IngentaConnect The Vulnerable Elders Survey: A Tool for Identifying Vulnerable O...

Authors: Debra Saliba¹; Marc Elliott¹; Laurence Z. Rubenstein¹; David H. Solomon¹; Roy T. Young¹; Caren J. Kamberg¹; RN Carol Roth¹; Catherine H. MacLean¹; Paul G. Shekelle¹; Elizabeth M. Sloss¹; Neil S. Wenger¹

Source: Journal of the American Geriatrics Society, Volume 49, Number 12, December 2001 , pp. 1691-1699(9)

Publisher: Blackwell Publishing

Abstract:

J Am Geriatr Soc 49:1691–1699, 2001. OBJECTIVES:

To develop a simple method for identifying community-dwelling vulnerable older people, defined as persons age 65 and older at increased risk of death or functional decline. To assess whether self-reported diagnoses and conditions add predictive ability to a function-based survey. DESIGN:

Analysis of longitudinal survey data. SETTING:

A nationally representative community-based survey. PARTICIPANTS:

Six thousand two hundred five Medicare beneficiaries age 65 and older. MEASUREMENTS:

Bivariate and multivariate analyses of the Medicare Current Beneficiary Survey; development and comparison of scoring systems that use age, function, and self-reported diagnoses to predict future death and functional decline. RESULTS:

A multivariate model using function, self-rated health, and age to predict death or functional decline was only slightly improved when self-reported diagnoses and conditions were included as predictors and was significantly better than a model using age plus self-reported diagnoses alone. These analyses provide the basis for a 13-item function-based scoring system that considers age, self-rated health, limitation in physical function, and functional disabilities. A score of

3 targeted 32% of this nationally representative sample as vulnerable. This targeted group had 4.2 times the risk of death or functional decline over a 2-year period compared with those with scores <3. The receiver operating characteristics curve had an area of .78. An alternative scoring system that included self-reported diagnoses did not substantially improve predictive ability when compared with a function-based scoring system. CONCLUSIONS:

A function-based targeting system effectively and efficiently identifies older people at risk of functional decline and death. Self-reported diagnoses and conditions, when added to the system, do not enhance predictive ability. The function-based targeting system relies on self-report and is easily transported across care settings.

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The Vulnerable Elders Survey: A Tool for Identifying Vulnerable Older People in the Community