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Committee on Approaching Death: Addressing Key End of Life Issues; Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington (DC): National Academies Press (US); 2015 Mar 19.

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Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.

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TABLE E-6Association of Functional Status and Medical Conditions with Medicare Costs in the Last 6 Months of Life

Patient CharacteristicsAdjusted Rate Ratio95% Confidence Interval
Functional status (reference: independent in activities of daily living)  
 Stable moderate impairment1.120.92-1.36
 Stable severe impairment1.201.04-1.39
 Decline from independent to moderate impairment1.341.15-1.56
 Decline from moderate to severe impairment1.421.23-1.64
 Decline from independent to severe impairment1.641.46-1.84
Dementia/Alzheimer's disease0.780.70-0.86
Diabetes1.141.04-1.24
Chronic kidney disease1.241.11-1.38
Stroke/transient ischemic attack1.151.04-1.28
Congestive heart failure1.080.98-1.18
Cancer1.060.95-1.19
Chronic obstructive pulmonary disease1.030.95-1.13
Depression1.030.92-1.15

SOURCE: Health and Retirement Study and linked Medicare data, decedents 2000-2008. Adjusted for age, race, ethnicity, education, net worth, Medicaid, Medigap, nursing home residence, relative nearby, religiosity, Self Reported Health, three other chronic conditions, advance directive, regional hospital beds, and local pattern of end-of-life spending (Kelley et al., 2011).

From: Appendix E, Epidemiology of Serious Illness and High Utilization of Health Care

Copyright 2015 by the National Academy of Sciences. All rights reserved.

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