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

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.