Background: This study investigated the relationship between the Hospital Frailty Risk Score (HFRS) and geriatric syndromes in acute-care hospitals. Methods: A cross-sectional analysis was performed on 8,205 inpatients aged >= 65 years from November 1, 2016, to October 31, 2021. HFRS was determined using ICD-10 codes in the electronic medical records. Cognitive impairment, depression, polypharmacy, dysphagia, malnutrition, and pain were assessed by attending nurses within 48 h of admission. Results: The cohort consisted of 3,872 men and 4,333 women, averaging 74.4 and 75.4 years old, respectively. Patients in the highest HFRS tertile (Q3) showed significantly higher risks of cognitive impairment, depression, and polypharmacy after adjusting for age, sex, and body mass index than those in the lowest tertile (Q1). Conclusions: Elevated HFRS is significantly associated with increased risk of geriatric syndromes, highlighting its usefulness in identifying at-risk elderly patients in hospital settings without face-to-face assessments by medical staff. (c) 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)