PP15 Reshaping care for older people: trends in emergency admissions to hospital during a period of simultaneous interventions in glasgow city

Abstract

Background Emergency admissions to hospital have been increasing for several decades in Glasgow, and across Scotland as a whole. The Reshaping Care for Older People Programme is a national programme aimed at enabling older people to stay independent and well at home without the need for care and support. The Change Fund was set up to stimulate a shift from institutional care to home and community based care via a programme of interventions across Scotland. This study aimed to describe the change in emergency admissions to hospital and inequalities in emergency admissions to hospital during the Change Fund period in Scotland. Methods Monthly crude and standardised rates of emergency admission between April 2011 and August 2014 were calculated, for residents of Glasgow City aged 65 years+, using annual population and corresponding monthly estimates. Multilevel Poisson models for emergency admissions nested by datazone were created, adjusting for sex, 5-year agegroup, area-level deprivation (SIMD quintile), season, month and month squared. Results Emergency admissions first rose then fell between Apr 2011 and Aug 2014. Similar trends were also observed in crude and standardised rates during this period. When modelled, both month (RR and 95% CI = 1.03 (1.02, 1.03)) and month squared (RR = 0.997 (0.997, 0.997)) were significant, indicating a rise in admissions followed by a fall. Males were more likely to be admitted to hospital than females, and risk increased with increasing agegroup. A seasonal effect was also measured with a greater risk of admission in winter (RR = 1.22 (1.19, 1.24)) when compared with spring, and a lower risk in summer (RR = 0.81 (0.79, 0.82)). SIMD1 (most deprived) residents accounted for 10 times as many emergency admissions as SIMD5 (most affluent). After adjustment for age and sex, risk of going into hospital for those from SIMD5 was 0.37 (0.35, 0.39) relative to those from SIMD1. An interaction term between month and SIMD quintile suggested significantly greater reductions in admissions among those living in SIMD1. When modelled separately, risk of admission increased over time for those living in SIMD5 (RR = 1.02 (1.01, 1.02 that of previous month)), while for those living in SIMD1 both month (RR = 1.08 (1.08, 1.09)), and month squared (RR = 0.997 (0.997, 0.997)) were significant, describing an increase, followed by a reduction from around July 2012 onwards. Conclusion Overall, emergency admissions have reduced during the Change Fund period. Additionally, socioeconomic inequalities in emergency admissions among those aged 65 years+ reduced over time.