Frailty is a state of vulnerability resulting from decreased physiological reserve across multiple organ systems, impairing an individual's ability to withstand stressors. As the elderly population grows worldwide, the proportion of older adults undergoing surgical procedures continues to rise, and frailty is expected to become increasingly prevalent among surgical candidates.
Anxiety is one of the most common psychiatric conditions, affecting approximately one in three individuals globally. Preoperative anxiety may negatively influence surgical outcomes, particularly in older and more vulnerable patients.
This prospective observational study aims to evaluate the relationship between preoperative anxiety level and frailty score in elderly patients aged 65 years and older scheduled for elective hip arthroplasty. Frailty will be assessed using the FRAIL Scale (Fatigue, Resistance, Ambulation, Illness, Loss of Weight), and anxiety will be measured using the Hamilton Anxiety Rating Scale (HAM-A). Secondary outcomes include the prevalence of frailty and anxiety, the effect of frailty on length of hospital stay, postoperative intensive care unit admission rates, and the relationship between frailty and preoperative laboratory and hemodynamic parameters.
Patients of both sexes aged 65 years and older
Patients with ASA physical status classification I, II, or III scheduled for elective hip arthroplasty
Patients who voluntarily agree to participate in the study
Patients with intact orientation and sufficient cooperation for assessment
Patients with ASA physical status classification IV or V
Patients who refuse to participate in the study
Patients with impaired orientation or insufficient cooperation for assessment
Patients scheduled for emergency surgery
Patients aged 65 years and older of both sexes scheduled for elective total hip arthroplasty at the Anesthesiology and Reanimation Clinic of Başakşehir Çam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey. Participants were enrolled between December 2024 and June 2026.
Cohort
Prospective
Not listed
Association Between Frailty Score and Preoperative Anxiety Level
The primary outcome is to evaluate the relationship between frailty score assessed by the FRAIL Scale (Fatigue, Resistance, Ambulation, Illness, Loss of Weight; total score range 0-5) and preoperative anxiety level measured by the Hamilton Anxiety Rating Scale (HAM-A; total score range 0-56) in elderly patients aged 65 years and older scheduled for elective hip arthroplasty. A higher FRAIL Scale score indicates greater frailty, and a higher HAM-A score indicates greater anxiety severity.
Prevalence of Frailty
The proportion of participants classified as robust (FRAIL Scale score 0), pre-frail (score 1-2), and frail (score 3-5) within the study population.
Prevalence of Preoperative Anxiety
The proportion of participants classified as no anxiety (HAM-A score 0-5), minor anxiety (score 6-14), and major anxiety (score 15 and above) within the study population.
Correlation Between Frailty Score and Length of Hospital Stay
Correlation between frailty score assessed by the FRAIL Scale (score range 0-5, units on a scale) and total length of hospital stay (in days) from admission to discharge.
Correlation Between Preoperative Anxiety Level and Length of Hospital Stay
Correlation between preoperative anxiety level measured by the Hamilton Anxiety Rating Scale (HAM-A; score range 0-56, units on a scale) and total length of hospital stay (in days) from admission to discharge.
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