Building Age-Friendly Inpatient Geriatric Services in Viet Nam: Organizing Comprehensive Geriatric Assessment, Ward-Based Teams and Hospital-Wide Support
AGE-FRIENDLY CARE QUALITYMEASUREMENT, IMPLEMENTATION & LEARNING
AGE-FRIENDLY CARE QUALITY · MEASUREMENT, IMPLEMENTATION & LEARNING
Last reviewed: October 2026
An older woman is admitted to a general hospital in Viet Nam with pneumonia. The treating physician focuses on controlling the infection and monitoring her response. Nurses notice that she needs more assistance with everyday activities than expected. Rehabilitation staff identify difficulties with mobility, while medication-related concerns and nutritional needs also require attention.
Each professional contributes useful information, but the findings are recorded at different times and discussed through separate clinical processes. The pneumonia begins to improve, yet several concerns that may affect the woman's recovery have not been brought together into a coordinated plan.
This does not necessarily reflect a lack of professional competence. It may reflect how the hospital organizes care.
Hospitals are commonly structured around medical specialties, clinical departments and defined treatment responsibilities. This organization is essential for delivering specialized healthcare. However, some older patients have needs that extend across several disciplines, and treating the condition responsible for admission may not address everything that influences their recovery.
The challenge becomes particularly apparent when different professionals recognize important problems but no established process connects their findings, determines priorities and identifies who is responsible for taking action.
The central question is: How can hospitals in Viet Nam organize inpatient geriatric services that translate comprehensive geriatric assessment into coordinated team-based care and appropriate support across hospital wards?
Answering this question requires more than establishing a geriatric department, appointing a specialist or introducing additional assessment forms.
Hospitals need to determine which patients are likely to benefit from specialist geriatric input, what service model they can realistically provide and how different professionals will work together. They also need to ensure that assessment findings influence clinical decisions, daily care and the patient's experience of hospitalization.
The appropriate organizational model will differ between hospitals.
Some may have the workforce and resources to establish dedicated inpatient geriatric units. Others may develop consultation services supporting patients admitted under different specialties. Hospitals with limited specialist capacity may initially strengthen age-friendly practices in selected wards while establishing appropriate arrangements for geriatric advice.
These approaches can complement one another, but they are not interchangeable. The appropriate choice depends on the patient population, authorized services, workforce, clinical responsibilities and the hospital's ability to sustain the proposed activities.
This article examines a proposed Inpatient Geriatric Service Organization and Implementation Framework for Viet Nam.
Its focus is the organization of comprehensive geriatric assessment (CGA), selection of service models, ward-based interdisciplinary teamwork, hospital-wide geriatric support, clinical accountability, workforce readiness and measurement of implementation quality.
It does not provide a clinical manual for individual CGA instruments or repeat the detailed assessment and management of frailty, delirium, falls, malnutrition, polypharmacy, multimorbidity or hospitalization-associated disability.
Those subjects remain important components of older-person care. The concern here is different: how hospitals organize the people, responsibilities and working processes needed to identify relevant needs and respond to them appropriately.
For Healthy Longevity Vietnam (HLVN), this provides an opportunity to examine inpatient geriatric care through the practical lens of quality, safety, governance and implementation, while distinguishing international evidence from requirements established under Vietnamese law.
Why Inpatient Geriatric Services Matter for Viet Nam
Population aging is changing the demands placed on healthcare systems, including the care provided in general hospitals.
Older patients may require treatment from cardiology, respiratory medicine, neurology, surgery or other specialties while also experiencing functional limitations, cognitive difficulties, multiple chronic conditions or circumstances that complicate treatment and recovery.
These factors may interact. A treatment plan may be clinically appropriate but difficult for a patient to follow without additional support. Reduced mobility may affect recovery, while communication or cognitive difficulties may influence participation in clinical decisions.
The challenge is not simply that older patients have more medical conditions. It is that their medical, functional and personal circumstances may need to be considered together.
Under the Law on the Elderly No. 39/2009/QH12, older people in Viet Nam are Vietnamese citizens aged 60 years and above. This legal definition should be distinguished from the eligibility thresholds used in international clinical research, where many inpatient CGA studies focus on people aged 65 or older.
Chronological age, however, does not adequately describe clinical complexity.
Some people in their eighties remain relatively independent and recover from acute illness without extensive specialist geriatric involvement. Others in their sixties may have substantial frailty, dependency or complex treatment needs.
Hospitals therefore need a method for identifying patients who may benefit from geriatric expertise rather than assuming that everyone above a particular age requires the same assessment or service.
The policy context makes this increasingly relevant.
Decision No. 1116/QĐ-TTg, issued on June 22, 2026, amended Decision No. 1579/QĐ-TTg approving the national Program on Health Care for Older Persons to 2030.
One of the revised targets is that, by 2030, 100% of provinces and centrally governed cities should have a geriatric hospital or a general hospital with a geriatric specialty.
This is an important objective for developing specialized healthcare capacity. However, it is a target at the provincial or centrally governed city level, not a requirement that every hospital establish a dedicated inpatient geriatric ward or perform CGA for every older patient.
Nor does the presence of a geriatric specialty automatically demonstrate that a hospital has an effective interdisciplinary inpatient care model.
A geriatric specialty may provide outpatient consultations, inpatient care, specialist advice to other departments or a combination of these activities, depending on the hospital's organizational arrangements and capabilities.
The implementation challenge is therefore to move beyond the formal existence of a specialty and examine how geriatric expertise is actually incorporated into patient care.
Comprehensive Geriatric Assessment Is More Than an Assessment Form
Comprehensive geriatric assessment is a central component of organized geriatric care.
The British Geriatrics Society describes CGA as a multidimensional, interdisciplinary process that identifies an older person's medical, psychological, functional and social needs and uses those findings to develop a coordinated plan for treatment and continuing support.
This differs from assessment focused primarily on a single disease or organ system.
CGA considers how health conditions, functional ability, cognition, psychological well-being, social circumstances and personal priorities may influence clinical decisions.
The German S3 guideline on CGA for hospitalized patients, issued in May 2024 and summarized in Deutsches Ärzteblatt International in 2025, identifies six core dimensions: self-care ability, mobility, cognitive function including delirium, mood or affect, nutrition and social situation.
Additional areas may require attention depending on clinical circumstances, including sensory difficulties, communication, swallowing, continence, pain, multimorbidity and medication-related concerns.
These domains provide useful international references, but they should not be presented as a newly established Vietnamese mandatory assessment standard.
For hospitals in Viet Nam, the main implementation question is not which international assessment template can be adopted most quickly. It is how relevant information can be obtained, interpreted and used to guide care.
Some hospitals already assess mobility, cognition, nutrition and other concerns through existing professional activities. Introducing CGA does not necessarily mean repeating every assessment through a separate team.
The improvement opportunity may be to connect the findings and make them clinically useful.
A patient with several identified needs requires more than completed scores. The team must determine which findings are important, what actions are appropriate, who will carry them out and when progress should be reviewed.
Some actions may involve changes to medical treatment. Others may require nursing assistance, rehabilitation, additional professional evaluation or adjustments to daily care.
The patient's preferences and priorities should also inform the plan.
CGA is not simply the completion of several assessments. It is a coordinated clinical process that connects multidimensional findings with clinical decisions, professional action and ongoing review.
This distinction is particularly important when hospitals introduce electronic CGA forms or standardized assessment packages.
Documentation can improve consistency, but it cannot replace professional judgment, interdisciplinary communication or ensure that identified needs are addressed.
What the International Evidence Shows
The international evidence supports organized inpatient geriatric care, although the size and consistency of benefits vary across patient populations, service models and outcomes.
A Cochrane systematic review published in 2017 examined CGA for older adults admitted to hospital.
The review included 29 trials involving 13,766 participants across nine countries, most of them high-income settings.
Compared with usual hospital care, organized CGA increased the likelihood that patients would be alive and living in their own homes at follow-up between three and twelve months.
The reported relative risk was 1.06, with a 95% confidence interval of 1.01–1.10, based on 16 trials involving 6,799 participants.
CGA also reduced the likelihood of admission to a nursing home or similar institution during follow-up, with a relative risk of 0.80 and a 95% confidence interval of 0.72–0.89.
These findings support the value of coordinated geriatric care for appropriate hospitalized older adults.
However, the review found little or no difference in overall mortality, with a relative risk of 1.00 and a 95% confidence interval of 0.93–1.07.
It also found little or no difference in dependency, while variation between studies limited conclusions concerning some other outcomes, including cognitive function and length of hospital stay.
Cost-effectiveness findings remained uncertain.
These results should therefore not be presented as evidence that CGA consistently reduces mortality, hospital expenditure or length of stay in every hospital.
A systematic review and meta-analysis by O'Shaughnessy and colleagues, published in Age and Ageing in 2022, examined care delivered through acute geriatric units.
The review included 11 randomized trials involving 7,496 participants across three countries.
Acute geriatric unit care was associated with reduced functional decline at six-month follow-up, with a relative risk of 0.79 and a 95% confidence interval of 0.66–0.93.
However, the review found little or no difference in several other outcomes, including mortality, hospital readmissions, length of stay and costs.
These findings support the potential value of organized geriatric units while reinforcing the importance of evaluating the outcomes that a particular service is designed to improve.
More recent evidence comes from a systematic review and meta-analysis by Kuo and colleagues, published online in May 2025 and included in the July 2026 issue of the Journal of the Formosan Medical Association.
This review focused specifically on hospitalized older adults whose frailty had been identified using defined assessment criteria.
It included 18 randomized trials involving 2,724 participants. The literature search covered studies published through October 2022, an important distinction when interpreting how recent the underlying trial evidence is.
The authors found no statistically significant difference in overall mortality between CGA and usual care.
A subgroup analysis suggested reduced mortality during follow-up periods of six months or less. However, that finding should be interpreted cautiously because it arose from a more limited analysis and did not establish an overall mortality benefit.
The review also reported favorable findings in areas including daily functioning, health-related quality of life, patient satisfaction and aspects of medication management.
Nevertheless, differences between studies and service models limit the conclusions that can be drawn for an individual hospital.
The German S3 guideline provides additional context.
Its evidence review found stronger support for CGA in acute geriatric medicine, oncology and orthopedic or trauma care, with less established evidence in some other settings, including general surgery and emergency departments.
A partial update of the guideline was registered in May 2026. That registration represents an updating process, not the publication of a completed replacement guideline.
Taken together, the evidence provides a sound basis for hospitals to consider organized geriatric services for appropriate patients.
It does not establish that every model is equally effective or that one organizational arrangement is universally superior.
For Viet Nam, the most useful interpretation is that CGA should be considered as part of a functioning service model, with clearly identified patients, appropriate expertise, coordinated action and meaningful evaluation.
What Research From Viet Nam Adds
Research conducted in Viet Nam provides useful information about the complexity of older patients receiving hospital care.
A study published in the Vietnam Journal of Community Medicine in March 2026 examined CGA among 229 patients aged 60 years and older treated in the Emergency and Stroke Department of the National Geriatric Hospital between September 2024 and September 2025.
Patients underwent assessment within 24–48 hours of admission. The researchers examined functional ability, cognition, delirium, nutrition, frailty, fall risk, polypharmacy and other relevant factors.
The study identified substantial levels of functional impairment and geriatric syndromes within this selected patient population.
Several assessment findings were associated with short-term clinical outcomes.
These results illustrate the range of concerns that may be identified through multidimensional assessment in a Vietnamese acute hospital setting.
However, the study was observational and conducted in a single specialist hospital.
It did not compare alternative inpatient geriatric service models or demonstrate that CGA itself caused improvements in patient outcomes.
Its findings should therefore not be used to estimate the prevalence of geriatric syndromes across all Vietnamese hospitals or establish the effectiveness of a nationwide intervention.
The study's practical significance lies in showing that relevant needs can be identified through CGA in a Vietnamese clinical environment.
The next challenge is organizational: how hospitals can bring those findings into treatment decisions, interdisciplinary care and appropriate follow-up.
That requires service design, clinical leadership and reliable implementation processes.
Begin With the Hospital's Patient Population and Current Capabilities
Before establishing an inpatient geriatric service, hospital leaders should examine the patients they currently treat and the resources already available.
A large general hospital may care for older people across many departments. Another may have most complex older patients concentrated in internal medicine, neurology or selected surgical wards.
Some hospitals already have geriatric physicians and established rehabilitation services. Others may have limited specialist personnel and depend on collaboration between existing departments.
These differences affect what can be implemented.
An initial organizational review should examine the number and characteristics of older inpatients, common reasons for admission, relevant levels of clinical complexity and existing services.
It should also consider how older patients with complex needs are currently identified and what happens after those needs are recognized.
For example, nurses may routinely document functional difficulties, physicians may assess multiple conditions, and rehabilitation staff may evaluate mobility.
If the findings remain in separate records, the main improvement opportunity may involve better coordination rather than additional assessment forms.
In another hospital, the principal gap may be the absence of appropriately qualified clinicians able to provide geriatric advice.
A third hospital may have specialist expertise but insufficient time or staffing to support several wards reliably.
The organizational review should therefore distinguish missing expertise from weak coordination and insufficient operational capacity.
These are different problems and may require different solutions.
Service development should begin with the hospital's actual needs and resources rather than a decision to reproduce a model used elsewhere.
Identifying Patients Who May Benefit From Geriatric Input
Hospitals need a practical method for identifying older patients who may benefit from more extensive geriatric assessment and coordinated intervention.
Using age alone is unlikely to be sufficient.
Although Vietnamese law recognizes older people from age 60, many international inpatient CGA trials have focused on participants aged 65 or older with significant clinical complexity.
The evidence should therefore be adapted thoughtfully rather than translated into one age-based eligibility rule.
Patients with substantial frailty, new functional decline, cognitive difficulties, complex multimorbidity or other factors affecting treatment and recovery may benefit from specialist geriatric input.
However, these factors should be interpreted in context.
An older patient with relatively straightforward needs may receive appropriate care through the existing ward team without full specialist CGA.
Another patient may require comprehensive assessment and interventions involving several disciplines.
Hospitals should establish how these different needs will be recognized.
Screening instruments may be useful, but their validity, intended population and practical limitations should be considered before routine use.
A screening score is not equivalent to CGA and should not replace clinical judgment.
Referral criteria should also reflect available specialist capacity.
A geriatric consultation service that receives more requests than it can reasonably manage may become unable to respond promptly to patients with the greatest needs.
Conversely, criteria that are too restrictive may exclude patients who could benefit.
The service should determine how consultations are prioritized, when assessment is expected and how urgent clinical questions are addressed.
Necessary emergency treatment and time-sensitive specialist interventions should not be delayed while additional geriatric assessments are arranged.
The objective is to direct geriatric expertise toward patients who may benefit from it without creating unnecessary barriers to essential care.
Choosing the Appropriate Inpatient Geriatric Service Model
Hospitals can organize inpatient geriatric care through several models.
A dedicated inpatient geriatric unit provides a defined clinical setting in which suitable patients receive care from professionals experienced in geriatric medicine and interdisciplinary management.
This arrangement can support regular team communication, consistent ward processes and closer integration of CGA findings into daily care.
However, establishing a dedicated unit requires more than allocating beds.
The hospital needs appropriate medical leadership, nursing competence, rehabilitation access, suitable facilities and dependable arrangements for investigations, treatment and specialist consultation.
A geriatric ward should not be considered operationally capable merely because its name appears in the hospital's organizational structure.
A geriatric consultation or liaison service provides another approach.
Under this model, a specialist team assesses selected patients admitted under other hospital departments and provides advice or participates in their care.
This can extend geriatric expertise across several wards without requiring every patient to move to a separate unit.
However, a consultation service may have limited effect if its recommendations are not integrated into the treating team's work.
A third approach involves structured geriatric co-management.
In suitable clinical settings, geriatric and specialty teams may share defined aspects of care through an agreed organizational arrangement.
This can be relevant when older patients require specialized treatment alongside substantial geriatric support.
The allocation of responsibilities must be clear, particularly where decisions involve specialist treatment, medication changes or competing clinical priorities.
These approaches can coexist.
A hospital may operate a dedicated geriatric ward while providing consultations to other departments.
Another may begin with a small consultation service and strengthen geriatric competencies among selected ward teams.
The evidence does not establish that every hospital should adopt one identical configuration.
The relevant question is which model can deliver appropriate assessment, coordinated action and accountable clinical care within the hospital's actual capabilities.
What Makes a Dedicated Geriatric Ward Effective?
A dedicated geriatric ward should provide an environment in which multidimensional assessment leads to coordinated clinical action.
This requires a clearly defined patient population and a team with the expertise needed to address that population's needs.
Medical treatment remains central. However, ward processes should also allow relevant functional, psychological and social concerns to influence treatment and recovery planning.
The service should establish how CGA is initiated, how findings are shared and how the team determines priorities.
Daily care should reflect the agreed plan.
For example, the patient's functional goals should be understood by the professionals involved in everyday assistance rather than remain only in a rehabilitation note.
Important medication or nutritional concerns should reach the professionals responsible for reviewing and addressing them.
The ward also needs access to other specialties.
A geriatric team cannot independently provide every treatment required during hospitalization. Clear arrangements are needed for consultations, investigations, procedures and services outside its own scope.
Staffing must reflect the level of clinical and functional support patients require.
The number of designated beds is not a sufficient measure of capacity.
A unit may have available accommodation but lack the personnel or supporting services needed to deliver its intended model safely.
The effectiveness of a dedicated ward depends on whether its workforce, clinical processes and supporting departments function together.
Making Geriatric Consultation Useful to Other Wards
Consultation services require particular attention to communication and accountability.
The geriatric team may assess patients in medical, surgical or other departments and provide advice to the treating clinicians.
The value of the service depends not only on the quality of its assessment, but also on whether its recommendations are relevant, understood and acted upon.
A consultation that ends with a detailed report but no clear responsibilities may add documentation without substantially changing care.
Hospitals should therefore define how referrals are made, who reviews them and how recommendations are communicated.
The treating team should understand which decisions remain within its responsibility and when further specialist involvement is needed.
The geriatric team should also establish when follow-up is appropriate.
Some patients may require one focused assessment. Others may need further review as their condition or treatment changes.
Consultation arrangements should reflect these differences rather than automatically impose the same number of visits on every patient.
The service must also consider how recommendations will be implemented during evenings, weekends and periods when specialists are unavailable.
A reliable consultation model cannot depend entirely on the personal presence of one clinician.
It needs a process that allows the treating ward to continue appropriate care within its competencies while obtaining further advice when necessary.
Turning Multidisciplinary Staffing Into Interdisciplinary Care
The presence of several professional disciplines does not automatically create an interdisciplinary service.
Physicians, nurses, rehabilitation professionals, pharmacists, dietitians, social workers and other staff may each contribute valuable expertise while working largely independently.
Their assessments may be appropriate, yet the overall care plan can remain fragmented.
Interdisciplinary teamwork requires a process that connects their contributions.
The hospital should establish how relevant findings are reviewed, how priorities are agreed upon and how responsibilities are assigned.
The treating physician or other appropriately designated clinician remains accountable for relevant medical decisions according to the hospital's professional arrangements.
Nurses contribute essential information about the patient's condition and functioning throughout the hospital stay.
Rehabilitation professionals may help establish functional priorities and provide suitable interventions within their competencies.
Pharmacists, dietitians, social workers, mental health professionals and other disciplines contribute according to patient needs and available services.
Not every hospital will have all these professionals assigned directly to a geriatric ward.
Some expertise may be accessed through other departments. In certain circumstances, suitable external arrangements may also be relevant.
The hospital should determine which capabilities are required, how they can be accessed and what limitations remain.
The goal is not to maximize the number of professionals involved in each case.
It is to ensure that the appropriate expertise contributes to one coherent plan.
For the patient, the value of teamwork should be apparent through consistent information, appropriate clinical decisions and care that reflects agreed priorities.
Making Team Decisions Part of Routine Ward Work
Interdisciplinary care must function during ordinary hospital operations, not only during formal meetings.
A ward may hold regular multidisciplinary discussions but still experience gaps when important decisions are not communicated to the people providing daily care.
Hospital leaders should therefore consider how team decisions are incorporated into ward rounds, handovers, treatment plans and routine documentation.
The process should be practical.
A meeting that reviews many patients without identifying actions and responsible professionals may have limited value.
A more useful discussion establishes which concerns need attention, what has already been addressed and what should happen next.
For example, several professionals may recognize that a patient has difficulty moving safely.
The interdisciplinary process should determine whether further assessment or intervention is necessary, who will provide it and when progress will be reviewed.
The same principle applies when clinical priorities conflict.
The team needs a way to reconcile recommendations instead of leaving different professionals working toward inconsistent goals.
Communication across shifts is particularly important.
Hospital care continues when individual members of the geriatric team are not present. Important decisions and unresolved concerns should therefore remain accessible to the relevant staff.
A geriatric service becomes dependable when these processes are incorporated into routine ward care.
It should not depend exclusively on enthusiastic individuals or informal relationships between clinicians.
From CGA Findings to an Actionable Care Plan
The most important test of CGA is whether its findings lead to appropriate care.
An assessment may identify numerous concerns, but not every finding requires immediate intervention or specialist treatment.
The clinical team needs to determine which problems are important, which require further assessment and which can be addressed through existing services.
Priorities should reflect the patient's acute medical condition, functional needs, preferences and realistic recovery goals.
For one patient, preserving the ability to walk independently may be particularly important. Another may value returning to a familiar living environment or avoiding interventions that create an excessive treatment burden.
The care plan should connect these priorities with appropriate professional action.
It should be clear what needs to happen, who is responsible and how the response will be reviewed.
Recommendations without identified responsibility are easily overlooked.
This is particularly important when a geriatric team provides advice to another specialty.
The consulting team may identify a concern, but the treating department needs to understand whether it should implement a recommendation, request further specialist input or arrange appropriate follow-up.
The process should avoid competing or duplicate care plans.
Where recommendations differ, the responsible professionals need a way to resolve the disagreement and communicate the final decision.
A coordinated plan should support professional judgment rather than replace it with an inflexible checklist.
It should also change as the patient's condition changes.
A plan that was appropriate on admission may need adjustment after the acute illness improves or new information becomes available.
The objective is to make CGA part of ongoing clinical decision-making, not an isolated assessment completed at one point during hospitalization.
Keeping Clinical Accountability Clear
Inpatient geriatric services frequently work alongside established medical and surgical specialties.
An older person admitted for a cardiac condition, stroke, infection or surgical problem may benefit from CGA while continuing to require specialist management of the original condition.
Geriatric involvement should strengthen that care, not create uncertainty about responsibility.
In a dedicated geriatric ward, the geriatric medical team may hold primary responsibility for treatment while consulting other specialists as necessary.
In a consultation model, the original treating team may retain primary responsibility and request geriatric advice.
Co-management arrangements require particularly clear allocation of responsibilities.
The hospital should identify who makes treatment decisions, who implements agreed recommendations and how unresolved concerns are escalated.
Unclear responsibilities may cause delays, duplicated investigations or conflicting instructions.
International terminology such as co-management, liaison service or hospital-wide geriatric support does not create new professional authority under Vietnamese law.
Participating practitioners must operate within their lawful professional scope and the hospital's authorized activities.
Clinical governance should also address service limitations.
If the geriatric team lacks capacity to respond to a consultation or the treating ward cannot implement an important recommendation, that limitation should be recognized and addressed.
Clear accountability protects patients and allows the hospital to determine whether the service model is functioning as intended.
Supporting Geriatric Care Across Hospital Specialties
Many older people who may benefit from geriatric expertise will not be admitted to a dedicated geriatric ward.
Hospital-wide support can help address this gap, but it requires realistic boundaries.
The British Geriatrics Society's Hospital-Wide Comprehensive Geriatric Assessment project examined how CGA could be extended beyond specialist geriatric wards.
The project identified considerable variation in assessment practices and multidisciplinary arrangements.
It also demonstrated that introducing toolkits for non-geriatric teams was not sufficient on its own. Geriatric expertise, professional engagement and sustained implementation support were important.
This experience is relevant to hospitals in Viet Nam, particularly those with limited specialist capacity.
Distributing screening tools across every ward does not automatically establish effective hospital-wide CGA.
A hospital must determine which patients should be identified for specialist support, who will review relevant findings and how recommendations will influence care.
Some wards may be able to incorporate age-friendly practices into existing services without requesting comprehensive geriatric input for every patient.
Others may need specialist consultation for selected complex cases.
The distinction between routine age-friendly care and specialist CGA should remain clear.
The purpose of hospital-wide support is not to transfer responsibility for every older inpatient to a small geriatric team.
It is to strengthen the hospital's ability to recognize relevant needs and obtain appropriate expertise when it adds value.
This approach should complement existing specialty pathways.
Patients requiring urgent stroke treatment or time-sensitive surgery should continue to receive appropriate specialist care. Geriatric input may inform additional decisions but should not create unnecessary delays or duplicate responsibilities.
Keeping the Older Person's Priorities Visible
An age-friendly geriatric service should give meaningful attention to the older person's preferences.
Hospitalization can be disorienting, particularly when several professionals provide information or treatment decisions change rapidly.
CGA offers an opportunity to consider what matters to the patient alongside medical and functional findings.
However, asking about preferences is valuable only when that information influences appropriate decisions.
A patient may wish to preserve a particular activity, return to familiar living arrangements or understand how treatment choices could affect independence.
These priorities should be discussed through an appropriate clinical decision-making process.
Communication may need to be adapted for people with hearing, visual, cognitive or language difficulties.
Family members can provide valuable information about the patient's usual functioning and preferences, but their involvement does not automatically give them unrestricted authority to decide on the patient's behalf.
The patient's lawful rights, consent requirements and valid representative arrangements must be respected.
A diagnosis of dementia or the presence of functional dependency does not, by itself, establish loss of legal decision-making capacity.
These considerations are important because some older patients face difficult choices involving competing treatment goals, recovery expectations and continuing support.
The aim is to ensure that clinical decisions appropriately consider the person's values, circumstances and expressed preferences.
Workforce Readiness and Professional Development
An inpatient geriatric service requires appropriate professional expertise and dependable teamwork.
Hospitals should identify the competencies necessary for the model they intend to establish.
Some activities require geriatric medical expertise. Others depend on appropriately trained nurses, rehabilitation professionals, pharmacists, dietitians or other staff.
A dedicated ward may require a different workforce configuration from a consultation service.
Training should therefore be connected to actual roles and responsibilities.
Teaching staff to complete assessment instruments is only one part of preparation.
Professionals also need to understand how findings should be interpreted, when specialist advice is necessary and how results influence care.
Case discussions and interdisciplinary learning can help teams develop a shared approach.
Supervision is equally important.
Staff who are new to geriatric practice may require support when managing complex cases or deciding when a concern should be escalated.
The service should establish who provides this supervision and how it remains available during routine operations.
Workforce planning must reflect patient complexity and expected workload, not simply the number of geriatric beds or consultation requests.
A ward may struggle to provide its intended service if specialist physicians, nursing staff or rehabilitation professionals are consistently unavailable.
A consultation team may face similar problems when referrals exceed its capacity.
These limitations should be considered before services are expanded.
A focused program that consistently provides coordinated care may be more useful than a larger service whose planned activities cannot be delivered reliably.
Information Systems Should Support Clinical Work
Geriatric services use information contributed by several professional disciplines.
Documentation should allow relevant staff to find important assessment results, understand the current plan and identify outstanding actions.
This does not necessarily require a separate digital CGA platform.
Existing hospital records may be sufficient if they support appropriate documentation, communication and review.
The main objective is to prevent important findings from becoming isolated within separate professional notes.
A geriatric consultation may identify several concerns, but those findings have limited practical value if the treating team cannot access or interpret them.
Likewise, assessments should not be repeated unnecessarily simply because earlier information cannot be located.
Hospitals should establish how agreed actions are recorded and how responsibility for implementation is made visible.
Information access must remain appropriate to professional roles and lawful purposes.
Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements for personal data processing.
Hospitals must also comply with applicable rules governing medical records and healthcare information.
Digital systems can improve communication, but technology cannot resolve unclear clinical accountability or inadequate teamwork.
The information system should support the service model rather than become its defining feature.
Connecting Inpatient Geriatric Care With Discharge Planning
Inpatient geriatric care should consider what happens after hospitalization, particularly when functional or support needs have changed.
However, its principal purpose remains organizing appropriate care during the admission.
Discharge planning is relevant because CGA findings may influence clinical decisions, recovery goals and continuing care requirements.
NICE guideline NG27 on transitions between hospital and community or care home settings emphasizes coordinated assessment and planning for adults with complex health and social care needs.
For geriatric services, this supports considering relevant discharge needs early rather than waiting until acute treatment has been completed.
However, the geriatric team should not be assumed to replace the hospital's established discharge processes.
The hospital should define how specialist findings contribute to planning and which teams remain responsible for the relevant decisions and arrangements.
Identifying a need for rehabilitation or continuing assistance does not automatically establish that the service is available or publicly funded.
Similarly, recommending a destination does not remove the receiving organization's responsibility to determine whether it can meet the patient's needs.
Geriatric assessment should improve the information available for discharge decisions without duplicating existing care transition pathways.
Legal and Professional Governance in Viet Nam
Any inpatient geriatric service must operate within the legal framework applicable to the hospital and its healthcare practitioners.
The Law on Medical Examination and Treatment No. 15/2023/QH15, as amended, provides the main legal foundation for medical examination and treatment.
Consolidated Document No. 26/VBHN-VPQH, issued by the Office of the National Assembly on February 26, 2026, is relevant when examining the legislation in consolidated form. Hospitals should also consider applicable amendments and implementing provisions that took effect after that consolidation.
Decree No. 96/2023/NĐ-CP provides further provisions concerning healthcare practitioners and medical examination and treatment establishments.
Circular No. 32/2023/TT-BYT and subsequent amendments, including applicable provisions of Circular No. 25/2026/TT-BYT effective August 15, 2026, should also be considered.
Hospitals need to verify that proposed activities are consistent with their authorized professional scope and organizational arrangements.
Introducing CGA does not automatically establish a new professional license, authorize unqualified individuals to perform regulated healthcare activities or create a separate reimbursement entitlement.
Likewise, describing a model as geriatric co-management does not independently determine how clinical responsibility is legally allocated.
The hospital's governance arrangements should establish who remains responsible for medical decisions, how specialist recommendations are handled and how concerns are escalated.
These arrangements should be reviewed when the service model changes.
International CGA guidance and hospital service models are useful professional references, but they should not be presented as mandatory Vietnamese regulatory standards unless a corresponding legal requirement exists.
For HLVN, the proposed organizational framework is an evidence-informed implementation approach, not an official licensing standard, accreditation scheme or national clinical protocol.
Financial and Operational Sustainability
Developing a geriatric service requires continuing resources.
A dedicated ward may need specialist clinical leadership, nursing capacity, rehabilitation support, equipment and access to other departments.
A consultation service also requires protected professional time, reliable referral arrangements and sufficient capacity to review patients when needed.
The cost of establishing a geriatric service is therefore not limited to allocating beds or introducing assessment forms.
Hospitals should estimate the resources necessary to deliver their proposed model safely and consistently.
International research supports several clinical benefits of organized CGA, but cost-effectiveness findings remain uncertain.
Evidence from other healthcare systems should not be treated as proof that introducing CGA will automatically reduce expenditure in a Vietnamese hospital.
Health insurance reimbursement requires particular care.
Hospitals should not assume that completing a CGA form, establishing a geriatric ward or adopting an international service model automatically creates a separately reimbursable healthcare benefit.
Payment arrangements must comply with applicable legislation, authorized services and relevant reimbursement requirements.
The hospital should therefore distinguish the clinical and organizational value of CGA from assumptions about payment.
Investment in geriatric expertise may support important care and quality objectives, but operational sustainability still requires careful planning.
The appropriate model is one the hospital can maintain, not merely one it can launch.
Measuring Whether the Geriatric Service Is Working
The performance of an inpatient geriatric service should not be judged only by the number of assessments completed or consultations provided.
Those figures describe activity, but they do not establish whether care has improved.
A meaningful measurement approach should examine service access, implementation reliability, interdisciplinary action and relevant patient outcomes.
At the service level, a hospital may examine whether patients meeting its clinical criteria are identified appropriately and whether specialist input is provided when needed.
It should also examine what happens after assessment.
Were important findings communicated to the treating team? Were appropriate actions agreed upon? Was responsibility assigned? Were unresolved concerns reviewed?
These process measures are particularly useful during early implementation because they indicate whether the intended service model is functioning.
Patient outcomes also matter, but they require careful interpretation.
Functional ability may be relevant when assessed with appropriate methods and compared with the patient's condition before hospitalization.
However, functional outcomes are affected by baseline dependency, severity of illness, treatment and other factors.
Length of stay, readmissions and discharge destinations may provide additional information, but none should be treated as a direct measure of geriatric service quality without considering the clinical circumstances.
A shorter hospital stay does not necessarily indicate better care. Appropriate admission to residential long-term care does not automatically represent a failure.
The international outcome of being alive and living at home also requires interpretation according to the person's previous living arrangements.
A hospital serving many patients who were already residents of long-term care facilities should not be judged as though every patient had lived independently before admission.
Patient and caregiver experiences can provide further information about communication, involvement in decisions and whether the care plan reflected relevant priorities.
Hospitals should select a manageable number of indicators that correspond to the service's actual purpose.
An elaborate dashboard is of limited value if its information is unreliable or cannot guide improvement.
Avoiding Unintended Consequences of Measurement
Quality indicators can influence organizational behavior.
A geriatric service evaluated mainly on shorter hospital stays may experience pressure to discharge patients before appropriate arrangements are complete.
If assessment completion becomes the dominant target, staff may prioritize documentation rather than the actions that should follow.
If hospitals compare outcomes without considering frailty, dependency and clinical complexity, services caring for more dependent patients may appear to perform worse.
A balanced approach should therefore consider both implementation processes and outcomes relevant to patients.
Hospitals should examine whether proposed indicators encourage appropriate care or create unintended incentives.
Not every adverse outcome is preventable, and a well-reasoned clinical decision does not guarantee a favorable outcome.
Quality review should support learning and appropriate action rather than automatically assign blame based on numerical differences.
The purpose of measurement is to understand whether the service works as intended and where it needs improvement.
A Practical Inpatient Geriatric Service Organization and Implementation Framework
For Viet Nam, the principles described above can be brought together in a proposed Inpatient Geriatric Service Organization and Implementation Framework.
The framework begins with an Inpatient Older-Person Population and Service Needs Review.
This examines the hospital's older inpatient population, patterns of clinical complexity, existing assessment and referral arrangements, and areas where geriatric expertise may improve care.
Its purpose is to identify actual service needs before choosing an organizational model.
The second component is a Geriatric Service Model and Capability Assessment.
This compares potential approaches, including a dedicated geriatric ward, specialist consultation service and structured interdisciplinary support within existing departments.
The assessment should consider authorized activities, workforce, facilities, patient volume and operational sustainability.
The third component is a CGA Eligibility and Clinical Prioritization Process.
This establishes how patients are identified for appropriate geriatric assessment or consultation using clinical criteria and professional judgment rather than chronological age alone.
The fourth component is a CGA-to-Care-Plan Implementation Process.
This connects findings with clinical priorities, appropriate actions, assigned responsibilities and review arrangements.
Its central principle is that identified needs should lead to meaningful decisions rather than remain as unaddressed entries in an assessment record.
The fifth component is a Ward-Based Teamwork and Clinical Accountability Arrangement.
This defines how participating professionals communicate, coordinate their work and address unresolved decisions during routine inpatient care.
The sixth component is a Hospital-Wide Geriatric Support Pathway.
This establishes how selected patients outside a dedicated geriatric ward can obtain appropriate specialist input and how their treating teams will use relevant recommendations.
Finally, a Geriatric Service Quality and Implementation Review can examine service access, consistency, clinical action, patient outcomes and opportunities for improvement.
These components are proposed organizational and quality improvement tools.
They are not nationally mandated Vietnamese CGA templates, a new licensing category or an official accreditation framework.
Their value is that they connect patient selection, service design, assessment, teamwork, accountability and evaluation within one coherent approach.
The framework can be adapted to different hospital types, levels of specialist capacity and stages of service development.
Beginning With a Focused Implementation Pilot
A hospital does not need to introduce a new geriatric model across every department at once.
A more practical approach may begin with one inpatient ward or a clearly defined group of patients.
The hospital should first examine existing practice.
It may discover that many components of CGA are already performed but that the findings are not integrated into a shared plan.
Another hospital may identify limited geriatric expertise or uncertainty about responsibility for acting on consultation recommendations.
These findings should guide the pilot.
For example, a general medical ward might introduce structured identification of patients likely to benefit from interdisciplinary geriatric review.
A hospital with available geriatric specialists might establish a consultation pathway for selected patients in other departments.
An existing geriatric ward may focus on strengthening teamwork and ensuring that findings consistently lead to appropriate care.
Before implementation, the hospital should confirm workforce availability, clinical responsibilities and how the proposed process will fit into routine operations.
The professionals expected to deliver the service should participate in its design.
Training, documentation and communication arrangements should support their actual work.
Initial evaluation should consider both feasibility and quality.
A process that generates extensive documentation but overwhelms staff may require simplification.
A consultation service that produces detailed recommendations without improving coordination may need stronger links with the treating wards.
A successful pilot should demonstrate that the intended activities are feasible and that relevant findings lead to appropriate action.
Expansion should follow implementation experience and demonstrated readiness rather than the assumption that a model used successfully in one ward will work unchanged throughout the hospital.
Building Hospital-Wide Support Without Diluting Specialist Expertise
As hospitals develop geriatric expertise, they may wish to make it available more broadly.
This can be valuable because older patients with complex needs receive care throughout the hospital.
However, hospital-wide support should not become a commitment to provide full CGA for every older patient regardless of clinical need or service capacity.
Hospitals should distinguish specialist CGA from the age-friendly practices that competent ward teams can provide through routine care.
Some patients need comprehensive interdisciplinary assessment and continuing geriatric involvement.
Others may benefit from targeted advice or appropriate support through existing clinical pathways.
The hospital should define when a ward can manage a concern within its competencies and when further geriatric expertise is necessary.
The geriatric team must also have a realistic method for prioritizing requests.
The long-term objective is not to transfer responsibility for every older inpatient to a small specialist team.
It is to strengthen the hospital's ability to recognize and respond to complex needs while preserving specialist expertise for situations where it adds meaningful value.
Experience from the British Geriatrics Society's Hospital-Wide CGA project supports this approach.
Assessment tools and implementation guidance can help, but sustained professional engagement, specialist expertise and organizational support remain important.
A hospital-wide service should therefore develop through manageable stages and be evaluated against what it can genuinely deliver.
From a Geriatric Specialty to an Effective Inpatient Service
Viet Nam's objective of developing geriatric hospital or specialty capacity across all provinces and centrally governed cities by 2030 provides an important direction for healthcare development.
However, establishing a geriatric specialty is only one part of improving inpatient care for older people.
The quality of a geriatric service depends on how the hospital organizes expertise, interdisciplinary work and clinical responsibility.
A dedicated ward may provide an effective setting for coordinated care, but it requires an appropriate workforce and dependable clinical processes.
A consultation team may extend expertise across departments, but its value depends on whether its recommendations influence care.
CGA may identify important needs, but those findings must be interpreted, prioritized and acted upon.
Different organizational models may be appropriate for different hospitals.
The international evidence provides a strong foundation for examining these approaches. It does not remove the need to adapt them to Vietnamese law, patient populations and available resources.
Hospitals should therefore begin with the needs of the patients they treat, identify important gaps in existing services and select a model they can implement reliably.
The objective should not be to maximize the number of assessment forms, geriatric consultations or designated specialist beds.
It should be to establish a service in which appropriate assessment leads to coordinated decisions and meaningful care.
An effective inpatient geriatric service is not defined simply by having a geriatric ward or completing comprehensive assessments. It is defined by whether the hospital can identify complex needs, bring the appropriate professionals together and translate their findings into coordinated care that matters to the older patient.
For Viet Nam, an Inpatient Geriatric Service Organization and Implementation Framework could provide a practical foundation for developing dedicated units, effective ward-based teamwork and appropriate hospital-wide support.
It could also help hospitals assess readiness, maintain clinical accountability and improve service quality as geriatric capabilities develop.
The goal is not one identical organizational model for every hospital.
It is to build inpatient services that respond appropriately to older patients' needs while maintaining safe clinical practice, realistic capabilities and measurable quality.
As Viet Nam expands its geriatric healthcare capacity, the ability to organize these services effectively will become an increasingly important part of delivering safer, more coordinated and genuinely age-friendly hospital care.
References
National Assembly of Viet Nam. Law on the Elderly No. 39/2009/QH12. Adopted November 23, 2009; effective July 1, 2010, as amended. See also Office of the National Assembly, Consolidated Document No. 23/VBHN-VPQH, February 26, 2026.
National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. Adopted January 9, 2023; principally effective January 1, 2024, as amended. See also Office of the National Assembly, Consolidated Document No. 26/VBHN-VPQH, February 26, 2026.
Government of Viet Nam. Decree No. 96/2023/NĐ-CP Detailing Certain Provisions of the Law on Medical Examination and Treatment. December 30, 2023, as applicable and amended.
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