Frailty is highly prevalent in elderly patients with chronic obstructive pulmonary disease (COPD), contributing to poor clinical outcomes and reduced quality of life. To examine the effects of grip strength, CAT score, multimorbidity, GOLD stage, and age on frailty for hospitalised elderly with COPD through path analysis. This cross-sectional study used convenience sampling to select 283 hospitalised patients from March to August 2024. Path analysis explored the direct and indirect effects among grip strength, CAT score, multimorbidity, GOLD stage, and age. Grip strength was measured with a digital dynamometer, CAT score assessed disease impact, multimorbidity was based on patient-reported diagnoses, and GOLD stage was determined by pulmonary function tests. Among 283 hospitalised elderly COPD patients, the prevalence of frailty was 33.92%. The path analysis model showed good fit (χ/df = 1.170, RMSEA = 0.027, 90% CI = 0.024-0.085, CFI = 0.992, TLI = 0.982, SRMR = 0.051, GFI = 0.981). Grip strength was the strongest predictor of frailty, followed by multimorbidity. The model explained 46.9% of the variance in frailty, with grip strength accounting for 11.2%. Hospitalised elderly patients with COPD who exhibited low grip strength, high CAT score, advanced age, multimorbidity, and a higher GOLD stage were more likely to experience frailty. These findings suggest that interventions aimed at improving grip strength and managing multimorbidity may help alleviate frailty in elderly COPD patients.