VES-13 Role to Identify Limited Life Expectancy in Older Adults in Primary Care Settings

Abstract

Background: Population aging is a phenomenon that represents a challenge to the health systems, especially to settings with limited economic resources. In this scenario, it is essential to perform adequate screening, diagnostic, and therapeutic approaches to reduce health vulnerability. To investigate, for the first time, the potential role of Vulnerable Elders Survey (VES-13) to identify older adults with Limited Life Expectancy (LLE) (defined as estimated 10-year mortality risk ≥ 50%) in Primary Health Care (PHC) settings. Methods: This cross-sectional study was performed in all PHC units in Jatai (Brazil) from July to December 2018. The sample size of 407 elderly individuals was obtained considering an older population (≥60 years old) of 10,853, a 50% prevalence, a 5% margin of error, a 95% confidence level, and 10% of possible losses. Participants answered a questionnaire about sociodemographic and clinical characteristics, including the VES-13 (a tool to identify health vulnerability) and the Suemoto index (an index to estimate 10-year mortality risk for community-dwelling older adults). We tested the association between LLE and VES-13, using multiple logistic regression analysis. In addition, we investigated the discrimination of the VES-13 in identifying individuals with LLE using the area under the receiver operator characteristic curve (AUROC). Results: The mean age was 68.9 ± 6.6yo, and 58% were women. The mean score of VES-13 was 2.0 ± 2.2, the mean score of Suemoto index was 31.5 ± 21.1%, and 17.2% had LLE. The VES-13 was associated with LLE (OR=1.57; p=<0.0001). Moreover, a VES-13 score ≥2 points was able to discriminate LLE (AUROC=0.764 (95%CI=0.078-0.820); sensitivity 81%). Conclusion: VES-13was able to identify older adults with LLE in PHC settings. Thus, the VES-13 could play a role in detecting older adults that would not benefit from screening (e.g., colorectal cancer) and strict control of chronic diseases (e.g., diabetes). However, other longitudinal studies are needed to confirm the role of VES-13 in identifying older adults with LLE, before the VES-13 can be adopted in routine clinical practice decisions in PHC, since we used a prediction model to identify LLE.