title: The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Analysis of longitudinal survey data.
  
  
  METHODS
  A nationally representative community-based survey.
  
  
  METHODS
  Six thousand two hundred five Medicare beneficiaries age 65 and older.
  
  
  METHODS
  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 >or=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.
authors.affiliation: RAND, Santa Monica, California 90401, USA.
authors.forename: D
authors.initials: D
authors.lastname: Saliba
authors.forename: M
authors.initials: M
authors.lastname: Elliott
authors.forename: L Z
authors.initials: LZ
authors.lastname: Rubenstein
authors.forename: D H
authors.initials: DH
authors.lastname: Solomon
authors.forename: R T
authors.initials: RT
authors.lastname: Young
authors.forename: C J
authors.initials: CJ
authors.lastname: Kamberg
authors.forename: C
authors.initials: C
authors.lastname: Roth
authors.forename: C H
authors.initials: CH
authors.lastname: MacLean
authors.forename: P G
authors.initials: PG
authors.lastname: Shekelle
authors.forename: E M
authors.initials: EM
authors.lastname: Sloss
authors.forename: N S
authors.initials: NS
authors.lastname: Wenger
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012111:Residence Characteristics; D012307:Risk Factors; D012680:Sensitivity and Specificity