Abstract: Objective: To analyze the frailty status and its influencing factors in elderly inpatients and compare the predictive value of the fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale and the Edmonton frail scale (EFS) for adverse outcomes. Methods: Based on a prospective cohort study design, 467 elderly medical inpatients were enrolled from the First Affiliated Hospital of Guangxi Medical University. Frailty status was assessed using the FRAIL scale and EFS. Influencing factors were identified through univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy of both scales for functional decline (decline in Katz index), full-time care needs, and mortality at 3 months post-discharge. Results: The incidence of frailty was 60.81% (284/467). Independent risk factors included divorce/widowhood (OR=7.75-8.10), low income (OR=2.62-17.46), frequent hospitalization (OR= 0.94-2.38), polypharmacy (OR=1.55), at nutritional risk (OR=14.62), decreased muscle strength (OR=0.35), high fall risk (OR=3.16) frequent falls (OR=2.26), and insufficient sleep (OR=0.58) (all P＜0.05). The FRAIL scale demonstrated moderate predictive efficacy for full-time care needs (AUC=0.636, cutoff=3.5), while the EFS showed high predictive efficacy for mortality risk (AUC=0.755, cutoff=5.5 points). Both scales exhibited limited predictive value for functional decline (AUC≤0.579). Conclusion: Frailty status of elderly medical inpatients is influenced by multidimensional factors. The FRAIL scale is suitable for the rapid screening of care needs, while the EFS is more effective for predicting mortality risk. In clinical practice, appropriate tools should be selected according to the purpose of assessments to optimize frailty management by integrating dynamic monitoring.