Actuality: An aging population, leading to an increase in the proportion of older people, is a major demographic trend of our time. Frailty concept was proposed in the early 2000s to characterize the state of depletion of the body’s internal reserves, which allows predicting a high risk of death and other adverse outcomes in the elderly and senile. According to foreign studies, the prevalence of frailty among people 65 years of age and older at home is on average about 10.7%, and prefrailty is 41.6% [5]. At the same time, there are not enough developments to manage older patients with this syndrome during surgical interventions on the abdominal organs [9]. Purpose: To study the preoperative risk factors for postoperative delirium associated with frailty in patients who underwent planned or emergency surgical interventions on the abdominal cavity. Material and methods: In total, 477 patients were included in the study. The risk factors were determined in patients with postoperative delirium and frailty, which underwent emergency surgery on the abdominal organs. Results: In patients with postoperative delirium with frailty, polypharmacy syndrome was much more common. Three groups of medications were identified according to their effect on postoperative delirium risk in association with frailty. When studying geriatric status, cognitive impairment, malnutrition, and uncorrected hearing and visual impairment increase the risk of postoperative delirium in frail patients. Risk factors were determined in frail patients with postoperative delirium during emergency surgery. Conclusions: 1. Somatic pathologies do not significantly increase postoperative delirium; polypharmacy syndrome is an additional factor in increasing the risk of postoperative delirium in frailty patients. 2. In frail patients, to reduce the risk of postoperative delirium during planned surgical interventions in the abdominal cavity, it is necessary to exclude or reduce the dosage of drugs (piracetam, furazemide, atropine, benzodiazepines), in the absence of contraindications, the use of pyribedil. 3. In frail patients, in order to reduce the risk of postoperative delirium during planned surgical interventions on the abdominal organs, it is necessary to study geriatric status and treatment of risk factors. 4. In frail patients after emergency surgery on the abdominal organs, the risk of postoperative delirium is significantly increased with a combination of risk factors: blood loss, duration of surgery for more than 3 hours, blood transfusion, pain for more than 3 hours, hypoalbunemia.