External validation of the Vulnerable Elder\u2019s Survey for predicting mortality and emergency admission in older community-dwelling people: a prospective cohort study

Emma Wallace,Susan M Smith,Kathleen Bennett,Tom Fahey,Ronald Mcdowell

doi:10.1186/s12877-017-0460-1

Emma Wallace, Susan M Smith + Show 3 more

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https://doi.org/10.1186/s12877-017-0460-1

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Journal: BMC Geriatrics	Publication Date: Mar 20, 2017
Citations: 8	License type: open-access

Affiliation: Royal College of Surgeons in Ireland

Abstract

BackgroundProspective external validation of the Vulnerable Elder’s Survey (VES-13) in primary care remains limited. The aim of this study is to externally validate the VES-13 in predicting mortality and emergency admission in older community-dwelling adults.MethodsDesign: Prospective cohort study with 2 years follow-up (2010–2012). Setting: 15 General Practices (GPs) in the Republic of Ireland. Participants: n = 862, aged ≥70 years, community-dwellers Exposure: VES-13 calculated at baseline, where a score of ≥3 denoted high risk. Outcomes: i) Mortality; ii) ≥1 Emergency admission and ≥1 ambulatory care sensitive (ACS) admission over 2 years. Statistical analysis: Descriptive statistics, model discrimination (c-statistic) and sensitivity/specificity.ResultsOf 862 study participants, a total of 246 (38%) were classified as vulnerable at baseline. Fifty-three (6%) died during follow-up and 246 (29%) had an emergency admission. At the VES-13 cut-point of ≥3 denoting high-risk model discrimination was poor for mortality (c-statistic: 0.61 (95% CI 0.54, 0.67), ≥1 emergency admission (c-statistic: 0.59 (95% CI 0.56, 0.63) and ≥1 ACS emergency admission (c-statistic: 0.63 (95% CI 0.60, 0.67).ConclusionsIn this study the VES-13 demonstrated relatively limited predictive accuracy in predicting mortality and emergency admission. External validation studies examining the tool in different health settings and healthier populations are needed and represent an interesting area for future research.

Highlights

Prospective external validation of the Vulnerable Elder’s Survey (VES-13) in primary care remains limited
* Correspondence: emmawallace@rcsi.ie 1HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland (RCSI), 123 Stephen’s green, Dublin 2, Ireland Full list of author information is available at the end of the article (VES-13) is a risk prediction tool designed in the United States (US) to predict functional decline and death in older community-dwelling (≥65 years) people over 2 years follow-up [3]
The Vulnerable Eelders Survey (VES-13) was derived through a methodologically robust process, whereby variables with potential predictive power were identified from the US Medicare database and different models tested for relevant outcomes [3]

Summary

Introduction

Prospective external validation of the Vulnerable Elder’s Survey (VES-13) in primary care remains limited. The term vulnerability refers to a wider range of older people who are at increased risk of functional decline or death [3]. (VES-13) is a risk prediction tool designed in the United States (US) to predict functional decline and death in older community-dwelling (≥65 years) people over 2 years follow-up [3]. It has good clinical utility, as it is easy to administer and can be used to identify older people at higher risk of poorer health outcomes who can be targeted for community-based interventions.

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