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

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.