Existing survey studies among Chinese nurses indicate that their knowledge of CGA is moderate, with shortcomings in the knowledge dimensions of certain CGA. Gao et al. [20] conducted a survey on 184 nurses in geriatric ward of a tertiary hospital in Beijing using a self-designed CGA-KAP questionnaire (including 14 knowledge items, with a total score of 51 points, and a standard score ≥ 85 points for excellent), the results showed that the knowledge standard score was (82.79 ± 9.24) points, among which 43.0% were excellent, 55.4% were moderate, and 1.6% were failing, this indicates that the group of nurses surveyed in this study mainly had moderate knowledge of CGA. Hao [21] conducted a survey of 120 nurses from a tertiary hospital in Hebei Province using a self-designed CGA-KAP questionnaire. The results showed that the respondents scored the highest 15 points, the lowest 3 points, and the median 11 points (out of 16 points) in the knowledge section of CGA. Li et al. [22] surveyed 108 nurses from Hunan medical institutions before CGA training using a self-designed CGA-KAP questionnaire. The mean knowledge score was 77.16 ± 9.35 (standardized to 100), indicating a basic understanding of CGA theory but not yet reaching a good level. Lyu et al. [23] reported a self-rated CGA knowledge score of 3.90 ± 0.97 (out of 5) among 200 Shandong geriatric nurses, indicating moderate mastery.

At the same time, Chinese nurses have shortcomings in the knowledge dimensions of certain CGA. For instance, Gao et al. [20] found that mastery rates for “CGA target population” and “assessment objectives” were only 3.8% and 4.9%. Hao [21] reported higher correct rates for pressure ulcer causes (85.0%) and health assessment content (82.35%), but only 45.83% for psychological assessment methods, indicating uneven knowledge across dimensions. The survey[23] data from Shandong Province also revealed that 200 Shandong geriatric nurses knew the concept of CGA, they had blind spots in assessment tool selection, use, and result interpretation.

Chinese nurses generally hold a positive attitude toward CGA, but have concerns regarding their willingness to implement it. Zhang Zheng et al. [24] conducted semi-structured interviews with 14 nurses from a tertiary hospital in Beijing who participated in CGA and found that nurses generally believed that CGA could help them identify hidden health problems of patients (such as swallowing disorders, severe depression, and other issues that are difficult to detect with routine care), and drive the improvement of nursing quality. Zhong Jingzhi et al. [25] conducted a focus group interview with 13 elderly specialized nurses from Chongqing, which also showed that nurses rated the operability of the CGA scale as 7.6 ± 0.8 points (0 - 10 points, with 10 points indicating very easy operation), and all respondents expressed willingness to promote the scale.

Quantitative research further confirms this positive attitude. Gao et al. [20] found that the attitude standard score of Chinese elderly ward nurses towards CGA is (81.54 ± 11.30) points (converted from 100 points), with a pass rate of 96.2%, indicating that the vast majority of nurses hold a positive attitude. Li et al. [22] conducted a pre training survey on 108 nurses in Hunan medical institutions, and found that the standard score of nurses’ attitude was as high as 79.58 ± 12.31 (after the full score of 100 was converted). According to a survey conducted by Hao [21] on 120 clinical nurses, the median attitude dimension of nurses towards CGA was 108 points (converted from a maximum score of 120 points).

However, Zhang et al. [24] revealed a core contradiction: nurses recognize CGA’s value but face structural constraints—“no time to do evaluations,” “no dedicated position,” and “not making money” (N10). Quantitative data confirmed this: Lyu et al. [23] found that only 50.5% of institutions performed CGA, with nurses citing “assessment time” (64%), “insufficient multidisciplinary involvement” (62%), and “lack of reimbursement” (48%) as main barriers, highlighting the ideal-reality gap.

Overall, Chinese nurses’ CGA practice remains weak. This survey of nurses in the geriatric wards in Beijing [20] shows that the overall level of CGA behavior of the respondents is low: their standard score for practicing CGA is only (59.72 ± 11.06) points, with an unqualified rate as high as 47.8%, and the excellent rate is 0%. Deng et al. [26] surveyed 390 institutions nationwide, finding only 55.1% conducted CGA-related work and 11.6% of CGA tasks were performed by nurses. Shen et al. [27] surveyed 164 Zhejiang institutions (96 nurses), revealing that only 12.5% of nurses “often or always” used CGA in clinical practice, while 47.9% used it “occasionally” and 39.6% “never or were unclear.” These findings indicate that despite exposure to CGA, routine clinical application remains infrequent.

From the evaluation content of CGA, it can be seen that nurses’ CGA practice mainly relies on single risk assessment, with insufficient comprehensive evaluation. Multiple studies have consistently shown that activities of daily living (ADL), risk of falls, risk of pressure ulcers, and pain are the most commonly assessed items in clinical practice [20][22][27], as these items are often included in the scope of routine nursing evaluation in hospitals.

From the format of CGA, paper-based forms remain prevalent: 39.5% of institutions use paper-only, 44.7% use a “paper + electronic” hybrid, and only 15.8% use fully electronic systems [26]. Dong et al. [28] reported on a CGA information platform used by 86 nurses to complete 3930 assessments, with a usability rating of 4.76 ± 0.53 (out of 5), indicating strong nurse acceptance of digital CGA tools.

From the perspective of the multidisciplinary collaboration in CGA, the team participation is insufficient. Lyu et al. [23] found that 62.0% of 200 Shandong geriatric nurses identified “insufficient MDT participation” as a primary implementation barrier. Zhang et al. [24] further revealed that while nurses aspire to serve as “connectors and supervisors” within the MDT, current multidisciplinary CGA practice lacks continuity.

There is controversy over the impact of age, professional title, and education on CGA knowledge level. Hao [21] found that nurses aged 31 - 40 scored higher in knowledge than those aged 21 - 30 and over 41 (P = 0.045), and supervisor nurses scored higher than nurse practitioners and nurses (P = 0.015). A survey of 108 clinical nurses using a self-designed CGA-KAP questionnaire revealed that nurses with a bachelor’s degree or higher had higher scores in the KAP standards of CGA compared to those with a diploma or lower education (P < 0.035) [22]. However, another KAP survey of 184 geriatric nurses on CGA did not find significant effects of age, professional title, and education level [20], which may be related to differences in sample composition.

Marital status and experience in caring for the elderly are newly discovered independent factors. Hao [21] showed that the total score of married nurses was higher than that of unmarried nurses (P = 0.046), and those with elderly care experience scored significantly higher than those without experience in all dimensions (P < 0.01). Nurses who have worked for 5 - 10 years are the main force in CGA practice, while newly hired nurses have lower awareness and practical experience.

Hao [21] found that the CGA training experience is an important factor affecting nurses’ KAP of CGA. Gao et al. [20] found that nurses who received training within one year had significantly higher practical standard scores than those who did not receive training (61.24 vs 55.54, P = 0.002); The knowledge scores of nurses in the base ward were significantly higher than those in the general ward (85.59 vs 81.91, P = 0.021). The training intervention study by Hao [21] showed that after 2 weeks of online training, the total CGA score of nurses increased from 149.09 ± 32.48 to 180.34 ± 26.49 (P = 0.001). Lyu et al. [23] confirmed that training is one of the strongest predictive factors for implementing CGA (OR = 5.389).

Nurse shortages and lack of dedicated CGA positions have constrained nurses’ CGA-related KAP development [29]. Xie et al. [30] surveyed 36 geriatric departments in Sichuan and found a positive correlation between nurse-to-bed ratio and CGA implementation (β = 15.6, P = 0.03), indicating that better staffing enables more comprehensive CGA. However, Liu et al. [31] reported that among 337 Shandong hospitals, the average nurse-to-bed ratio was only 0.39—far below the national standard of 0.6, with only 22.26% meeting the requirement. This severe shortage leaves nurses with no time for CGA. Zhang et al. [24] further revealed negative emotions stemming from this burden, with nurses stating they had “no time to conduct evaluations” and “no dedicated position” for CGA (N10), leading to frustration when CGA tasks are added to heavy workloads without support.

Lyu et al. [23] found that 62% of nurses listed “insufficient participation in multidisciplinary teams” as the main obstacle. The survey conducted by Gao [20] found that the participation of medical staff, pharmacists, and nutritionists in CGA resulted in low scores. As a result, nurses are unable to draw assessment knowledge from different professional perspectives such as nutritionists, pharmacists, and rehabilitation therapists from MDT discussions, and their knowledge structure is limited to traditional nursing categories. The interview conducted by Zhang et al. [24] revealed that the team lacks continuity and CGA finds it difficult to achieve a closed loop. It can be seen that there is a lack of interdisciplinary collaboration mechanisms in the implementation of CGA in Chinese medical institutions.

Information technology can significantly improve the efficiency of nurses implementing CGA [28], but the current penetration rate is extremely low. Deng et al. [26] showed that only 15.8% of institutions use pure electronic systems. At present, paper-based methods are still the main mode, which has limitations such as long processing time, strong subjectivity, insufficient standardization, and difficulty in dynamic continuous monitoring [32]. Nurses are prone to avoid using CGA due to fear of difficulties.

The main obstacles are the lack of medical insurance payment, economic benefits, and incentive systems. 48% of the surveyed nurses pointed out that CGA was not included in the scope of medical insurance reimbursement [23], and the assessment work was time-consuming without any economic return, which weakened nurses’ willingness to continue practicing CGA. In an interview with Zhang et al. [24], nurses bluntly stated that “not making money is the reason for the difficulty in implementation”. In addition, the completion of CGA is rarely included in nursing quality assessment or performance allocation, and nurses lack economic rewards and career development recognition (such as promotion bonus points), forming a contradiction of “high recognition, low practice”.

It is suggested to establish an individualized and hierarchical training and development plan [33], specifically, based on the basic information such as the age, professional title, educational background, marital status, and experience in caring for the elderly of the trainees, different training contents, durations, quantities, and practical exercises should be set. For example, for junior nurses, unmarried nurses, and those without experience in caring for the elderly, the core theory of CGA and scenario simulation training for psychological and social assessment should be strengthened to make up for the lack of life experience; for nurses aged 31 - 40, senior nurses, and married nurses, their knowledge advantages should be utilized to cultivate them as key instructors for CGA and assume the role of experience transmission.

It is recommended that health administrative departments include CGA as a mandatory continuing education requirement for nurses, and require nurses in secondary and above-level hospitals to receive at least one training session every two years. Secondly, relying on regional geriatric medical centers, a “province-city-county” three-level training network should be established, fully leveraging the leading and driving role of tertiary hospitals and training bases. Additionally, a blended online–offline model should be promoted [34], supported by a CGA MOOC library containing standardized videos, virtual simulation cases, and question banks online. Nurses can use fragmented time to learn CGA knowledge, and the offline part will be conducted in the form of practical workshops to ensure that every nurse can access homogeneous training resources no matter where they are.

Health administrative departments should continue to promote the development of geriatrics departments in hospitals at Level II and above, and raise the bed-to-nurse ratio to above 0.6 as required by national standards [32]. At the same time, it is encouraged to establish “full‑time CGA nurse” positions in geriatric‑related departments, with at least one dedicated staff member responsible for assessment coordination and quality control. For medical institutions that are unable to set up such dedicated positions, it is also recommended to optimize nurse scheduling, and to include CGA assessment time as an independent workload item in the scheduling system.

It is suggested that medical institutions establish standardized multidisciplinary CGA workflows. Given that older adults face aging, multimorbidity, and geriatric syndromes, multidisciplinary team (MDT) support is essential [35]. Drawing on existing MDT experience, it should be clarified that nurses assume the core hub role in the multidisciplinary CGA team, undertaking assessment, education, intervention, and multidisciplinary liaison [36]. Together with team members including physicians, pharmacists, rehabilitation therapists, and dietitians, they jointly develop a comprehensive intervention plan based on the assessment results, ensuring closed-loop management. In addition, MDT participation can be incorporated into departmental performance evaluation, and an electronic team communication platform should be established.

Considering the actual circumstances in China, a platform should be developed that integrates both rapid screening and comprehensive geriatric assessment. This platform should strengthen the closed‑loop management of “assessment–intervention–follow‑up,” and interface with the Hospital Information System (HIS) and Electronic Medical Records (EMR) to improve work efficiency. The deep integration of AI technology with CGA is expected not only to automate and objectify certain assessment tasks, but also to uncover potential risk factors for older adults’ health, thereby providing decision support for early intervention and precision management [37].

It is recommended that Chinese nursing associations and hospital administrations jointly submit a health economic evaluation report on CGA to the medical insurance authorities to advocate for its inclusion in the fee schedule and reimbursement coverage. Before policy implementation, medical institutions may offer performance-based subsidies to CGA-performing departments or nurses. Meanwhile, CGA completion rate, assessment accuracy, and intervention implementation rate should be incorporated into nursing quality indicators, and linked to individual performance, professional title advancement, and merit evaluations. This will create a positive incentive mechanism characterized.