BACKGROUND: there are few longitudinal studies of the prognosis of falling at home. OBJECTIVE: to determine outcomes in older people who fall once and more than once. DESIGN: longitudinal prospective cohort study. SETTING: primary care in the UK. SUBJECTS: 1815 subjects over 75 who had a standardized and validated health check. METHOD: annual interviews over 4 years. Practice records were used to establish death and admission to institutions. RESULTS: risk of death was increased at 1 year [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.4-4.7] and 3 years (OR 1.9, 95% CI 1.2-3.0) for recurrent fallers but not single fallers (OR 0.9, 95% CI 0.5-1.6 at 1 year; OR 0.97, 95% CI 0.7-1.4 at 3 years). Risk of admission to long-term care over 1 year was markedly increased both for single fallers (OR 3.8, 95% CI 1.8-8.3) and recurrent fallers (OR 4.5, 95% CI 1.7-12). Functional decline was not related to faller status, the latter being very variable from one year to the next. CONCLUSIONS: the stronger relationship between falling and admission to long-term care rather than mortality supports the hypothesis that the perceived risks for those who fall only once are exaggerated.