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Background Patient-reported outcome measures (PROMs) are more meaningful than service-orientated metrics, but representation must be equitable. PROM-OPAC is currently the only PROM for Older People living with frailty receiving Acute Care. However, there is limited evidence for its feasibility among the 40% of that cohort who have cognitive impairment. This study examined PROM-OPAC for feasibility and psychometric reliability in people with cognitive impairment.Methods Older people living with frailty and cognitive impairment were recruited during emergency attendance at a UK hospital. They completed the six-item cognitive impairment test (6CIT), PROM-OPAC and the EuroQol EQ-5D-5L. Analyses were for feasibility (response rate, completeness, completion time) and reliability (response distribution, internal consistency).Results 60 people (63% (95% CI 53% to 73%) of 95 approached) with significant cognitive impairment participated (median 6CIT 21/28; IQR 16–25). 92% responses were complete, with median time 8 (IQR 5–11) min. Internal consistency was acceptable (Cronbach’s alpha, 0.70) but the observed response distribution (SD <1 in two items) and end effects suggested interpretability issues. Cognitive impairment severity neither correlated with completion time (Spearman’s, p=0.268) nor completeness (Kruskal-Wallis, p=0.858).Conclusion Older people living with frailty and cognitive impairment can complete PROMs during emergency care. This study adds to evidence for PROM-OPAC feasibility and psychometric properties. PROM-OPAC presents a means for patient-centred evaluation of acute frailty care.