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Abstract Introduction Frailty and fall risk predict perioperative complications and recovery outcomes in older adults. Gait speed, recognised as the ‘sixth vital sign,’ is a critical health indicator but often underutilised due to measurement challenges. This study evaluates gait speed as a frailty assessment tool, leveraging artificial intelligence (AI)-enabled mobile technology for precision and accessibility. Methods A cohort of 24 adults (median age 79 years [IQR: 76–82], 45.8% male) was assessed. Gait speed (mean: 1.07 m/s [SD: 0.38], ≤0.8 m/s in 20.8%) was measured using AI-enabled mobile technology GaitKeeper. Other measures included Fear of Falling (FOF; 45.8% positive), the Falls 3 Key Questions (Falls 3KQ; 50% high risk), the Charlson Comorbidity Index (CCI; median: 5.0 [IQR: 4.0–7.0]), the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI), the Clinical Frailty Scale (CFS) and the EQ-5D-5L health questionnaire. Results Gait speed strongly correlated with frailty, including SHARE-FI (r = −0.623, p = 0.001) and CFS (r = −0.741, p < 0.001), and showed a moderate negative correlation with CCI (r = −0.472, p = 0.020). Participants with moderate (U = 3.000, p = 0.021) and severe mobility impairment (U = 3.000, p = 0.021) had slower gait speeds than those without self-reported mobility issues. However, gait speed did not significantly differentiate between individuals with and without FOF (p = 0.769). Conclusions Gait speed is a well-established indicator of frailty and multimorbidity, yet its clinical adoption is limited by practical challenges in measurement. AI-enabled mobile technology, like GaitKeeper, offers a scalable, objective solution to integrate gait speed assessment into routine preoperative evaluations. Its implementation alongside frailty indices may enhance risk stratification, enabling timely interventions to optimise perioperative outcomes.