Background/ purpose: older people are usually afraid of falling. The purpose of this study was to determine the fear of falling and underlying related risk factors among elderly people from Hamadan, Iran. Methods: A total of 321 elderly residents, aged 60 years and older, from 6 district heal th centers and 2 nursing homes were enrolled in this cross -sectional study. Fear of falling was evaluated by the Falls Efficacy Scale - International (FES-I) questionnaire, which contains 16 questions about different daily activities for elderly individuals. The study methods were compliant with the STROBE checklist. Data were analyzed with SPSS16 software. Results: The mean age of participants was 70± 7.46 years. We noted that 70% of participants had positive medical history of chronic diseases of which the most prevalent types were: osteoarthritis (63%), hypertension (42%) and diabetes (19%). The mean FES-I score was 27.83±9.87. The FES-I results indicated that 16.1% of participants had low fear of falling (score: 16-19), 37.6% had moderate fear (score: 20 -27), and 46.3% had severe fear (score: 28 -64). The fear of falling score in the study participants had a significant relationship with age, gender (female), living condition (alone), previous disease history and medication intake (all p values <0.05). Conclusions: The high mean FES-I score (27.83±9.83) alongside high proportion of moderate and severe fear of falling (83.9%) in this study indicates that elderly people from Hamadan, Iran are very concerned about falling. Fear of falling should be specificall y addressed for elderly people and the underlying risk factors should also be investigated.