The VES-13: A Guide to Assessing Vulnerability in Elderly Cancer Patients
"Learn how the Vulnerable Elders Survey-13 is being adapted for use in Brazil, enhancing geriatric oncology care."
As our global population ages, healthcare systems face the growing challenge of providing comprehensive care for elderly patients, particularly those battling cancer. Geriatric oncology, a field dedicated to addressing the unique needs of older adults with cancer, is becoming increasingly crucial. Effective assessment tools are essential to identify vulnerable individuals who may require specialized support and interventions. One such tool is the Vulnerable Elders Survey-13 (VES-13), a widely used instrument for assessing vulnerability in older adults.
The VES-13 is a brief, easy-to-administer questionnaire designed to identify older adults at risk of functional decline or mortality. It consists of 13 items that assess age, self-rated health, functional abilities, and physical condition. The survey has demonstrated good reliability and validity in various settings, including studies of older adults with prostate cancer. Recognizing the potential of the VES-13 to improve geriatric oncology care in Brazil, researchers have undertaken the task of adapting the instrument for use in the Brazilian context.
This article explores the initial stages of the cross-cultural adaptation of the VES-13 for use in cancer care in Brazil. It highlights the rigorous process undertaken to ensure the instrument's cultural relevance and linguistic accuracy. By adapting the VES-13 for the Brazilian context, healthcare professionals can better identify vulnerable older adults with cancer, facilitating timely interventions and personalized care plans.
Origins and Validation of the VES-13
The Vulnerable Elders Survey was developed to identify community-dwelling older people at increased risk of death or functional decline. Published research by Min, Elliott, Wenger, and Saliba in the Journal of the American Geriatrics Society in December 2001 reported that higher VES scores predicted death and functional decline. The VES-13 became a component of the ACOVE project, Assessing Care of Vulnerable Elders, and was designed as a simple, function-based screening tool. Its assessment domains include age, self-rated health, physical functioning, and comorbidities.
Adapting the VES-13: A Step-by-Step Approach
The cross-cultural adaptation of the VES-13 followed a structured methodology to ensure that the translated version retained the meaning and intent of the original instrument. The adaptation process consisted of several key steps:
- Formal Assessment of Meaning: A formal assessment of the general and referential meanings of the translated items was conducted by a geriatrician with expertise in cross-cultural adaptation. This assessment involved evaluating the conceptual, item, semantic, and operational equivalence of the translated items.
- Synthesis Version: Based on the translations and the formal assessment of meaning, a synthesis version of the VES-13 in Portuguese was developed. This version represented the best possible translation of the original instrument while maintaining its cultural relevance.
- Pretesting: The synthesis version of the VES-13 was pretested on a sample of 33 elderly patients in an oncologic hospital in Brazil's public healthcare system (SUS). The pretest aimed to evaluate the comprehensibility and acceptability of the translated items.
Recent Applications in Research
Recent studies have applied the VES-13 across community and cancer-related research settings. A cross-sectional study of 769 older people examined vulnerability and quality of life using the VES-13 alongside the WHOQOL-OLD and WHOQOL-BREF instruments. Research in Araras, Sao Paulo, Brazil, applied the VES-13 with the Mini Mental State Examination, Edmonton Frailty Scale, and Lawton and Brody scale, analyzing results in SPSS version 23. A 2026 study evaluated the diagnostic and prognostic value of VES-13 scores in cancer patients aged 65 years and older who may require comprehensive geriatric assessment.
Comparing Screening Approaches
Comparative research has examined whether the VES-13 can identify older cancer patients who need formal geriatric assessment. In patients with aggressive non-Hodgkin lymphoma, the VES-13 was reported to have associations with important outcomes similar to those of the FIL comprehensive geriatric assessment, while potentially being more practical in clinical practice. Another study compared the VES-13 with the G8, modified G8, and six-item Brief Geriatric Assessment tools for identifying patients requiring geriatric assessment and for examining treatment modifications after assessment. These comparisons focus on screening efficiency and the ability to guide further evaluation and treatment decisions.
Future Directions: Psychometric Testing and Implementation
With the initial stages of the cross-cultural adaptation successfully completed, the researchers are now focusing on testing the psychometric properties of the Portuguese version of the VES-13. This will involve assessing the instrument's reliability, validity, and responsiveness in a larger sample of elderly cancer patients. Once the psychometric properties have been established, the VES-13 can be implemented in clinical practice to identify vulnerable older adults with cancer and guide individualized care plans. The adaptation of the VES-13 represents a significant step forward in improving geriatric oncology care in Brazil.
Expanding Practical Screening
The RAND Corporation describes the VES-13 as a component of the ACOVE project, Assessing Care of Vulnerable Elders. It is a simple, function-based screening tool for community-dwelling populations. Its intended use is to identify older people at risk for health deterioration, supporting continued application as an accessible approach to vulnerability screening.