Prevalence of Frailty Among Adult Inpatients at a Teaching Hospital in the Kurdistan Region of Iraq

Introduction
Frailty is a clinical syndrome characterised by reduced physiological reserve associated with poor hospital outcomes. Limited epidemiological data exists in Middle Eastern populations, specifically the Kurdistan Region of Iraq. This study aimed to determine frailty prevalence and predictive factors among inpatients in Rizgary Hospital, Erbil, addressing a regional evidence gap.

Method
A cross-sectional observational study was conducted of 162 inpatients (mean age: 72.4±8.7 (82 male, 80 female)), at Rizgary Hospital between December 2024 and March 2025. Frailty was assessed using the Clinical Frailty Scale (CFS), defining frailty as CFS ≥5, alongside validated functional measures and a 5-component Fried phenotype questionnaire. Multivariable logistic regression identified independent associations. 

Results
Frailty prevalence was 77.2% (125/162, 95% confidence interval (CI): 70.1-83.3%). Prevalence increased with age: 27.3% (50-64 years), 75.5% (65–74), 98.0% (75–84), and 100% (≥85) (p<0.001). Frailty prevalence was greater in females (88.8% vs 65.9% males, adjusted odds ratio (aOR): 3.8, 95% CI: 1.4–10.7). Polypharmacy (≥5 medications), affecting 66%, showed the strongest association with frailty (aOR 21.7, 95% CI: 8.2–58.0). Multimorbidity (≥3 chronic conditions) independently predicted frailty (aOR 6.6, 95% CI: 2.9–14.8). Among patients with diabetes mellitus (DM), 97% of participants aged ≥75 met frailty criteria. Greater frailty prevalence was identified with co-existing hypertension and DM (n=42) than isolated DM (90.5% vs 48.0%, p<0.001). Frail patients were more likely to have a history of previous admission relative to non-frail patients (76.0% vs 32.4%, p<0.001).

Conclusions
Frailty was highly prevalent among hospitalised adults in this teaching Kurdish hospital with associations with female sex, polypharmacy, multimorbidity and increasing age. Higher frailty prevalence among patients with DM co-existing with advanced age or hypertension highlighted a vulnerable subgroup. Routine frailty screening on admission, supported by medication review and functional assessments may aid identification of high-risk patients and support holistic inpatient assessment.