What question did this study set out to answer?

To develop and validate the EHSAS tool for early identification of geriatric syndromes in rural older adults.

February 8, 2026

3698 Introducing EHSAS- a tool for rapid community-based screening in low resource rural settings to assess eligibility for CGA

Key Points

To develop and validate the EHSAS tool for early identification of geriatric syndromes in rural older adults.
Three-phase mixed-methods approach
Tool development through literature review and expert consensus
Scale evaluation using diagnostic accuracy testing and reliability assessment
Final EHSAS tool includes 11 items across key geriatric domains
Cut-off of ≥3 'Yes' responses maximizes sensitivity and specificity
Achieved sensitivity of 76.3% and specificity of 76.5% with high internal consistency

Abstract

Abstract Background Comprehensive Geriatric Assessment (CGA) is a cornerstone of geriatric care but is challenging to implement in low- and middle-income countries (LMICs) due to scale, workforce limitations and the absence of culturally appropriate tools. Community Health Workers (CHWs) play a critical role in rural India, yet they lack a suitable screening instrument to identify older adults who require further and detailed CGA. Objectives To develop and validate the Elderly Health Status Assessment and Screening (EHSAS) tool—a concise, culturally adapted, and multidimensional screening tool for early identification of common geriatric syndromes among rural community-dwelling older adults in India. Methods We employed a three-phase mixed-methods approach: tool development (literature review, expert consensus, face and content validation, field testing with older adults and CHWs), scale development (exploratory factor analysis, convergent and discriminant validity testing), and scale evaluation (cut-off score determination, diagnostic accuracy testing, and reliability assessment). The tool’s performance was benchmarked against standard geriatric assessment instruments, with frailty status as the criterion variable. Results The final EHSAS tool comprises 11 items spanning the key geriatric domains, excluding the frailty item. A cut-off of ≥3 ‘Yes’ responses was selected based on ROC curve analysis and Youden’s Index to maximise sensitivity and specificity. It demonstrated good psychometric properties, including high internal consistency (Cronbach’s alpha 0.7), substantial test–retest reliability (Cohen’s kappa 0.79), and balanced diagnostic accuracy (sensitivity 76.3%, specificity 76.5%, negative predictive value 93.2%). Field testing confirmed that EHSAS was usable by and acceptable to CHWs and older adults. Conclusion The EHSAS tool fills a critical gap in geriatric care in LMIC settings by offering a validated, brief, and culturally appropriate screening instrument for CHWs. Its adoption can strengthen early detection of geriatric syndromes and support timely referrals for CGA, ultimately improving health outcomes for older adults in resource-constrained rural areas.

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