Vulnerable Elders Survey-13 Score Research Articles

Geriatric 8 and Vulnerable Elders Survey-13 predict length of hospital stay and postoperative complications in Japanese patients undergoing urological surgery

IntroductionThe Geriatric 8 (G8) and Vulnerable Elders Survey-13 (VES-13) are established screening tools for assessing vulnerability in older patients. Here we investigated their usefulness as predictors of length of hospital stay and postoperative complications in Japanese patients undergoing urological surgery. Materials and MethodsThis study included 643 patients who underwent urological surgery (74% were for malignancy) at our institute from 2017 to 2020. G8 and VES-13 scores were routinely recorded upon admission. These indices and other clinical data were obtained through chart review. The correlation between G8 group (high, >14; intermediate, 11–14; low, <11) or VES-13 group (normal, <3; high, ≥3) and length of total hospital stay (LOS), postoperative hospital stay (pLOS), and postoperative complications including delirium were analyzed. ResultsThe median patient age was 69 years. A total of 44%, 45%, and 11% of patients were classified into high, intermediate, and low G8 groups, respectively, while 77% and 23% were classified into normal and high VES-13 groups, respectively. Univariate analyses revealed that low G8 scores were associated with prolonged LOS (vs. intermediate, odds ratio [OR] 2.87, P < 0.001; vs. high, OR 3.87, P < 0.001), prolonged pLOS (vs. intermediate, OR 2.37, P = 0.005; vs. high, OR 3.06, P < 0.001), and delirium (vs. intermediate, OR 3.23, P = 0.007; vs. high, OR 5.38, P < 0.001), and high VES-13 scores were associated with prolonged LOS (OR 2.85, P < 0.001), prolonged pLOS (OR 2.97, P < 0.001), and Clavien-Dindo grade ≥ 2 complications (OR 1.74, P = 0.044), and delirium (OR 3.18, P = 0.001). Furthermore, multivariate analyses revealed that low G8 and high VES-13 scores were independent factors which predicted prolonged LOS (low G8; vs. intermediate, OR 2.96, P < 0.001; vs. high, OR 3.94, P < 0.001; high VES-13; OR 2.98, P < 0.001) and prolonged pLOS (low G8; vs. intermediate, OR 2.41, P = 0.008; vs. high, OR 3.18, P = 0.002; high VES-13; OR 3.47, P < 0.001), respectively. DiscussionThe G8 and VES-13 may be effective tools for predicting prolonged LOS/pLOS and postoperative complications in Japanese patients who undergo urological surgery.

Risk factors for postoperative delirium in elderly patients undergoing gastroenterological surgery: A single-center retrospective study.

To investigate the risk factors for postoperative delirium among elderly patients undergoing elective surgery for gastroenterological cancer. From May 2020 to March 2022, patients ≥75 years old with gastroenterological cancer who underwent radical surgery were enrolled. The geriatric assessment, including evaluations of frailty, physical function, nutrition status, and cognitive function, was conducted preoperatively. The confusion assessment method was used to diagnose postoperative delirium. A multivariate logistic regression analysis was used to determine risk factors for postoperative delirium. A total of 158 patients were eligible for inclusion in this study. Of these 53 patients (34%) developed postoperative delirium. In the univariate analysis, the age, regular use of sleeping drugs and benzodiazepine, Charlson Comorbidity Index score, performance status, Fried's frailty score, Vulnerable Elders Survey-13 score, grip weakness, Short Physical Performance Battery (SPPB) score, Mini Nutritional Assessment Short-Form score, and Mini-Mental State Examination score were statistically associated with the incidence of postoperative delirium. In the multivariate analysis, a SPPB score ≤9, Mini Nutritional Assessment score ≤11, a Mini-Mental State Examination score ≤24, and regular use of benzodiazepine were found to be independent preoperative risk factors for postoperative delirium. Certain findings during the preoperative geriatric assessment, especially low SPPB, Mini Nutritional Assessment Short-Form and Mini-Mental State Examination scores, and regular use of benzodiazepine were risk factors for postoperative delirium in elderly patients undergoing gastroenterological surgery.

A prospective phase II study of biweekly S-1, leucovorin, and gemcitabine in elderly patients with locally advanced or metastatic pancreatic adenocarcinoma – The Taiwan Cooperative Oncology Group T1217 study

BackgroundElderly patients with advanced pancreatic adenocarcinoma (APC) are conceived to be frailer and susceptible to treatment toxicity that has led to disparity in lower likelihood of receiving chemotherapy and survival. Optimal chemotherapy is an unmet medical need for elderly patients with APC. Patients and methodsPatients with chemo-naive APC, age ≥70 years, and Eastern Cooperative Oncology Group (ECOG) performance score ≤2 were eligible. The treatment was consisted of biweekly gemcitabine 800 mg/m2, 10 mg/m2/min infusion on day 1 plus oral S-1 and leucovorin (40–60 and 30 mg, respectively) twice daily on days 1–7, the GSL regimen. The primary end-point was progression-free survival with an interested P1 of 5.0 months. ResultsOf the 49 enrolled patients, the median age was 76 years, ECOG performance score ≥1 in 59.2%, metastatic diseases in 65.3%, Vulnerable Elders Survey-13 score ≥3 in 71.4%, and Geriatric 8 score ≤14 in 93.9%. After a median 11 cycles of treatment, the overall response rate and disease control rate were 26.5% and 75.5%, respectively. The median progression-free and overall survivals were 6.6 months (95% confidence interval [CI], 5.4–9.2) and 12.5 months (95% CI, 8.9–14.7), respectively. The most common grade 3–4 treatment-related toxicities were anaemia (20.4%), neutropenia (18.4%), and mucositis (12.2%). Patients had improved emotional function and global health status scores during the GSL treatment. ConclusionThe study met its primary end-point, which supports further investigation on the merit of GSL in Asian elderly APC patients.

G8 and VES-13 as screening tools for geriatric assessment and predictors of survival in older Indian patients with cancer

BackgroundGeriatric 8 (G8) and Vulnerable Elders Survey-13 (VES-13) are quick and easy-to-use screening tools, developed and validated in older patients living in North America and Europe for predicting abnormalities in the subsequent geriatric assessment. The applicability of these screening tools in older Indian patients with cancer is not known. MethodsAn observational study in 308 Indian patients with cancer aged ≥60 years, who were evaluated in the Geriatric Oncology clinic at the Tata Memorial Hospital, Mumbai, India, between June 2018 and November 2020. Patients underwent the G8 and VES-13 screening tools followed by a geriatric assessment. The objectives were to determine the diagnostic accuracy of the G8/VES-13 screening tools to detect an abnormal geriatric assessment, to determine their association with the Eastern Cooperative Oncology Group (ECOG) performance status (PS)/Cancer Aging and Research Group (CARG) scores, to determine the optimal cut-off value on the G8 scale for older Indian patients with cancer, and to determine whether an abnormal G8/VES-13 score was associated with shorter survival. We also aimed to assess the utility of combining the G8 and VES-13 scores to predict for an abnormal geriatric assessment and poorer survival. ResultsThe sensitivity and specificity of the G8 (cut-off, ≤14) score were 84.4% and 17.6%, respectively, whereas those for the VES-13 score (≥3) were 34.9% and 82.4%, respectively. The appropriate abnormal G8 cut-off score was noted to be 12. Abnormal G8 (≤14) and VES-13 scores were not associated with an abnormal subsequent geriatric assessment [p = 0.736 (G8)], while abnormal G8 (≤14) scores did not predict for worse survival outcomes. Lowering the cut-off of the G8 score to <12 and/or combining an abnormal G8 (<12) with the VES-13 score were found to be associated with an abnormal subsequent geriatric assessment [p < 0.001 (G8), p < 0.001(G8 + VES-13)] and predicted for worse survival. ConclusionsAn abnormal G8 cut-off score < 12 is therefore appropriate in older Indian patients with cancer. G8 < 12 predicts for the presence of non-oncological vulnerabilities and shorter survival. Lowering the cutoff of G8 to 12translated to a 35% reduction in the number of patients undergoing a complete geriatric assessment. Combined with VES-13, the G8 can be reliably used to identify those patients who would benefit the most from a geriatric assessment and help in optimal resource utilization especially in busy Indian centers.

Abstract P5-14-11: Retrospective analysis of VES13 questionnaire prior oncology consultation in the Senior Women’s Breast Cancer Clinic at tertiary care center, what have we learned?

Abstract Purpose/Objectives: - Breast cancer mortality is the highest among older women due to co morbidities, increased frailty. Geriatric assessment with focus on frailty is important and several validated tools available to assist this. The Vulnerable Elders Survey 13 (VES-13) screening tool validated in community populations aged 70 and older is a self-reported tool developed to identify older patients at risk of further health decline, showed 4.2 time risk of functional decline over two year in high scorer. We introduced VES-13 screening tool in Senior Women’s Breast Cancer Clinic (SWBCC), prior patient’s visits with medical, radiation or surgical oncology consultations. The aim was to identify feasibility of using VES 13 as a screening tool and its impact on clinical decisions and treatment recommendations. Materials/Methods: - this is descriptive retrospective study, we reviewed VES-13 questionnaires collected SWBCC in patients above the age of 70. We reviewed electronic medical records, variables included ECOG, disease stage, number of comorbidities, and referral to geriatrician or other supportive services, presence of basic social supports, modifications in oncology treatment. We also investigated if the oncologists in the breast centre reviewed VES-13 scores and requested additional services or referral the patients to a geriatrician or other allied health services in the patients who scored higher on the VES-13 instrument. Descriptive statistics were used analyze the data. Results: - 701 patients completed VES-13 questionnaires in the SWBCC between October 2019 and January 2020. 235(33.5%) patient had a documented VES-13 score of 3 or greater. Analysis was focused on patients with a VES13 score of 3 or greater. Mean VES13 score was 6 ± 3.86 with a mean ECOG score of 1.09 ± 1.19.There was no statistically significant association between referrals for geriatric assessment and VES13 score (p=0.20) or ECOG (p=0.33. However, while referral to additional allied health services was not significantly associated with VES13 score (0.6114), it was significantly associated with patient ECOG status (p&amp;lt;0.0001). Higher VES13 scores, increased patient age and higher ECOG scores were significantly associated with modification of oncological treatment and recommendations (p&amp;lt;0.0001). Conclusions: - Our study demonstrates that clinicians do not frequently use the VES13 in their clinical assessment, as opposed to the patients’ ECOG status, which results in missed opportunities for referral of frail patients for additional supportive services. Lack of review by oncologists of the VES13 questionnaires due to time constrain in a busy oncology clinic, further complicate it. Proper Utilizing of VES-13 screening can help in more optimal assessment of older breast cancer patients, individualize treatment approaches and reduce the possibility of frailty related adverse treatment outcomes in older population. Proper infrastructure of introducing VES-13 screening and collection of the VES-13 instrument in a busy academic Breast Cancer Centre is recommended Citation Format: Benazir Mir Khan, Arman Zereshkian, Xingshan Cao, Rajin Mehta, Bonnie Bristow, Maureen Trudeau, Nayanee Henry-Noel, Matthew Neve, Mireille Norris, Mark Pasetka, Katie Rice, Fiona McCullock, Frances Wright, Ines Menjak, Ewa Szumacher. Retrospective analysis of VES13 questionnaire prior oncology consultation in the Senior Women’s Breast Cancer Clinic at tertiary care center, what have we learned? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-11.

Vulnerability in the elderly

Background: Aging process involves an increased risk for the development of vulnerability, because senescence is a process characterized by a multitude of changes that influence the living conditions and health of the individuals. In geriatrics, the term “vulnerability” implies a multidimensional aspect, among which, multimorbidity, functional incapacity, socio-economic and cognitive problems in the elderly. The main objective of the article is to systematize data from the literature through the analysis of the concept and prevalence of vulnerability, assessed by the score Vulnerable Elders Survey-13 (VES-13) in the elderly. For this purpose, publications from the database GoogleSearch, PubMed, Hinari, etc. were analyzed. The information was systematized, highlighting the main aspects of the contemporary vision of the last 5 years.A series of studies (USA, Brazil, etc.) revealed a high prevalence of vulnerability in the elderly according to the VES-13 score, it was estimated in respondents aged &gt; 65 years, between 40-50% of cases were vulnerable people, with a score ≥ 3 p. The vulnerability of the elderly results from different conditions, correlated with each other, especially biological, social and genetic factors. There was a functional decline between 13 and 24% of cases, especially in the elderly over 75 years, and an association with health problems, mobility and low autonomy in over 50% of cases, with a poor quality of life and increased risk of institutionalization. Conclusions: Vulnerability assessment measures are important for identifying older people at high risk of deteriorating health, which is an important target for interdisciplinary intervention.

Gait Speed vs. VES-13: A Pilot Study Comparing Screening Tools to Determine the Need for a Comprehensive Geriatric Assessment in Senior Women with Breast Cancer

Background/ObjectivesPatients aged 70 years and older may be suboptimally treated with cancer therapy because of the lack of clinical trial data in this population. The Comprehensive Geriatric Assessment can be time consuming, and access to geriatricians is limited. This study aims to determine whether gait speed (GS) analysis is equivalent to the widely accepted Vulnerable Elders Survey 13 (VES-13) in identifying vulnerable or frail patients in need of a Comprehensive Geriatric Assessment. MethodsA pilot prospective cohort study was carried out at a tertiary cancer centre in Toronto, Canada, in a radiation oncology breast follow-up clinic. GS analysis and VES-13 were completed by each patient at the same clinic visit. GS of <1 meter/second (m/s) and VES-13 score ≥3 were considered abnormal. Sensitivity, specificity, positive and negative predictive values, and Kappa characteristic were calculated for GS compared with VES-13. Results and DiscussionTwenty-nine participants aged 70 years and older with any stage of breast cancer were included. The GS was 67% sensitive and 95% specific for abnormal VES-13 scores. The GS had an 86% positive predictive value and 86% negative predictive value for abnormal scores on VES-13. Overall, the GS showed a substantial strength of agreement with the VES-13 (kappa 0.66, P < .0001). ConclusionThe GS analysis compared very well with VES-13 scores, and this may be a reasonable alternative to VES-13 screening. This pilot data warrant further study in a larger group of patients.

Vulnerable Elders Survey-13 (VES-13) Predicts 1-Year Mortality Risk in Newly Diagnosed Non-Hodgkin Lymphoma (NHL)

Vulnerable Elders Survey-13 (VES-13) Predicts 1-Year Mortality Risk in Newly Diagnosed Non-Hodgkin Lymphoma (NHL)

Older adults' preferred and perceived roles in decision-making about palliative chemotherapy, decision priorities and information preferences

AimPatients with cancer have varied preferences for involvement in decision-making. We sought older adults' preferred and perceived roles in decision-making about palliative chemotherapy; priorities; and information received and desired. MethodsPatients ≥65y who had made a decision about palliative chemotherapy with an oncologist completed a written questionnaire. Preferred and perceived decision-making roles were assessed by the Control Preferences Scale. Wilcoxon rank-sum tests evaluated associations with preferred role. Factors important in decision-making were rated and ranked, and receipt of, and desire for information was described. ResultsCharacteristics of the 179 respondents: median age 74y, male (64%), having chemotherapy (83%), vulnerable (Vulnerable Elders Survey-13 score ≥ 3) (52%). Preferred decision-making roles (n = 173) were active in 39%, collaborative in 27%, and passive in 35%. Perceived decision-making roles (n = 172) were active in 42%, collaborative in 22%, and passive in 36% and matched the preferred role for 63% of patients. Associated with preference for an active role: being single/widowed (p = .004, OR = 1.49), having declined chemotherapy (p = .02, OR = 2.00). Ranked most important (n = 159) were “doing everything possible” (30%), “my doctor's recommendation” (26%), “my quality of life” (20%), and “living longer” (15%). A minority expected chemotherapy to cure their cancer (14%). Most had discussed expectations of cure (70%), side effects (88%) and benefits (82%) of chemotherapy. Fewer had received quantitative prognostic information (49%) than desired this information (67%). ConclusionOlder adults exhibited a range of preferences for involvement in decision-making about palliative chemotherapy. Oncologists should seek patients' decision-making preferences, priorities, and information needs when discussing palliative chemotherapy.

Factors influencing the condition of vulnerability among the elderly

Abstract Objective: Describe health conditions and life habits using Vulnerable Elders Survey-13 scores, with the aim of understanding the factors associated with the vulnerability of the elderly. Method: A quantitative, cross-sectional study was conducted in the Distrito Federal, Brazil. Data were collected by a questionnaire containing the Vulnerable Elders Survey-13 and other variables. Descriptive statistics, correlation and regression analyses were carried out. Results: 956 people aged 60 years and older living in the Distrito Federal were interviewed. Of these, 32.4% had scores equal to or greater than three, and were therefore classified as vulnerable. Some variables exhibited a positive relation with VES-13 score, with intensity ranging from very weak, in the case of systemic arterial hypertension (p=0.035) and diabetes mellitus (p=0.027), to moderate, as was the case with depression (p&lt;0.001), urinary loss (p&lt;0.001) and falls (p&lt;0.001). It was also observed that a 1% increase in the income of the elderly resulted in a reduction of 0.27 points (p&lt;0,001) in Vulnerable Elders Survey score, reducing vulnerability. Conclusion: Depression most influenced vulnerability score, followed by urinary and hearing loss. Public policies aimed at the promotion of the physical and mental health of the elderly and the creation of a propitious environment to increase income, through reinsertion into the labor market or welfare policies, can help to reduce vulnerability.

Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study

Objectives(1) To compare changes in vulnerability after hospital discharge among older patients with cardiovascular disease who were discharged home with self-care versus a home healthcare (HHC) referral and (2) to...

Abstract P4-10-14: Pilot data from the development of the Senior Women's Breast Cancer Clinic at Sunnybrook Odette Cancer Centre

Abstract Introduction: Women over 70 are a growing demographic of breast cancer patients with specific needs requiring individualized care plans. We developed the interdisciplinary Senior Women's Breast Cancer Clinic (SWBCC) to improve access to a comprehensive geriatric assessment (CGA) and allied health services such as social work, occupational therapy, and pharmacy assistance. After initiation of the SWBCC, we conducted a pilot study using the VES-13 (vulnerable elders survey-13) tool to screen all patients over 70 with the goal of focusing referrals for patients who may benefit most from a CGA. The VES-13 was developed for community-dwelling elders and is validated in oncology patients. The objective of this study is to examine the outcomes of VES-13 screening, determine the medical issues identified by the CGA, and describe the development of this clinic. Methods: A retrospective review of the clinic from May 2015 - May 2017 was performed using the electronic medical records and paper screening forms. We separately describe the impact of the VES-13 to manage CGA referrals. A score of 3 or greater is a positive screen, and indicates the patient is at risk for death or decline. Non-parametric descriptive statistics were used for statistical analyses. Results: A total of 25 patients have been seen in the SWBCC for CGA to date. Median age was 83, (range 67-97). A median of two (range 1-4) new medical issues were identified from the CGA for each patient. The most common new diagnoses or issues identified were cognitive impairment (15/25), falls (6/25), neuropathy (4/25), and pain (4/25). The geriatric day program and falls prevention program were common referrals. After the introduction of VES-13 screening, a total of 54 patients were screened. Median age in that group was 78.5 years (range 70-95). The median VES-13 score was 1 (range 0-10). Of the 21 patients screened positive on VES-13, 7 went on to have a CGA. Of the remaining screen-positive patients, 3/21 patients declined SWBCC referral, and the others were not referred at the discretion of the physician. None of the patients with negative VES-13 were referred for CGA. The SWBCC structure was developed to utilize breast cancer-specific resources, whereby geriatricians provide consultation within the oncology space, and the allied health providers were affiliated with the breast centre. Oncology and geriatric administrative staff organized bookings to better coordinate schedules between the two disciplines. The geriatricians supervised trainees for the CGA, and follow-ups took place at SWBCC or in the geriatric outpatient clinic. Clinic coordinators affixed the VES-13 tool to all new patient charts for those aged ≥70. Nursing resources were dedicated to assist patients with VES-13 if needed, and document scores in the electronic medical record. Conclusions: A dedicated clinic for seniors with breast cancer providing geriatric assessment can identify important undiagnosed medical issues that warrant intervention or monitoring during breast cancer treatment. The VES-13 screening tool provides useful information to help manage resources for geriatrics referral. A prospective trial examining the role of CGA in decision-making for adjuvant chemotherapy is underway in this clinic. Citation Format: Menjak IB, Trudeau ME, Mehta R, McCullock F, Bristow B, Wright F, Rice K, Gibson L, Pasetka M, Szumacher EF. Pilot data from the development of the Senior Women's Breast Cancer Clinic at Sunnybrook Odette Cancer Centre [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-14.

The linear relationship between the Vulnerable Elders Survey-13 score and mortality in an Asian population of community-dwelling older persons

BackgroundThe Vulnerable Elders Survey-13 (VES-13) has been used as a screening tool to identify vulnerable community-dwelling older persons for more in-depth assessment and targeted interventions. Although many studies supported its use in different populations, few have addressed Asian populations. The optimal scaling system for the VES-13 in predicting health outcomes also has not been adequately tested. This study (1) assesses the applicability of the VES-13 to predict the mortality of community-dwelling older persons in Taiwan, (2) identifies the best scaling system for the VES-13 in predicting mortality using generalized additive models (GAMs), and (3) determines whether including covariates, such as socio-demographic factors and common geriatric syndromes, improves model fitting. Materials and methodsThis retrospective longitudinal cohort study analyzed the data of 2184 community-dwelling persons 65 years old or older from the 2003 wave of the national-wide Taiwan Longitudinal Study on Aging. Cox proportional hazards models and Generalized Additive Models (GAMs) were used. ResultsThe VES-13 significantly predicted the mortality of Taiwan’s community-dwelling elders. A one-point increase in the VES-13 score raised the risk of death by 26% (hazard ratio, 1.26; 95% confidence interval, 1.21-1.32). The hazard ratio of death increased linearly with each additional VES-13 score point, suggesting that using a continuous scale is appropriate. Inclusion of socio-demographic factors and geriatric syndromes improved the model-fitting. ConclusionsThe VES-13 is appropriate for an Asian population. VES-13 scores linearly predict the mortality of this population. Adjusting the weighting of the physical activity items may improve the performance of the VES-13.

Screening for Frailty in Older Patients With Early-Stage Solid Tumors: A Prospective Longitudinal Evaluation of Three Different Geriatric Tools

Frailty increases the risk of adverse health outcomes and/or dying when exposed to a stressor, and routine frailty assessment is recommended to guide treatment decision. The Balducci frailty criteria (BFC) and Fried frailty criteria (FFC) are commonly used, but these are time consuming. Vulnerable Elders Survey-13 (VES-13) score of ≥7, a simple and resource conserving function-based scoring system, may be used instead. This prospective study evaluates the performance of VES-13 in parallel with BFC and FFC, to identify frailty in elderly patients with early-stage cancer. Patients aged ≥70 years with early-stage solid tumors were classified as frail/nonfrail based on BFC (≥1 criteria), FFC (≥3 criteria), and VES-13 (score ≥ 7). All patients were assessed for functional decline and death. We evaluated 185 patients. FFC had a 17% frailty rate, whereas BFC and VES-13 both had 25%, with poor concordance seen between the three geriatric tools. FFC (hazard ratio = 1.99, p = .003) and VES-13 (hazard ratio = 2.81, p < .001) strongly discriminated for functional decline, whereas BFC (hazard ratio = 3.29, p < .001) had the highest discriminatory rate for deaths. BFC and VES-13 remained prognostic for overall survival in multivariate analysis correcting for age, tumor type, stage, and systemic treatment. A VES-13 score of ≥7 is a valuable discriminating tool for predicting functional decline or death and can be used as a frailty-screening tool among older cancer patients in centers with limited resources to conduct a comprehensive geriatric assessment.

Validation of the Vulnerable Elders Survey-13 (VES-13) in hospitalized older patients

ObjectiveTo compare the Vulnerable Elders Survey-13 (VES-13) scale, a screening tool for older patients, with four other popular indicators that describe the physical and mental state of patients, the Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS), and to determine which cut-off points of the VES-13 scale will be useful for health services. MethodsThe study included 864 older Caucasian people (mean age 80.9±8.2 years, 615 female) who were hospitalized in the Geriatric University Clinic. The VES-13, ADL, IADL, MMSE and GDS were conducted in all the patients. A “gold standard” was created as a composite reference value assuming a non-vulnerable person with satisfactory results of all the reference tests: ADL (≥5), IADL (≥7), MMSE (≥24) and GDS (<6). ResultsSignificant statistical correlations between the VES 13 and age (r=0.59), ADL (r=−0.53), IADL (r=−0.66), MMSE (r=−0.47) and GDS (r=0.37) were found. The sensitivity and specificity in detecting risk of functional vulnerability were 91.2% and 2.3%, 91.9% and 48.7%, 80.6% and 70.8%, 76.8% and 74.9%, and 71.6% and 82.2% for VES-13 scores of ≥3, ≥4, ≥5, ≥6, and ≥7, respectively. The Area Under the Curve (AUC) for the Receiver Operating Characteristic (ROC) was 82.6%. ConclusionThe VES-13 demonstrates high sensitivity and specificity in detecting functional deficits in older subjects. High correlations with other measures of Comprehensive Geriatric Assessment make it a valuable screening tool for older patients. A cut-off point of 6 seems optimal for screening purposes by health services.

Dysphonia in Nursing Home and Assisted Living Residents: Prevalence and Association With Frailty

Previous studies of geriatric dysphonia prevalence have been limited to ambulatory outpatient and senior communities. Our goal was to identify prevalence of dysphonia in nursing home residents and assisted living residents and search for correlations between indices of dysphonia and indices of frailty. Prospective epidemiological survey. Residents of a vertically integrated senior care organization who were 65 or older and able to understand and complete the questionnaire were recruited to complete the voice handicap index 10 (VHI-10) to assess for dysphonia (VHI-10>10=dysphonia) and Vulnerable Elders Survey 13 (VES-13), a validated instrument to assess for frailty (VES>3=frailty). A total of 119 residents were surveyed. Thirty-three percent of nursing home residents, and 25% of assisted living residents reported dysphonia with 29% of all respondents reporting dysphonia. The mean VHI-10 was 7.4, the median was 5, and the interquartile range was 2-12.5. There was a significant relationship between VHI-10 and VES-13 score (P=0.029). There were no statistically significant relationships between frailty, age, or type of living and dysphonia or VHI-10. There is a high prevalence of voice dysfunction in assisted living and nursing home residents. The correlation between VHI-10 and VES-13 suggests that voice declines as frailty increases.

Consistency and stability of vulnerable elders survey 13 (VES-13) scores in a sample of older patients treated for non-Hodgkin lymphoma

Introduction: The Vulnerable Elders Survey (VES-13) is a simplified tool used to track the elderly at risk of deteriorating health or death. Studies in different countries have established their validity and feasibility as a tool for screening vulnerable patients in oncology. Recently we performed the cross-cultural adaptation of the instrument for use in the Brazilian population. Objectives: To evaluate the consistency and stability of VES-13 scores in a sample of cancer patients. Methods: These are the preliminary results of a cross-sectional study being developed in a cancer referral hospital in Rio de Janeiro, Brazil. Patients were interviewed using a questionnaire containing sociodemographic and clinical variables and underwent a Comprehensive Geriatric Assessment, contemplating 7domains; functionality (Activities of Daily Living-ADL and Instrumental Activities of Daily LivingIADL, emotions (Geriatric Depression Scale 15-GDS), cognition (Mini-Mental State Examination-MMSE), comorbidities (Cumulative Illness Rating Scale-CIRSG), nutrition (Mini Nutritional Assessment-MNA) and number of medications. A descriptive analysis of the study population was performed thorough frequency distributions. To evaluate the consistency and stability of f VES-13 scores in relation to those of the AGM and of the other instruments, we estimated the intraclass correlation coefficients and the respective 95% confidence intervals. Results: The study population consisted of 77 patients, equally distributed in terms of gender. Of those, 68 (88.3%) were independent in ADL and 42 (54.5%) in IADL; themajority had no cognitive impairment nor depressive symptoms, 33 (42.9%) were not at nutritional risk. Only 9 (11.7%) had severe comorbidities and 22. 1% (17) used 4 or more medications. According to VES-13, 24 (31.2%) where classified as vulnerable and 53 (68.8) as fit. Meanwhile, CGA considered 41 (53.2) individuals as fit and 36(46.8) as unfit. The comparison of VES-13 scores to those of the CGA indicated an ICC of 0.774 (95% CI 0,476-0,749). VES 13 scores also showed good stability when compared to the scores of specific instruments, with the exception of CIRSG,whose ICC presented a wide 95% confidence interval. Conclusion: This study showed good consistency and stability between VES-13 and CGA scores and the scores of the specific instrument analysed, with the exception of CIRSG. This problem, possibly, arose from the fact that we used only the most simple form of classification derived from CIRSG (number of categories endorsed) and not the scores based on severity. Based on the results for this sample, the VES-13 could be used as a screening test for the identification of vulnerable patients that would need a more comprehensive evaluation.

Completion of radiotherapy is associated with the Vulnerable Elders Survey-13 score in elderly patients with cancer

Vulnerability assessment of geriatric patients with cancer may contribute to improved anti-cancer treatment with maximal results and minimal side effects. The aim of the present study was to evaluate whether the Vulnerable Elders Survey-13 (VES-13) score is associated with completion of radiotherapy among elderly patients with cancer. This was a prospective observational study that included patients greater than age 75 with histologically confirmed cancer disease, referred to the Department of Radiation Oncology to receive radical or palliative radiotherapy, from 2010 to 2012. VES-13 forms were filled in before the initiation of radiotherapy and scores were assigned according to a standardized scoring procedure. Of a total of 230 participants (median age 78.5 years), 41 (17.8%) did not complete radiotherapy. These patients had higher VES-13 scores (median with interquartile range: 5 [2-8.5]) compared to those who completed the treatment (3 [1-7]; P = 0.008). A VES-13 score >3 was associated with 2.14 times higher probability of not completing radiotherapy, whereas in patients with scores >7 this probability was 3.34 times higher. The association between higher VES-13 scores and non-completion of radiotherapy was independent of other factors, such as age, sex, comorbidities, type of radiotherapy, and presence of side effects. Patients with higher VES-13 scores had increased probability of not completing radiotherapy in our study, and this effect was independent of other factors that might affect radiotherapy completion.

Gender difference in vulnerability and geriatric syndromes among elderly cancer survivors.

9091 Background: Few studies have evaluated the gender difference of vulnerability and geriatric syndromes (GS) among cancer survivors. Methods: Using 2003 Medicare Current Beneficiary Survey, we applied multivariable logistic regression to evaluate the association of gender with vulnerability and GS among cancer survivors. Vulnerability is measured by Vulnerable Elders Survey-13 (VES-13), which is calculated from age, self-rated health status, difficulty with physical activities and functional activities. Vulnerability is defined by a VES-13 score of 3 or higher. 8 common geriatric syndromes were assessed: sight trouble, hearing trouble, nutrition problem, incontinence, falls, depression, memory loss and osteoporosis. Cancer survivors are defined as patients with cancer diagnosed more than one year ago. Results: Among the 1,883 cancer survivors, 749 (40.0%) were male; 1,134 (60.0%) were female. Female survivors had a higher prevalence of vulnerability (47.8% vs 35.7%), and GS (65.5% vs 44.6%) than male survivors. Mean GS number was 1.19 for female survivors, while 0.77 for male survivors (p&lt;0.001). More specifically, female survivors had significantly higher prevalence of sight trouble (7.73% vs 5.0%), incontinence (14.3% vs 7.1%), falls (28.9% vs 22.1%), depression (13.8% vs 7.7%) and osteoporosis (38.2% vs 6.7%). After adjusting for confounders, female survivors were more likely to be vulnerable (adjusted OR (AOR): 1.62; CI: 1.21-2.17; p=0.001); have a geriatric syndrome (AOR: 2.39; CI: 1.91-3.00; p&lt;0.001); have sight trouble (AOR: 1.70; CI: 1.00-2.87; p=0.049); have incontinence (AOR: 2.48; CI: 1.67-3.69; p&lt;0.001); have depression (AOR: 1.87; CI: 1.29-2.71; p&lt;0.001); and have osteoporosis (AOR: 8.48; CI: 6.07-11.84; p&lt;0.001). Conclusions: Female cancer survivors experience a higher prevalence of vulnerability and overall geriatric syndromes.

Can the short screening test Vulnerable Elders Survey 13 (VES-13) substitute for the time-consuming comprehensive geriatric assessment (CGA) to identify vulnerable/frail elderly breast cancer patients?

9114 Background: The aim of this prospective, double-blind study was to evaluate sensitivity, specificity, positive and negative predictive values of VES-13, a 13-item function-based self-report questionnaire, as a rapid tool to uncover vulnerability/frailty compared with full CGA. Methods: All consecutive breast cancer patients aged ≥70 years referred from April 2008 to January 2010 to our medical oncology division underwent both CGA and VES-13. Tests were performed by two different investigator groups, not interchangeable and reciprocally blinded. A final score of 3 or more at the VES-13 was considered as predictive for vulnerability/frailty. At CGA patients were divided into fit, vulnerable and frail (Balducci et al Oncology 2000). Results: 150 patients entered the study, median age 76 years (range 70-94). One hundred twenty-five patients (83.3%) presented with early disease. Ninety-five patients (63.3%) were able to complete VES-13 autonomously, 8 patients (5.3%) required help while in 47 cases (31.4%) the questionnaire was completely administered by a research nurse. With CGA, 84 patients were fit (56.0%), 66 were vulnerable/frail (44%). The median time to perform VES-13 was 4 minutes (range 2-12) compared to 29 minutes (range 11-65) for CGA. Twenty five point nine percent of elderly patients with favourable VES-13 score were vulnerable/frail at full CGA while 34.8% of patients with unfavourable VES-13 were fit, the negative and positive predictive values being 74.1% and 65.2%, respectively. Sensibility and specificity of VES-13 to uncover vulnerability/frailty at full CGA were 68% and 71%, respectively. Conclusions: One third of elderly breast cancer patients had significant troubles in self-compiling the questionnaire. VES-13 significantly reduced the time of geriatric assessment, but sensitivity and specificity were unsatisfactory. Caution should be recommended in using VES-13 as a substitute for full CGA in both everyday practice and clinical trials. No significant financial relationships to disclose.