Purpose of Review <p>Frailty is a state or syndrome related to multidimensional loss of reserve that results in vulnerability to adverse health outcomes. In the perioperative setting, frailty is now recognized as a leading risk factor for early adverse clinical and patient-reported outcomes. As such, multiple guidelines strongly recommend that frailty assessment be performed for all older adults being considered for surgery. This review will synthesize the evidence for frailty assessment, including evidence-based selection of an appropriate multidimensional tool. Additionally, best available evidence and experience will be discussed to help clinicians overcome barriers to implementation of routine frailty assessment.</p> Recent Findings <p>Available evidence clearly demonstrates that routine preoperative frailty assessment is not performed and identifies barriers to frailty assessment for perioperative clinicians. Converging evidence supports clinicians choosing a frailty instrument from among the Clinical Frailty Scale, Risk Analysis Index, Edmonton Frail Scale, Frailty Index or Fried Phenotype.</p> Summary <p>Routine preoperative frailty assessment is guideline recommended and feasible. Choosing a practical, clinically oriented tool, or integration of an electronic or automated approach should help to overcome many identified barriers.</p>