Objective: To investigate the impact of targeted nursing interventions based on frailty prediction models on peri-hospitalization clinical outcomes in middle-aged and elderly patients with upper gastrointestinal bleeding (UGIB). Methods: A prospective cohort study was conducted, and 126 middle-aged and elderly patients with UGIB admitted from August 2024 to August 2025 were selected as the study subjects. The patients were divided into the intervention group (63 cases) and the control group (63 cases) based on whether they received nursing intervention based on frailty prediction models. The control group received routine care, while the intervention group, on the basis of routine care, used the FRAIL scale combined with laboratory indicators (albumin, hemoglobin, etc.) to establish a predictive model to evaluate patients within 24 hours of admission, and implemented multi-dimensional targeted nursing intervention for pre-frailty or frailty patients screened out. The incidence of frailty, rebleeding rate, average length of stay, hospitalization cost, and nursing satisfaction during hospitalization were compared between the two groups. Results: The incidence of frailty during hospitalization in the intervention group was 11.1% (7 cases /63 cases), significantly lower than 31.7% (20 cases /63 cases) in the control group, and the difference was statistically significant (p < 0.05). The rebleeding rate of 4.8% vs 12.7%, the average length of stay of (7.2 ± 1.5) days vs (9.1 ± 2.2) days, and the average hospitalization cost of (23,000 ± 6,000) yuan vs (28,000 ± 7,000) yuan in the intervention group were all lower than those in the control group (all p < 0.05). The nursing satisfaction score of the intervention group (93.5 ± 4.2) points was higher than that of the control group (86.3 ± 5.8) points (p < 0.05). Conclusion: The frailty prediction model applied to the peri-hospitalization care of middle-aged and elderly patients with UGIB can effectively identify frailty risk. Through early targeted intervention, the incidence of frailty and rebleeding rate can be reduced, the length of hospital stay can be shortened, medical expenses can be reduced, and nursing satisfaction can be improved, which has clinical promotion value.