The scope of frailty assessment tools in the middle east: unraveling gaps and trends

• 103 studies mapped the use of 11 frailty tools across 17 Middle Eastern countries • Fried phenotype (28%), FRAIL scale (16%), and CFS (13%) were most commonly used • 75% of studies used tools without validation for local populations or Arabic versions • No studies were found from 6 ME countries, revealing critical research inequities • Authors recommend Arabic tool translation, national guidelines, and clinical training Frailty is a multidimensional syndrome associated with increased risk of adverse health outcomes in older adults. As Middle Eastern populations age, validated frailty assessment tools (FATs) are essential to inform care planning. However, regional uptake and validation remain unclear. This scoping review aimed to map the use and validation of FATs among adults aged 55 and above in the Middle East, identify research gaps, and explore cross-country trends. Following PRISMA-ScR guidelines, a comprehensive literature search was conducted in May 2022 and updated in December 2024 across PubMed, Embase, Web of Science, and Scopus. Search terms targeted “frailty,” “geriatric,” and 17 Middle Eastern countries. Inclusion criteria comprised primary studies using or discussing FATs among adults aged 55+, conducted in or including a Middle Eastern country. Non-English/Arabic texts, non-primary literature, and studies lacking frailty definitions or tools were excluded. In total, 103 studies were included. The Clinical Frailty Scale (CFS) and Fried Frailty Phenotype (FFP) were the most commonly used tools, appearing in 36 and 32 studies respectively. However, only 12 studies reported tool validation, and just 7 conducted cultural adaptation. Research output was highest in Turkey (28 studies), Iran (17), and Saudi Arabia (14), while 6 countries had no studies. Most studies used FATs in hospital settings. Frailty research is growing in the Middle East but remains fragmented and under-validated. Standardized tools adapted to local contexts are urgently needed. Strengthening clinical care and policy will require greater regional collaboration and investment in culturally relevant research