['To examine whether the Vulnerable Elders Survey (VES-13) score predicts risk of death and functional decline in vulnerable older adults.', 'Longitudinal evaluation with mean follow-up of 11 months (range 8-14 months).', 'Two managed care organizations in the United States.', 'Four hundred twenty community-dwelling older people identified as having moderate to high risk of death and functional decline based on a VES-13 score of 3 or higher. These older people were enrolled in the Assessing Care of Vulnerable Elders observational study.', 'Baseline: VES-13 score, sex, income, cognitive score, and number of medical diagnoses.', 'functional decline and death.', 'VES-13 scores strongly predicted death and functional decline (P<.001, area under the receiver operating curve=0.66). The estimated combined risk of death and decline rose with VES-13 score, increasing from 23% for older people with a VES-13 score of 3 to 60% for those with a score of 10. Other measures (sex, comorbidity) were not significant predictors of death or decline over this period after controlling for VES-13 score.'] Do higher vulnerable elders survey scores predict death and functional decline in vulnerable older people?