BACKGROUND: Previous studies have shown that the referral situation after cognitive screening is not optimistic. However, little is known about the situation in China. The current study assessed the cognitive function of older adults with an Eight-item Ascertain Dementia (AD8) score of ≥ 2 in a community health center and investigated their willingness to accept referrals. METHODS: In our cross-sectional study, a total of 970 participants completed a cognitive screen using AD8. Those with a score of ≥ 2 were further assessed using the Mini-Mental State Examination. Sociodemographic information was collected. The participants were asked to respond to a questionnaire about their acceptance and uptake of referral after screening and their knowledge of cognitive impairment. The data were analyzed using descriptive statistics, the chi-square test, the Mann-Whitney U rank sum test, and binary logistic regression. RESULTS: We screened 140 older adults with cognitive impairment from 970 participants. Among the 140 subjects, 37 (26.43%) indicated a willingness to be referred, and 103 (73.57%) declined to be referred. We investigated the reasons for declining referrals, and 69 (66.99%) indicated that they thought referrals were unnecessary. The knowledge of referrals, attitude toward referrals, and knowledge of cognitive impairment showed significant differences concerning participants' willingness to be referred(all p <
0.01). The participants with high knowledge of cognitive impairment were willing to accept referrals (p = 0.009
OR = 1.305
95% CI: 1.070-1.591). CONCLUSIONS: Chinese older adults with cognitive impairment exhibit a low willingness to be referred. Health education in older adults is needed to raise awareness of cognitive impairment, dementia prevention, treatment, and care.