Introduction: Falls from standing height in the elderly represent one of the main causes of visits to emergency services, contributing significantly to the overcrowding of emergency care units in the Brazilian Unified Health System (SUS).

Objective: To analyze, through an integrative literature review, the relationship between falls from standing height in elderly individuals and overcrowding in emergency services within the Brazilian Unified Health System (SUS), highlighting clinical, structural, and organizational repercussions, as well as implications for public health policies.

Methods: An integrative review was conducted in the SciELO, PubMed, LILACS, and Virtual Health Library (VHL) databases between April and June 2025. Articles published between 2018 and 2024, in Portuguese or English, addressing falls in the elderly and the burden on emergency services were included. Selection was based on thematic relevance, methodological quality, and applicability to the Brazilian context.

Results: The selected studies showed that approximately 30% of older adults suffer at least one fall per year, with a significant portion requiring immediate attention in emergency services, increasing the flow and length of stay in emergency care units.^1,2 Failures in fall prevention and longitudinal follow-up by Primary Health Care, a shortage of geriatric beds, insufficient trained multidisciplinary teams , and critical limitations in the long-term care network^3,4 were identified, which favors prolonged hospitalizations and unnecessary readmissions.

Conclusion: Falls from standing height in the elderly significantly worsen overcrowding in emergency services and highlight the urgent need to reorganize the Health Care Network, strengthening Primary Health Care, implementing risk stratification protocols, and improving the quality of care. emergencies and expansion of rehabilitation and long-term care services for the elderly population.⁵

Keywords: falls, elderly, emergency services, overcrowding, unified health system, elderly health

Population aging in Brazil has intensified in recent decades, leading to a significant increase in the demand for urgent and emergency services. Among the most prevalent causes of care in this age group are falls from standing height, which frequently occur due to multifactorial factors such as muscle weakness, postural changes, polypharmacy, cognitive decline, visual impairment, and inadequate home environments.^1,2 This scenario directly contributes to the overcrowding of emergency care units (UPAs) and public hospitals, characterizing a multifactorial challenge that requires coordinated responses between levels of health care, public policies, and prevention strategies.

To analyze, through an integrative literature review, the interface between falls from standing height in older adults and overcrowding in emergency services within the Brazilian Unified Health System (SUS), with emphasis on clinical, structural, and organizational consequences, as well as implications for the planning of public policies aimed at population aging.

An integrative literature review was conducted in the SciELO, PubMed, LILACS, and Virtual Health Library (BVS) databases between April and June 2025. The controlled descriptors used were: "Falls," "Elderly," "Emergency Services," "Overcrowding," and "Unified Health System." Inclusion criteria included articles published between 2018 and 2024, in Portuguese or English, addressing the relationship between falls in the elderly and the overload of emergency services. Selection was based on thematic relevance, methodological quality, and applicability to the Brazilian context.

Analysis of selected studies revealed that falls constitute one of the main causes of hospital admissions in the elderly, with a significant impact on morbidity and mortality and costs for the public health system.¹ It is estimated that around 30% of the elderly fall at least once a year, with a significant proportion requiring immediate attention.² Emergency care units and emergency services, already operating at reduced capacity, become even more overburdened in the face of this recurring demand.³ Studies conducted in Latin American countries describe annual fall prevalences similar to the Brazilian reality, highlighting risk factors such as multimorbidity, use of multiple medications, visual impairment and home environmental barriers.⁴

The authors cite and discuss these findings in Reyes-Ortiz CA, Polanco HA, Hernández H, Wang K et al. (2021), who identify modifiable risk factors for medical falls in older Latin Americans, such as urinary incontinence, depression, poor self-rated health, and limitations in activities of daily living, which increase medical complications, reduce quality of life, and generate high costs for health services; as well as Salmeron-Amadiz LM, Salhub M, Chen NW in older adults ≥60 years and older adults (2025), who analyze falls in older Asians over 60 years of age, reinforcing regional patterns.^5,6 The high proportion of emergency room visits and subsequent hospitalizations demonstrates the significant impact of these falls on the organization and responsiveness of emergency care units. The authors cite and discuss these findings in Reyes-Ortiz CA, Pacheco S, Slovacek CA, Jiang M, Salinas-Fernandez IC, Ocampo-Chaparro JM. Medical falls among older adults in Latin American cities. Salud Pública. 2020;22(5):527-532, which identifies risk factors for falls in older adults in Latin American cities, such as mobility, vision, and balance problems, leading to medical complications, reduced quality of life, and increased hospital costs; and Valderrama-Hinds LM, Al Snih S, Chen NW, Rodriguez MA, Wong R. Falls in Mexican older adults aged 60 years and older. Aging Clin Exp Res. 2018;30(11):1345-1351, which reveal a prevalence of 35.6% of falls in elderly Mexicans, associated with advanced age, diabetes and depression, exacerbating the burden on emergency services.^5,6 The high proportion of emergency room visits and subsequent hospitalizations demonstrates the significant impact of these falls on the organization and response capacity of emergency care units.^4,5

Furthermore, the data indicate critical flaws in the organization of the entry point to the SUS, with underutilization of Primary Health Care (PHC) as a privileged space for prevention, early detection and longitudinal monitoring of risk factors for falls.⁴ The inversion of the age pyramid, as pointed out by IBGE (2022), projects a scenario in which the elderly will represent more than 25% of the Brazilian population by 2040, which imposes the urgency of profound reformulations in the healthcare network, including standardized protocols for risk stratification, efficient management of care flows and training of professionals.^4,5 Studies also highlight the critical shortage of geriatric beds, the insufficiency of specialized and trained multidisciplinary teams in gerontology, and the need for hospital environments adapted to the clinical and functional particularities of aging. The lack of integrated public policies aimed at fall prevention, health education for caregivers and family members, and the improvement of home environments contributes significantly to the recurrence of events and the perpetuation of the cycle of hospitalizations.^3,5

The high demand for continuity of care for elderly victims of falls represents a growing challenge in the context of Brazilian public health, especially given the scarcity of hospital beds for prolonged hospitalizations. Many of these patients, after initial clinical stabilization, remain hospitalized for long periods not due to a strict need for acute hospital care, but due to a lack of adequate support. This reality exposes the fragility of public policies aimed at the long-term care network, as the Unified Health System (SUS) lacks a consolidated structure to guarantee a safe and humane transition of care, whether to qualified home care services , long-term care facilities for the elderly (ILPIs) integrated into the system, or rehabilitation centers with interdisciplinary support .^4,5,6 The lack or insufficiency of long-term care facilities and the lack of coordination between levels of healthcare perpetuate unnecessary prolonged hospitalizations, significantly increasing system costs, exposing patients to avoidable risks such as nosocomial hospital infections and accelerated functional decline, and compromising the effectiveness of elderly-centered care.^4,5

Falls from standing height in the elderly constitute a highly complex problem in the context of Brazilian public health, with direct repercussions on the overcrowding of emergency services and the overload of the Unified Health System.^3,5 The response to this growing demand must be based on an intersectoral and integrated approach that involves everything from health promotion and fall prevention at home, to the comprehensive reorganization of the Health Care Network, focusing on the effectiveness of Primary Health Care, professional qualification of emergency services and expansion of hospital support and long-term care.^4,5 It is imperative that public health policies consider population aging as a strategic and urgent priority, systematically incorporating scientific evidence in the formulation of guidelines, in the improvement of service infrastructure, in the continuous training of professionals involved in the care of the elderly, and in the strengthening of integrated care networks. Addressing this challenging scenario requires not only significant investments in health, but also firm political will and institutional commitment to the dignity, autonomy, and quality of life of the elderly.

None.

The authors declare no conflict of interest.

1. Perracini MR, Ramos LR. Factors associated with falls in a cohort of elderly people living in the community. Rev Saúde Pública. 2002;36(6):709–716.
2. Ministry of Health. Synthesis of Evidence for Health Policies: Falls in the Elderly - Risk Factors and Prevention. Brasília; 2023.
3. Silva RSD, Ciosak SI, Costa MFBNA, Atallah AN. Falls in the elderly and associated factors: a study in a public hospital. Rev Bras Geriatr Gerontol. 2021;24(6):e210162.
4. Projections of the Brazilian Population and of the Federative Units by Sex and Age: 2010-2060. Rio de Janeiro; 2022.
5. Ministry of Health. National Health Policy for the Elderly. Brasília: Secretariat of Health Care; 2018.
6. Reyes-Ortiz CA, Pacheco S, Slovacek CA, et al. Medical falls among older adults in Latin American cities. Salud Pública. 2020;22(5):527–532.
7. Valderrama-Hinds LM, Al Snih S, Chen NW, et al. Falls in Mexican older adults aged 60 years and older. Aging Clin Exp Res. 2018;30(11):1345–1351.