Frailty assessment in perioperative geriatric patients: a narrative review

Frailty is increasingly recognized as a major determinant of perioperative risk in the geriatric population. It is characterized by reduced physiological reserve and impaired stress tolerance and arises from multisystem dysregulation involving chronic inflammation, neuroendocrine changes, sarcopenia, and organ dysfunction. Unlike chronological aging, frailty reflects biological vulnerability independent of comorbidity or disability and is strongly associated with postoperative complications, prolonged hospitalization, cognitive decline, and mortality. Therefore, early and systematic frailty assessment is essential to optimize perioperative management, support clinical decision-making, and implement tailored interventions. Multiple validated frailty assessment strategies exist, ranging from phenotypic models such as the Fried Frailty Phenotype to deficit accumulation tools such as the Frailty Index (FI). Practical bedside instruments, including the Clinical Frailty Scale, Edmonton Frail Scale, fatigue, resistance, ambulation, illnesses, loss of weight (FRAIL) questionnaire, modified FI, and disease-specific screening tools, enable rapid detection in clinical settings. Frailty assessment should be performed early and efficiently to facilitate targeted prehabilitation, nutritional optimization, and cognitive support, all of which have been associated with improved functional outcomes. It also informs individualized anesthetic strategies, including drug titration, hemodynamic stabilization, lung-protective ventilation, and delirium prevention. However, barriers to implementation—such as limited clinician awareness, time constraints, and lack of standardized protocols—continue to hinder routine use. Future integration may be accelerated by artificial intelligence, telemedicine, and digital monitoring technologies to enhance geriatric anesthesia. This review provides a comprehensive overview of frailty in geriatric patients, highlighting its definition, pathophysiology, assessment methods, and clinical impact.