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The Vulnerable Elders-13 Survey Predicts 5-Year Functional Decline and Mortality Outcomes in Older Ambulatory Care Patients |
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| Authors: | Lillian Min MD MSHS William Yoon Jeff Mariano MD Neil S. Wenger MD MPH Marc N. Elliott PhD Caren Kamberg MSPH Debra Saliba MD MPH |
| Affiliation: | From the Divisions of Geriatrics;and General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, California;;Virginia Commonwealth University School of Medicine;;RAND, Santa Monica, California;;Geriatrics Research, Education and Clinical Care Center, Veterans Affairs Greater Los Angeles Healthcare Systems, Los Angeles, California;;and University of California at Los Angeles/Jewish Homes Borun Center for Gerontological Research, Los Angeles, California. |
| Abstract: | OBJECTIVES: To test the predictive properties of the Vulnerable Elders-13 Survey (VES-13) a short tool that predicts functional decline and mortality over a 1- to 2-year follow-up interval over a 5-year interval. DESIGN: Longitudinal evaluation with mean follow-up of 4.5 years. SETTING: Two managed-care organizations. PARTICIPANTS: Six hundred forty-nine community-dwelling older adults (≥75) enrolled in the Assessing Care of Vulnerable Elders observational study who screened positive for symptoms of falls or fear of falling, bothersome urinary incontinence, or memory problems. MEASUREMENTS: VES-13 score (range 1–10, higher score indicates worse prognosis), functional decline (decline in count of 5 activities of daily living or nursing home entry), and deaths. RESULTS: Higher VES-13 scores were associated with greater predicted probability of death and decline in older patients over a mean observation period of 4.5 years. For each additional VES-13 point, the odds of the combined outcome of functional decline or death was 1.37 (95% confidence interval (CI)=1.25–1.50), and the area under the receiver operating curve was 0.75 (95% CI=0.71–0.80). In the Cox proportional hazards model predicting time to death, the hazard ratio was 1.23 (95% CI=1.19–1.27) per additional VES-13 point. CONCLUSION: This study extends the utility of the VES-13 to clinical decisions that require longer-term prognostic estimates of functional status and survival. |
| Keywords: | vulnerable elder functional decline survival |