A prospective study of risk factors for falls in the elderly at home was conducted in a cohort of tenants (N = 169) of six senior-citizen buildings in New Jersey. Within this study, we evaluated whether benzodiazepine sedative use was associated with risk of falling. The mean age (+/- SD) of the cohort was 79.8 +/- 7.3 years, and 80% were women. Monthly telephone interviews yielded a total of 77 falls during an average follow-up time of 5.6 months. Benzodiazepine use at baseline was categorized as either none, as needed, or continuous, eg, nightly use. Continuous use appeared to increase the risk of falling in this cohort (unadjusted relative risk [RR] = 1.53, 95% confidence interval = 0.93, 2.52; RR adjusted for age, gender, and follow-up time = 1.82, 95% confidence interval = 0.92, 3.62). Any use of benzodiazepines was related to multiple falls in persons who fell. The risk of falling from continuous benzodiazepine use may be higher in persons with position-sense loss in the toes (RR = 2.00) than in persons without such loss (RR = 1.35). We suggest that periodic review of the need for benzodiazepines in the elderly be made.