Introduction: The population of Valle del Cauca is experiencing accelerated aging: 16.9% are aged over 60 years and 86.7% belong to low socioeconomic strata, exposing older adults to simultaneous vulnerabilities across health, economy, and support networks. The Centro Vida program, operated by the Gobernación del Valle del Cauca, provides comprehensive care addressing these needs. Objective: To construct and apply a multidimensional vulnerability index in program beneficiaries to stratify risk and strengthen equity in care delivery. Materials and methods: Descriptive cross-sectional study with 441 active beneficiaries from four municipalities in Valle del Cauca (2024). An index comprising seven categories — physical health, mental health, socioeconomic conditions, social support network, access to services, demographic factors, and functional status — was constructed and classified into low, medium, and high vulnerability levels using quartile distribution. An ordinal logistic regression model was fitted to identify determinants. Results: 91.3% of beneficiaries had at least one active diagnosis, with cardiovascular diseases predominating (71%) and a mean of 2.5 diagnoses per person. 79.7% had no personal income and 28% did not participate in preventive programs despite high insurance coverage. 26.3% were classified as high vulnerability, with statistically significant differences across program sites (Chi² = 55.02; p < 0.0001). Age and multimorbidity were the strongest predictors of vulnerability; educational attainment acted as a protective factor. Conclusion: The index constitutes a reproducible, low-cost tool for prioritizing interventions and evaluating program impact. The gap between formal insurance coverage and effective access to preventive services represents the critical node for reducing vulnerability in this population.
