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Higher Vulnerable Elders Survey Scores Predict Death and Functional Decline in Vulnerable Older People

Authors

  • Lillian C. Min MD,

    1. From the Divisions of *Geriatrics and General Internal Medicine and Health Services Research, University of California, Los AngelesRAND, Santa Monica, California§Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
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  • Marc N. Elliott PhD,

    1. From the Divisions of *Geriatrics and General Internal Medicine and Health Services Research, University of California, Los AngelesRAND, Santa Monica, California§Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
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  • Neil S. Wenger MD,

    1. From the Divisions of *Geriatrics and General Internal Medicine and Health Services Research, University of California, Los AngelesRAND, Santa Monica, California§Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
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  • Debra Saliba MD, MPH

    1. From the Divisions of *Geriatrics and General Internal Medicine and Health Services Research, University of California, Los AngelesRAND, Santa Monica, California§Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
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  • Dr. Min is supported by a Geriatrics Health Outcomes Research Scholars Award from the Hartford/Foundation for Health in Aging and by the Bureau of Health Professions Geriatric Faculty Training Program (2003–2005). Dr. Saliba was supported by a Career Development Award from the Veterans Affairs Health Services Research and Development Service.

Address correspondence to Lillian C. Min, MD, Department of Medicine, Division of Geriatrics, University of California, Los Angeles, 10945 Le Conte Avenue, Suite 2339, Box 951687, Los Angeles, CA 90095. E-mail: lmin@mednet.ucla.edu

Abstract

OBJECTIVES: To examine whether the Vulnerable Elders Survey (VES-13) score predicts risk of death and functional decline in vulnerable older adults.

DESIGN: Longitudinal evaluation with mean follow-up of 11 months (range 8–14 months).

SETTING: Two managed care organizations in the United States.

PARTICIPANTS: Four hundred twenty community-dwelling older people identified as having moderate to high risk of death and functional decline based on a VES-13 score of 3 or higher. These older people were enrolled in the Assessing Care of Vulnerable Elders observational study.

MEASUREMENTS: Baseline: VES-13 score, sex, income, cognitive score, and number of medical diagnoses. Outcome measures: functional decline and death.

RESULTS: VES-13 scores strongly predicted death and functional decline (P<.001, area under the receiver operating curve=0.66). The estimated combined risk of death and decline rose with VES-13 score, increasing from 23% for older people with a VES-13 score of 3 to 60% for those with a score of 10. Other measures (sex, comorbidity) were not significant predictors of death or decline over this period after controlling for VES-13 score.

CONCLUSION: The VES-13 score is useful as a screening tool to detect risk of health deterioration in already vulnerable older populations, and higher scores reflect greater risk over a short follow-up period.

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