INTRODUCTION: Falls among hospitalized patients pose a significant concern for patient safety, influencing quality of life, mortality, and healthcare costs. This study aimed to assess the incidence of falls and related adverse events among general ward inpatients at a regional general hospital in Japan and identify associated risk factors. METHODS: The study involved 14650 patients aged 15 years or older, admitted between April 2016 and March 2023. Fall risk was evaluated using a 16-item assessment score sheet that considered factors such as age, history of falls, cognitive function, and physical condition. Patients were categorized into risk levels I, II, and III. Adverse events (level 3b or higher) were analyzed, and multivariate analysis was conducted to identify risk factors. RESULTS: Falls occurred in 373 patients (2.5%) during hospitalization, with a total of 475 falls and a fall rate of 1.99 per 1000 patient-days. Recurrent falls were noted in 67 patients. Higher fall risk was found in those aged 65 or older. Adverse events, including head injuries or fractures, affected 11 patients, mainly those aged 80 or older, with five undergoing surgery for hip fractures. Seven significant risk factors for falls were identified, including age ≥70 (odds ratio: 3.26), prior fall history (odds ratio: 1.58), and unstable gait (odds ratio: 2.07). The main risk factor for severe adverse events was needing assistance with mobility or excretion (odds ratio: 30.64). CONCLUSIONS: This study identified the risk factors for falls and for adverse events in inpatients and demonstrated the need to pay special attention to patients who require assistance with mobility or excretion. These results suggest the importance of individualized interventions for fall prevention.