The Vulnerable Elders Survey and its prognostic relationship to survival in an older community-based palliative population
- 1Centre for Palliative Care, Fitzroy, Australia
- 2Deaprtment of Palliative Care, Melbourne Health, Parkville, Victoria, Australia
- 3Melbourne Epicentre, Melbourne Health, Parkville, Victoria, Australia
- Correspondence to Dr M D Chapman, Centre for Palliative Care, 6 Gertrude St, Fitzroy 3065, Australia;
Objectives Frailty denotes a vulnerability to poor outcomes and is a common risk factor for mortality in older persons. The Vulnerable Elders Survey (VES) is an easy to administer validated screening tool to detect a frail population. Assessment of frailty has the potential to aid in prognostication for the older community dwelling palliative population. This study seeks to evaluate the relationship of the VES to prognosis in this population.
Methods Prospective cohort study of patients over 65 years old admitted to a community palliative care service. The VES was performed in addition to the usual assessments of physical function. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Physical function and CCI were assessed to determine whether they improved the prognostic power of the VES. Patients were followed-up for 8 months with the primary endpoint of survival.
Results 197 patients completed the study with a high proportion of malignant diagnoses (87.5%); 98% of patients died during the study with a median survival of 61 days; 93.4% of patients were vulnerable on the VES and high risk scores predicted death within 100 days.
Conclusions In this study the VES demonstrated high rates of vulnerability and has the potential to improve the accuracy of prognosis in older palliative community dwelling patients. Improving prognostication has potential clinical benefits, including aiding clinical communication and determining the best use of community services. The limitations of this study and the evolving understanding of frailty suggest that further work in this area is required.
- Received 11 October 2012.
- Revision received 9 January 2013.
- Accepted 19 February 2013.
- Published Online First 12 March 2013
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions