Fatal falls down stairs in south-east Scotland were studied using prospectively collected data between 1992 and 1997. 51 individuals, comprising 27 men and 24 women with mean age 68.9 years, died following falls down stairs, 30 (59%) of which were unwitnessed. 43 (84%) individuals died following falls within their own homes. Overall, 27 (53%) fatal falls resulted in death at the scene of the accident. Analysis of injuries according to the Abbreviated Injury Scale yielded injury severity scores (ISS) of between 5 and 75, but only four individuals had injuries recognised to be unsurvivable (ISS = 75). Injury to the brain and/or spinal cord was responsible for the vast majority of most severe injuries. The results demonstrate that stairs represent a significant hazard for the elderly. Most of the deaths in the pre-hospital setting appeared to be more the result of the fact that the victim was alone and unable to summon assistance, rather than as a result of unsurvivable injuries. Consideration needs to be given to both how the safety of stairs can be improved and whether a particular elderly person can safely cope with stairs.