The Purpose and Components of the Vulnerable Elderly Scale (VES-13)
The The Vulnerable Elders Survey (VES-13) is a tool for identifying vulnerable older adults living in the community who are at a higher risk for adverse health outcomes, including functional decline, hospitalization, and mortality. Developed by researchers at RAND and UCLA, this self-report questionnaire takes less than five minutes for a patient to complete and can be administered in person or over the phone. Its primary advantage lies in its simplicity and effectiveness, as it relies on a patient's self-assessment rather than requiring a complex clinical examination.
Unlike more comprehensive geriatric assessments (CGAs) that can be time-consuming and require specialized personnel, the VES-13 serves as an efficient and easy-to-use screening instrument. A positive result on the VES-13 (typically a score of 3 or higher) can trigger a more detailed CGA to identify specific areas of concern. This targeted approach ensures that resources are allocated efficiently, helping to prevent unnecessary hospitalizations and improve long-term outcomes for those most at risk.
The 13 questions comprising the scale address four main areas of assessment:
- Age: Age is a direct factor, with older age correlating with higher vulnerability. Points are typically assigned for those aged 75–84 and again for those aged 85 and older.
- Self-Rated Health: The survey asks individuals to rate their overall health as excellent, very good, good, fair, or poor. A rating of fair or poor indicates a higher degree of risk.
- Physical Function: This section assesses difficulties with specific physical tasks, such as stooping, lifting, reaching, walking a quarter of a mile, and performing heavy housework.
- Functional Disabilities: The final section probes for health-related difficulties in performing key instrumental and basic activities of daily living (IADLs and ADLs), such as shopping, managing money, and bathing.
Scoring and Interpreting the VES-13
The scoring of the VES-13 is straightforward, with a higher score indicating greater vulnerability. A cutoff score is used to identify individuals who are considered vulnerable and who would benefit from further evaluation. In the validation study, a score of 3 or higher was found to be a significant predictor of adverse outcomes.
- Score 0–2: Low risk of functional decline or death. These individuals are generally considered non-vulnerable and may not require immediate geriatric intervention.
- Score ≥3: High risk of functional decline or death within a two-year period. These individuals are identified as vulnerable and should be evaluated further with a CGA to create a targeted intervention plan. Studies have shown this group has more than four times the risk of adverse outcomes compared to those with lower scores.
Comparison of the VES-13 and Comprehensive Geriatric Assessment (CGA)
| Feature | Vulnerable Elderly Scale (VES-13) | Comprehensive Geriatric Assessment (CGA) |
|---|---|---|
| Purpose | Brief screening to identify at-risk individuals. | Detailed, multi-dimensional evaluation and care planning. |
| Time Required | Less than 5 minutes. | Can take several hours and multiple sessions. |
| Administration | Can be self-administered, or conducted by non-clinical staff via phone or in-person. | Administered by a multidisciplinary team of healthcare professionals. |
| Data Sources | Patient self-report. | Patient interview, proxy report, physical examination, and laboratory data. |
| Scope | Focuses on functional status, physical performance, age, and self-rated health. | Covers functional status, comorbidity, cognition, psychological state, medication, nutrition, and social support. |
| Outcome | Identifies individuals needing further assessment. | Develops a comprehensive care plan tailored to the individual's needs. |
The Impact and Application of the VES-13 in Healthcare
The implementation of screening tools like the VES-13 has a significant impact on clinical practice and public health. For community health organizations, it provides an efficient method for population-level risk stratification. By identifying at-risk individuals early, healthcare providers can intervene proactively with preventative measures, potentially delaying or mitigating the onset of functional decline and chronic conditions. This can lead to a reduction in healthcare costs associated with hospitalizations and long-term care.
In clinical settings, such as geriatric oncology, the VES-13 is used to help select patients who would most benefit from a full CGA before starting a cancer treatment plan. This helps healthcare teams better predict potential toxicities and complications during treatment, allowing for adjustments to be made to optimize patient care. The scale's ability to predict longer-term outcomes, such as mortality over a five-year period, further extends its utility beyond initial screening.
Conclusion
The Vulnerable Elderly Scale (VES-13) represents a valuable, streamlined approach to geriatric screening. By focusing on critical, self-reported factors, it effectively identifies a subgroup of older adults at a significantly increased risk of health decline. While it does not replace a comprehensive geriatric assessment for in-depth care planning, its function as a fast and reliable initial screen makes it an essential tool for healthcare providers. The widespread use of the VES-13 helps ensure that vulnerable elders receive the timely, targeted care necessary to maintain their functional independence and overall well-being, ultimately improving health outcomes and quality of life.
