The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community.
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.
Saliba
D
D
RAND, Santa Monica, California 90401, USA.
Elliott
M
M
Rubenstein
L Z
LZ
Solomon
D H
DH
Young
R T
RT
Kamberg
C J
CJ
Roth
C
C
MacLean
C H
CH
Shekelle
P G
PG
Sloss
E M
EM
Wenger
N S
NS
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