Reshaping Care for Older People: Trends in emergency admissions to hospital during a period of simultaneous interventions in Glasgow City, April 2011-March 2015

This study describes trends in emergency admissions (EAs) in Glasgow City during a period when interventions were designed and implemented, aimed at shifting the balance from institutional to community-based care. Standardised monthly rates of EAs between April 2011 and March 2015 were calculated, for residents of Glasgow City aged 65 years and over. Multilevel zero-inflated Negative Binomial models for EAs nested by datazone were created, adjusting for sex, 5-year age group, area-level deprivation (SIMD quintile), season, month and month squared. Models were also run for EAs by cause, for three causes: chronic obstructive pulmonary disease (COPD), falls and dementia. The rate of EAs first rose then fell during the study period. When modelled, RRs for month (RR for month 12 relative to month 1 and 95% CI = 1.02 (0.99, 1.06)) and month squared (RR = 0.999 (0.998, 0.999)) indicated a rise in admissions until February 2012, followed by a fall. Risk of admission was greater for males and increased with increasing age group. The risk of going into hospital for those from SIMD 5 (most affluent) was 0.58 (0.56, 0.59) relative to those from SIMD 1 (most deprived). Socioeconomic inequalities were particularly great for COPD-related admissions, where RR for SIMD 5 was 0.25 (0.23, 0.28) times that of SIMD 1. An interaction term between month and SIMD was not significant for any outcome. For dementia-related EAs there was a suggestion that inequalities may be reducing over time. EAs for those aged 65 years and more reduced during the Change Fund period, with similar relative reductions observed across all deprivation quintiles.