Avaliação do Vulnerable Elders Survey-13 como preditor de reinternação e mortalidade em idosos após seis meses da alta hospitalar

Abstract

Introduction: The increasing age of the population in Brazil and worldwide is raising the risk of functional decline and greater health vulnerability among the elderly. In response to this scenario, the Vulnerable Elders Survey (VES-13) was developed. It is a tool designed to identify elderly individuals at high risk of both functional decline and death within two years in an outpatient setting. This tool is not only useful for identifying elderly people who may require additional care but also for planning interventions that simultaneously preserve health and well-being. Therefore, the objective of this research is to evaluate the role of the VES-13 in detecting elderly individuals at higher risk of readmission or death within six months after hospital discharge. Methodology: This prospective cohort study was conducted at a tertiary private reference hospital in Brasília. Consecutively, patients of both sexes aged 60 years or older were included. Patients who had been hospitalized for at least 48 hours were eligible for the study. After consent, the researcher followed up with them by phone and administered the VES-13 questionnaire within 48 hours of hospital discharge. Six months later, another phone contact was made to check the occurrence of readmission or death Results: This study included 400 patients. However, contact was not obtained with 2 of them after 6 months. Therefore, the final sample consisted of 398 participants, with a mean age of 74.4 ± 8.1 years. Among these participants, 157 (39.4%) were women, and 150 (37.7%) had experienced falls. The mean CCI was 6.6 ± 1.6, and the mean VES-13 score was 3.1 ± 3.2. Six months after hospital discharge, the rates were 15.8% (n=138) for readmission and 11.3% (n=45) for mortality. In the multivariate analysis, the following were independently associated with readmission within 6 months of hospital discharge: (1) falls (HR: 2.40; 95%CI: 1.28-4.51; p=0.007); (2) higher CCI scores (HR: 1.37; 95%CI: 1.13- 1.66; p=0.002); and (3) higher VES-13 scores (HR: 1.56; 95%CI: 1.33-1.83; p<0.001). In the multivariate analysis, the following were independently associated with death within 6 months of hospital discharge: (1) falls (HR: 38.37; 95%CI: 7.92-186.01; p<0.001); (2) ICU admission (HR: 2.06; 95%CI: 1.05-4.07; p=0.037); (3) higher CCI scores (HR: 1.35; 95%CI: 1.07-1.12; p=0.012); and (4) higher VES-13 scores (HR: 2.38; 95%CI: 1.53-3.73; p<0.001). Conclusion: The VES-13 has proven to be effective in identifying elderly individuals at higher risk of readmission and mortality within six months of hospital discharge. The practical use of this tool could benefit healthcare systems by early identification of patients who require additional care, potentially improving clinical outcomes and optimizing resources allocated to elderly care.