Vulnerable Elders Survey-13 Score Research Articles

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.

A pilot study of the vulnerable elders survey‐13 compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation

Impairments in geriatric domains adversely affect health outcomes of the elderly. The Comprehensive Geriatric Assessment (CGA) is a key component of the treatment approach for older cancer patients, but it is time consuming. In this pilot study, the authors evaluated the validity of a brief, functionally based screening tool, the Vulnerable Elders Survey-13 (VES-13), for identifying older patients with prostate cancer (PCa) with impairment in the oncology clinic setting. Patients with PCa aged >or=70 years who actively were receiving androgen ablation treatment and who were followed within the clinics at the University of Chicago were eligible. Patients self-completed the VES-13 and CGA instruments and repeated the VES-13 1 month later. Physical performance and cognitive assessments were administered by a research assistant. Of 50 participating patients, 50% were identified as impaired by the VES-13 (score >or=3). Sixty percent of patients scored as impaired on >or=2 tests within the CGA, exhibiting deficits in multiple domains. The reliability of the VES-13 (Pearson correlation coefficient) was 0.92. The cut-off score of 3 on the VES-13 had 72.7% sensitivity and 85.7% specificity for CGA deficits and was highly predictive for identifying impairment (area under the receiver operating characteristic curve, 0.90). Patients who had mean VES-13 scores >or=3 performed significantly worse on evaluations of activities of daily living (P = .001), physical performance (P = .002), comorbidity (P = .004), and cognitive impairment (P = .003). Functional and cognitive impairments are highly prevalent among older patients with PCa who receive androgen ablation in oncology clinics. The current results indicated that the brief VES-13 performed nearly as well as a conventional CGA in detecting geriatric impairment in this population.

A pilot study of the Vulnerable Elders Survey-13 (VES-13) as compared to Comprehensive Geriatric Assessment (CGA) to examine geriatric domains in older prostate cancer patients at risk for decline

8539 Background: Impairments in geriatric domains (e.g. function and cognition) adversely affect health outcomes of the elderly. CGA is a key component of the treatment approach for older cancer pts, but is time-consuming. We evaluated the reliability and validity of a brief functionally-based screening tool, the VES-13, in identifying those older prostate cancer (PCa) pts at risk for impairment in the oncology clinic setting. Methods: PCa pts aged ≥ 70 yrs treated with androgen ablation followed within the oncology clinics at the University of Chicago were eligible. Pts self-completed VES-13 and CGA at baseline with VES-13 repeated 1 mth later. Physical performance and cognitive assessments were administered by a research assistant. Pts with impairment were offered follow-up in a “standard of care” frail geriatric elders program. Results: Of 36 participating pts, 50% were impaired by VES-13 (score ≥ 3). 62% of pts scored as impaired on ≥ 2 tests within the CGA exhibiting deficits in multiple geriatric domains. The reliability of the VES-13 (comparing baseline to 1 mth scores) was 0.92 (pearsons correlation coefficient). The cut-off point of 3 on the VES-13 had 72.7% sensitivity and 85.7% specificity and was highly predictive in identifying impairment (ROC AUC 0.8977) when compared to the CGA. Pts with a mean score of VES-13 ≥ 3 performed significantly worse on evaluations of Instrumental Activities of Daily Living (measures ability to live independently) (p=.006), physical performance (p=.024), comorbidity (p<.001), numbers of medications (p=.022), and cognition (p=.018). In multivariate analysis, low education remained significant for VES-13 impairment after adjustment for age (p=.039). 50% of pts accepted referral to an off-site multidisciplinary geriatrics clinic. Reasons for refusal included perceived lack of need by the pt and transportation difficulties. Conclusions: Older PCa pts receiving androgen ablation have significant geriatric impairment. The VES-13 screening measure was predictive in identifying impairment when compared to the CGA and demonstrates feasibility for use in the oncology clinic setting. No significant financial relationships to disclose.

Assessing cognitive function: The complexities of assessment of an individual's cognitive status are important in making an accurate and comprehensive evaluation

To 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.The 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).Significant 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%.The 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.