care Unit of a single institution between April 2020 and March 2021. Possible sarcopenia was defined using the AWGS2019 criteria based on grip strength and calf circumference. Delirium was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria by a certified dementia care team. Clinical characteristics and known delirium risk factors were extracted from medical records. Logistic regression analysis was performed to identify independent predictors of delirium. Results Of the 543 patients screened, 486 were included in the final analysis. Possible sarcopenia was identified in 187 patients (38.4%). Delirium occurred in 46 patients (9.4%), and its incidence was significantly higher in the sarcopenia group (15.0%) than in the non-sarcopenia group (6.0%, p=0.001). Multivariate logistic regression analysis revealed that possible sarcopenia was independently associated with delirium onset [odds ratio (OR): 1.98, 95% confidence interval (CI): 1.01-3.91, p=0.048], second only to a history of delirium. Conclusions Our findings suggest that possible sarcopenia is a significant and independent predictor of delirium in older patients with acute stroke. Early identification of sarcopenia may facilitate targeted interventions to reduce delirium risk and improve clinical outcomes in this vulnerable population.