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. 2009 Nov;57(11):2070-6.
doi: 10.1111/j.1532-5415.2009.02497.x. Epub 2009 Sep 28.

The vulnerable elders-13 survey predicts 5-year functional decline and mortality outcomes in older ambulatory care patients

Lillian Min  1 , William Yoon, Jeff Mariano, Neil S Wenger, Marc N Elliott, Caren Kamberg, Debra Saliba
Affiliations

The vulnerable elders-13 survey predicts 5-year functional decline and mortality outcomes in older ambulatory care patients

Lillian Min et al. J Am Geriatr Soc. 2009 Nov.

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 (> or = 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.

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Figures

Figure 1
Figure 1
formula image Predicted probability of death formula image Combined probability of functional decline + death VES-13 = Vulnerable Elders-13 Survey Predicted probabilities of death (dotted line) or the additive probability of functional decline and death (solid line) were calculated based on a multinomial logistic regression with cluster adjustment for primary care clinician and weighted for loss to follow up.
Figure 2
Figure 2
Poorer (higher) VES-13 scores are associated with greater risk of dying throughout the 4.5 year follow up period for the overall whole sample, the falls subset, and the urinary incontinence subset. The dementia subset experienced similar mortality rates above and below VES-13 cutoff scores of 5. The hazard ratios associated with each 1-point increase on the VES-13 were: (whole sample) HR 1.23 (95% CI 1.19–1.27); (falls subset) HR 1.21 (95% CI 1.16–1.25); (urinary incontinence subset) HR 1.22 (95% CI 1.14–1.31); (dementia subset) HR1.07 (95% CI 0.95–1.22). The difference in effect of the VES-13 by screened conditions was not significant in a pooled model (p=.29 for joint test of interaction terms [VES-13 score with each condition]). VES-13: Vulnerable Elders-13 Survey
See this image and copyright information in PMC

References

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