Vulnerable Elders Survey (VES-13)

To develop the quality-of-care assessment system for ill older persons, a panel of nationally renowned geriatrics experts identified the medical conditions prevalent among the elderly that contribute to morbidity, mortality and functional decline, for which effective methods of treatment or prevention exist. For each condition, the RAND team developed quality of care indicators, which were finalized by expert panels and translated into a data collection instrument. This survey was used to assess quality of care for vulnerable older members of two managed care organizations.

What is the VES-13?

The Vulnerable Elders Survey (VES-13) is a simple function-based tool for screening community-dwelling populations to identify older persons at risk for health deterioration. The VES considers age, self-rated health, limitations in physical function, and functional disabilities.

  1. Development of the VES
  2. Feasibility of using the survey
  3. Advantages of the VES
  4. Scoring and using the VES

Survey instrument [PDF]

Development of the VES

A team of RAND, UCLA and VA researchers led by Debra Saliba, MD, MPH developed the VES-13. The survey includes functional disability items that have been examined for gender and age bias (Saliba D, Orlando M, Wenger N, Hays R, Rubenstein LZ. Identifying a Short Functional Disability Screen for Older Persons. Journal of Gerontology. 2000; 55A: M750-756).

The final content and scoring rules for the VES-13 are based on analyses of survey data from a nationally representative sample of elders in the Medicare Current Beneficiary Survey. Details of these analyses are reported in Saliba, S, Elliott M, Rubenstein LA, Solomon DH, et al. The Vulnerable Elders Survey (VES-13): A Tool for Identifying Vulnerable Elders in the Community. Journal of the American Geriatric Society. 2001;49:1691-9.

Feasibility of using the survey

The VES-13 relies on patient self-report. The feasibility of using the VES-13 was tested as part of the Assessing Care of Vulnerable Elders (ACOVE) project — an initiative to develop tools for measuring quality of care for elders at increased risk of health decline.

ACOVE was led by Neil Wenger, MD, Associate Professor of Medicine, University of California, Los Angeles and a RAND Health staff member. The ACOVE team used the VES-13 to screen 2200 elders by telephone. The average time to complete the screener with seniors was less than five minutes.

Advantages of the VES

Because the VES-13 is function-based, it is consistent with widely accepted health models that emphasize the functioning of individuals within their environment. It may help health care organizations, policy makers and researchers to identify a group of elders with increased vulnerability.

The VES-13 is easily transportable across settings, and will remain relevant as care systems evolve. It can be applied to care systems regardless of the quality of administrative data, does not require direct observation or laboratory data, and avoids reliance on utilization patterns or on the ability of a system to detect conditions. The VES can be used and scored by both clinicians and non-clinicians.

Scoring and using the VES

The VES can be administered in person or by phone. The instrument contains a scoring guide. In the national sample of elders used to test the VES-13, a score of 3+ vs. 0-2 on the screener identified 32% of individuals as vulnerable. This vulnerable group had four times the risk of death or functional decline when compared to elders scoring 3 or less.

The VES can be used without charge by researchers, health care professionals, and provider organizations. RAND's only requirement is that proper acknowledgement be given RAND as rights owner, citing the following publication:

The Vulnerable Elders Survey (VES-13): A Tool for Identifying Vulnerable Elders in the Community — 2001
Saliba, S, Elliott M, Rubenstein LA, Solomon DH, et al.
Journal of the American Geriatric Society 2001; 49:1691-9