Fall-related ER visits by elderly could quadruple by 2040, study warns

A research team at the National Medical Center analyzed fall-related emergency room use among adults 65 and older and found significant differences based on a region's level of urbanization and population density. The team also projected that fall-related ER visits in 2040 could reach two to four times the 2023 figure, factoring in population aging and trends in visit rates. The study drew on 943,692 fall-related ER visits by adults 65 and older recorded in the National Emergency Department Information System between 2016 and 2023.

Metropolitan areas recorded relatively higher age- and sex-adjusted fall-related ER visit rates, while non-metropolitan areas showed a higher share of ER patients who went on to be hospitalized. In practice, the hospitalization rate among fall-related ER patients was 34.9 percent in metropolitan areas and 42.8 percent in non-metropolitan areas — a gap of 7.9 percentage points.

The pattern held across population density levels as well: hospitalization rates were 34.3 percent in high-density areas, 44.0 percent in medium-density areas and 46.7 percent in low-density areas, indicating that lower population density was associated with higher hospitalization rates. Regional differences also appeared in injury type. The share of spinal injuries among ER patients was 17.4 percent in non-metropolitan areas, compared with 13.5 percent in metropolitan areas — a difference of 3.9 percentage points.

These findings show that the characteristics of fall-related emergency care use vary by region. The researchers said metropolitan areas need systems capable of handling relatively high ER demand, while non-metropolitan areas need care frameworks that account for their higher hospitalization rates.

Fall-related ER visit rates among older adults had been rising before the COVID-19 pandemic, dropped sharply in 2020, then climbed again from 2022 onward. Adults 85 and older experienced a steeper decline during the pandemic and a larger rebound afterward compared with those aged 65 to 74. The research team said the drop in ER visits during the pandemic may have reflected not only actual changes in fall incidence but also shifts in healthcare-seeking behavior, including reduced outdoor activity and reluctance to visit medical facilities.

Using Statistics Korea's population projections and age-specific trends in ER visit rates, the research team estimated the scale of fall-related ER visits through 2040 under three scenarios.

In the first scenario, where age- and sex-specific ER visit rates remain at 2023 levels, demographic aging alone is projected to push annual fall-related ER visits to about 306,000 by 2040 — roughly double the 2023 figure. If the pre-pandemic upward trend in visit rates continues over the long term, visits could reach about 628,000 by 2040, or about 4.1 times the 2023 level. Even under a middle scenario, in which the rate of increase gradually slows, visits are projected to reach about 370,000 — approximately 2.5 times the 2023 figure.

The projections show that future demand for fall-related emergency care among older adults could vary substantially depending not only on population aging but also on changes in age-specific ER visit rates. However, the research team said the three scenarios are estimates based on different assumptions, and actual visit numbers could differ depending on fall prevention programs, changes in healthcare-seeking behavior and shifts in the broader healthcare environment.

The study is notable for using nationwide emergency room data to comprehensively analyze the characteristics of fall-related emergency care use among older adults, regional differences and long-term demand projections.

Lee Gyeong-sin, a senior researcher at the National Medical Center who conducted the study, said fall-related ER use among older adults varies by region, making it necessary to develop fall prevention and emergency care response strategies tailored to the healthcare-use patterns of both metropolitan and non-metropolitan areas. Lee also said further research is needed to examine how local environmental factors — including terrain (elevation and slope), weather conditions (ice and snowfall) and pedestrian infrastructure — affect fall risk among older adults.

Seong Ho-gyeong, a specialist at the National Medical Center and the study's corresponding author, said demand for fall-related emergency care is expected to grow as South Korea ages rapidly, and that efforts to reduce preventable falls and injuries must go hand in hand with preparations for rising demand. Seong also said planning for emergency medical systems should account not only for nationwide demand projections but also for regional patient characteristics and the distribution of medical resources. The study was supported by the Central Injury Management Center and published in the November 2026 issue of BMJ Public Health.