Recognizing the importance of identifying fallers at risk for injury, the author studied factors associated with injury during falls by ambulatory nursing home residents. Forty-eight of 79 subjects (61%) fell during their first year of residence. Fourteen fallers suffered a serious injury. Among fallers, subjects with lower extremity weakness were more likely to be injured than were fallers without weakness (42 versus 12% injured). On the other hand, injured fallers needed less help than noninjured fallers (14% needed help with at least 2 activities of daily living versus 35%), and were less likely to be depressed than were noninjured fallers (7 versus 38%). Although frequently associated with falling, no injury occurred while rising from a chair. The contribution of environmental hazards was not well defined. The only acute factor distinguishing noninjurious from injurious falls was a recent previous fall (present in 30% of the former and 0% of the latter). The finding that injured fallers tend to be more independent, yet have greater lower extremity weakness, than noninjured fallers suggests that both components of injury, namely force of impact and protective responses of the faller, may contribute to likelihood of injury during a fall. This study suggests that if predictive characteristics of the injury-prone faller, or the fall, can be identified, preventive strategies could be targeted at the high risk group.