Abstract: Objective To understand the epidemiological characteristics and changing trends of falls among adults aged 60 years and above in Changshan County, Zhejiang Province, and to provide evidence for developing targeted fall prevention and control measures for the elderly. Methods Data on first-visit injury cases of adults aged ≥60 years from outpatient and emergency departments of three national injury surveillance sentinel hospitals in Changshan County during 2015-2024 were collected. The chi square test and chi-square test for trend were used to analyze the epidemiological features of elderly falls, and the average annual percent change (AAPC) was applied to evaluate the temporal trends of falls. Results A total of 17 145 fall cases among adults aged ≥60 years were reported in Changshan County from 2015 to 2024, accounting for 9.43% of all injury cases across all age groups, with a male tofemale sex ratio of 1:1.04. The proportion of falls among all injuries showed an increasing trend (AAPC = 3.10%, P < 0.001), and falls ranked as the leading cause of outpatient and emergency injury visits among the elderly (48.41%). The constituent ratio of falls declined in the 60-<70 years age group (AAPC = -1.78%, P = 0.001), while it increased in the 70-<80 years age group (AAPC = 3.41%, P < 0.001). Falls predominantly occurred between 8:00 and 12:00 (46.20%), and most events took place at home (65.92%). The proportion of home-occurred falls increased with advancing age (χ² _trend = 660.188, P < 0.001). Fracture was the principal nature of injury following falls (38.97%), and its proportion presented an upward trend (AAPC = 4.65%, P= 0.003); females had a higher proportion of fractures than males. The proportion of fractures rose as age increased (χ²_trend = 183.665, P < 0.001). Conclusion Fall prevention and control faces severe challenges in Changshan County. Falls are the leading cause of injuries and their proportion among all injuries is on the rise. Most falls occur at home, and fractures are the major consequent injury outcome. Targeted health education and comprehensive fall prevention and control strategies should be implemented.