Background Falls are a leading cause of unintentional injury among adults, especially those over 65 years of age. With increasing longevity and improving access to health care, falls are affecting a more mobile senior citizen population that does not fit the typical profile. We set out to evaluate the current nature of these falls in the elderly. Methods This is a 2-year retrospective chart review of all falls in patients 65 years or older at an urban Level I trauma center. Demographics, location and height of fall, associated injuries, and outcomes were obtained from chart review. Results There were 400 patients meeting inclusion criteria. The cohort had a mean age of 78.3 ± 8.8 years, 50% were male, and 72.5% had at least 1 comorbidity. Non-ground level falls (Non-GLF) were recorded in 56 patients (14%). These patients suffered a significantly higher injury burden. Non-GLF were associated with significantly higher intensive care unit length of stay (2.6 ± 5.6 vs 4.6 ± 6.7 days, P =.016) and a trend toward higher mortality than GLF. Conclusions Falls remain a source of considerable healthcare expenditure, especially among the elderly. Non-GLF account for 14% of cases and are associated with a significantly higher burden of injury and morbidity. Fall prevention strategies should include these active older individuals at risk of high-level falls. © 2014 Elsevier Inc. All rights reserved.