Current status and challenges of Comprehensive Geriatric Assessment in EDs: A comparative study between community and...

As China faces a rapidly aging population, older adults now account for nearly 40 % of emergency department (ED) visits, creating urgent demand for age-appropriate care models. Comprehensive Geriatric Assessment (CGA) has been internationally recommended to improve outcomes for older patients, yet its application in China's emergency settings remains limited. Within the country's tiered healthcare system, Community Health Service Centers (CHSCs) and General Hospitals (GHs) differ in resources and functions, affecting CGA feasibility. This study compares CGA-related practices, barriers, and training needs across CHSCs and GHs to inform context-sensitive implementation strategies.

A cross-sectional survey was conducted in August 2024 among 372 emergency healthcare providers from CHSCs and GHs in Wuhan. Descriptive and comparative analyses were used to examine differences in CGA awareness, application, and barriers among healthcare providers from different levels of institutions.

CGA awareness was suboptimal in both settings (CHSCs: 51.9 %, GHs: 40.2 %), yet support for implementation exceeded 70 % across providers. GHs reported more frequent encounters with complex geriatric cases and broader CGA application, especially in domains such as delirium, anxiety, and pressure ulcer screening (p < 0.05). However, GHs faced acute barriers including time and staffing shortages. CHSCs, though less involved in CGA delivery, expressed strong motivation for training (91.0 % vs. 84.0 %) and cited lack of professional knowledge as the primary barrier (p = 0.018).

This is the first empirical study to compare CGA practices between CHSCs and GHs in China's emergency care system. Findings highlight institutional misalignments that constrain CGA delivery, while also revealing complementary strengths. A two-tiered model-initial risk screening in GHs followed by longitudinal CGA in CHSCs-may offer a pragmatic path forward. Scalable training programs and hub-and-spoke collaboration structures are needed to build CGA capacity and improve emergency care quality for older adults.