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BACKGROUND: Falls are common internationally among the elderly. This study examined domiciliary environmental risk factors attributable to accidental falls among community-living older persons living in high-rise buildings in Hong Kong. METHODS: Over the preceding 6 months, 592 older persons were recruited from a housing resource center for baseline assessments. Among them, 456 participants completed monthly telephone follow-ups for 12 months. A home visit for environmental inspection was conducted within 3 days for those who reported falls in an indoor environment. The environments of participants with or without falls were compared for analysis. FINDINGS: Seventy-seven participants reported falls (indoor: outdoor = 1:2) over the preceding 12 months. The fall rate was 24.8%, and the one-year prevalence of falls (persons with at least one fall) was 16.7%; for two or more falls it was 3.9%. Self-reported previous falls in the preceding 12 months (OR 2.88, CI 1.67-7.17), female gender (OR 8.91, CI 0.27-0.47), and self-reported diabetes mellitus (OR 3.55, CI 1.10-3.55) were significant predictors for fallers with at least one fall. Significant differences were found between the homes of fallers and non-fallers in the sites of hazards with respect to seating (p =.011), toilets (p =.018), and kitchens (p =.026), particularly with steps or stair railings (p =.009). CONCLUSIONS: This study supports the existence of a difference in environmental risk factors between fallers and non-fallers in high-rise buildings, and the results can be generalized to other domiciliary environments for community-living older persons in most urban cities. Language: en