Get access

The Vulnerable Elders-13 Survey Predicts 5-Year Functional Decline and Mortality Outcomes in Older Ambulatory Care Patients

Authors

  • Lillian Min MD, MSHS,

    1. 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.
    Search for more papers by this author
  • William Yoon,

    1. 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.
    Search for more papers by this author
  • Jeff Mariano MD,

    1. 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.
    Search for more papers by this author
  • Neil S. Wenger MD, MPH,

    1. 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.
    Search for more papers by this author
  • Marc N. Elliott PhD,

    1. 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.
    Search for more papers by this author
  • Caren Kamberg MSPH,

    1. 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.
    Search for more papers by this author
  • Debra Saliba MD, MPH

    1. 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.
    Search for more papers by this author

Address correspondence to Lillian Min, 10945 Le Conte Avenue, Suite 2339, Box 951687, Los Angeles, CA 90095. E-mail: lmin@mednet.ucla.edu

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.

Ancillary