The aging of the Brazilian population has resulted in a significant increase in the demand for emergency services, particularly due to falls from standing height among the elderly. This article presents an integrative literature review addressing the relationship between falls in elderly individuals and overcrowding in emergency care units within the SUS. The review includes national epidemiological data and regional data from Ceará. Falls are shown to be a major cause of morbidity, mortality, and healthcare costs among older adults. The analysis explores clinical, organizational, and public health dimensions, emphasizing the structural challenges and the need for preventive strategies aimed at high-risk subpopulations. Future public health policies must prioritize fall prevention and sustainable aging infrastructure in Brazil.

Keywords: falls, elderly, emergency services, overcrowding, SUS; public health, prevention, Brazil

Population aging in Brazil has accelerated in recent decades, contributing to a substantial increase in the demand for emergency health services for the elderly. According to IBGE projections, by 2040, over 25% of the population will be 60 years or older. One of the most frequent causes of such emergency care is falls from standing height, often triggered by muscle weakness, gait disturbances, sensory impairment, and cognitive decline, use of multiple medications (polypharmacy), stroke history, poor visual acuity, and episodes of syncope. These falls have serious consequences, including fractures (particularly of the hip, wrist, and spine), joint dislocations, and traumatic brain injuries (TBI).

Objective

To analyze, through an integrative literature review, the relationship between falls from standing height among elderly individuals and the overcrowding of emergency care services within the Brazilian Unified Health System (SUS), highlighting clinical, structural, and organizational consequences and the implications for public health policy planning directed at the aging population.

An integrative literature review was conducted using databases such as SciELO, PubMed, LILACS, and the Virtual Health Library (BVS), in addition to official data from the Brazilian Ministry of Health and State Health Departments. The search focused on publications from 2018 to 2025. Selected materials included articles, reports, and epidemiological data concerning falls among the elderly. The selection criteria emphasized thematic relevance, methodological quality, and applicability to the Brazilian context.

Falls are a leading cause of hospitalization among older adults in Brazil, significantly impacting morbidity, mortality, and public healthcare expenditures. Approximately 30% of elderly individuals experience at least one fall annually, and a substantial portion require immediate medical attention. This demand contributes directly to the overcrowding of emergency care units (UPAs) and hospitals already functioning near or beyond capacity.

Additionally, failures in the SUS gateway system are evident, with underutilization of Primary Health Care (PHC) in fall prevention and risk monitoring. IBGE projections¹ estimate that by 2040, older adults will comprise over 25% of the Brazilian population, reinforcing the urgency of reorganizing healthcare networks. Effective strategies include risk stratification, flow management, and better integration between care levels.

Studies point to a shortage of geriatric beds, inadequately trained multidisciplinary teams, and a lack of environments adapted to the specific needs of elderly patients. Risk factors such as previous stroke, impaired visual acuity, slow gait, cognitive decline, and polypharmacy are frequently observed in fall-related admissions. Extrinsic factors include inadequate lighting, slippery surfaces, and architectural barriers.

Falls may result in severe consequences including femur fractures, joint dislocations, and traumatic brain injuries. These injuries are associated with loss of functional independence, increased mortality, psychological impacts such as fear of new falls, and social isolation.

Overcrowding compromises the quality of emergency care, delays treatment, and exacerbates clinical outcomes. Long-term hospitalizations are often unnecessary but occur due to a lack of post-discharge support structures such as rehabilitation centers, home care services, or long-term care institutions (ILPIs).

Epidemiological overview: Brazil and Ceará

In Brazil, approximately 25% of elderly individuals living in urban areas experienced at least one fall in 2024. The annual fall rate ranges from 28% to 35% among those aged 65 and over, increasing to 40% among those aged 80 and older. In 2024, over 344,000 medical visits or hospitalizations related to falls in elderly people were recorded, including 93,518 outpatient consultations and 122,195 hospital admissions for individuals aged 60 or older. There were 13,385 recorded deaths related to falls among older adults in the same year.

Between 2013 and 2022, the number of fall-related deaths among the elderly in Brazil nearly doubled, from 4,816 to 9,592 deaths annually. Falls became the third leading cause of death in individuals over 65 during this period. In total, 70,516 elderly individuals died from falls between 2013 and 2022.

In Ceará, the Dr. José Frota Institute (IJF) provided care to over 16,000 fall-related cases in 2023, with more than 5,000 involving elderly patients. In 2024, over 4,000 elderly patients were hospitalized due to falls within the first nine months of the year. The Vale do Jaguaribe Regional Hospital recorded 492 elderly admissions for falls in just the first half of 2024. From 2017 to 2021, there were 1,941 elderly deaths due to falls in Ceará, particularly affecting those aged over 80.

Future prevention strategies for high-risk populations

To reduce fall-related hospitalizations and fatalities, Brazil must adopt a coordinated national fall prevention program. This strategy should include: (1) comprehensive geriatric assessment for individuals with a history of stroke, gait abnormalities, and visual impairment; (2) exercise-based interventions to improve balance and strength; (3) home safety modifications; and (4) structured medication reviews to minimize polypharmacy-related risks.

Public policies must prioritize vulnerable elderly populations with recurrent falls, cognitive deficits, or limited social support. Community outreach, caregiver training, and PHC-based monitoring will be essential components in ensuring successful long-term outcomes. Furthermore, investments in rehabilitation and long-term care facilities integrated with SUS are fundamental to reduce unnecessary hospital stays.

The implementation of future national fall prevention programs must be guided by a multidimensional approach, with a special focus on elderly individuals in situations of vulnerability and high risk.

We propose the creation of the National Program for Fall Prevention in Aging (NPFPA), with integrated actions across primary health care, social assistance, health surveillance, and community centers. This program could include: (1) annual comprehensive geriatric assessments for all older adults in primary care, with individual fall risk mapping and tailored intervention plans; (2) multiprofessional teams composed of physicians, nurses, physiotherapists, occupational therapists, psychologists, and social workers, working collaboratively to provide broad, continuous, and coordinated care; (3) mobile units for home visits in high-risk areas, focusing on physical rehabilitation, environmental adaptation, and family education; (4) mandatory training for community health workers to detect early signs of frailty and fall risk; (5) tax incentives and logistical support for structural home modifications for low-income elderly residents; and (6) partnerships with universities and technical schools for the ongoing training of community caregivers.

These actions must be supported by ongoing public health education campaigns promoting active aging, self-care, and the prevention of domestic accidents. Institutionalizing a program with stable funding, intersectoral coordination, and a strong multiprofessional approach is essential to reduce preventable hospitalizations, improve quality of life among older adults, and mitigate the burden of overcrowding in SUS emergency services.

Health system challenges and structural gaps

In medium to low-income communities, the incidence of falls among the elderly tends to be higher due to a combination of socioeconomic, environmental, and behavioral factors. Studies indicate that older adults living in these areas are more exposed to precarious housing conditions, such as uneven flooring, poor lighting, and lack of safety adaptations, which significantly increase fall risk.

Furthermore, lifestyle habits such as physical inactivity, inadequate nutrition, and poor adherence to pharmacological treatment contribute to muscle weakness, postural instability, and frailty. Family dynamics in these contexts may also represent a conflicting factor: while multigenerational cohabitation can offer protective support, it is often marked by emotional overload, lack of specialized caregiving, or even neglect, which compromises the continuous monitoring and safety of the elderly.

These vulnerabilities highlight the urgent need for intersectoral public policies that integrate environmental safety, health education, and caregiver training as pillars of fall prevention in socioeconomically vulnerable populations.

Brazil’s Unified Health System (SUS) still shows limitations in addressing the needs of the elderly population at different levels of care. There is a significant underutilization of Primary Health Care (PHC) in risk assessment and longitudinal prevention of falls. The care flow remains centered on emergency services, leading to bottlenecks and inadequate patient outcomes.

Post-acute care is also compromised. Many elderly patients remain hospitalized longer than necessary not due to clinical need, but due to the lack of adequate support services such as qualified home care, long-term care institutions (ILPIs), and rehabilitation centers. This reflects a fragile network for transitional and long-term care within SUS, contributing to high costs, risk of hospital-acquired infections, loss of autonomy, and poor aging experience.^2–10

Falls from standing height among elderly individuals represent a serious public health concern with profound consequences for SUS emergency services. The association between falls and overcrowding reflects a systemic fragility in care transitions and long-term support structures. Addressing this multifactorial issue requires investment in preventive strategies, intersectoral coordination, and prioritization of aging in health policy agendas. National and regional epidemiological data confirm the scale of the problem and the urgent need for action. A multidisciplinary approach, with emphasis on early risk detection, rehabilitation, caregiver education, and systemic reform, is essential to reduce morbidity, mortality, and economic burden.

None.

The author declares there is no conflict of interest.

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