BACKGROUND: Falls and fall-related injuries represent significant public health concerns, yet no reliable and valid assessment tool exists for evaluating fall risk in hospitalized older adults (≥80 years old). OBJECTIVE: This study compared the discriminative properties of 5 commonly utilized fall risk assessment tools and comprehensive geriatric assessments for fallers and non-fallers among older adult inpatients. METHODS: Comprehensive geriatric assessments, which included evaluations of fall risk, were conducted on 82 older adult inpatients. The incidence of falls during hospitalization was documented. The analysis compared the consistency of these scales with actual fall incidents, and the predictive values for fall risk were assessed using the areas under the receiver operating characteristic curve. RESULTS: More than 30 older adult inpatients had a documented history of falls. The incidence of falls recorded in this study was 27.6 per 1000 patient days. The assessment scores of the National Health Commission Fall Scale, Morse Fall Scale, Berg Balance Scale, and Barthel Index revealed that fallers were at a significantly higher risk compared with non-fallers. The Morse Fall Scale showed the best consistency between score and fall occurrence (kappa = 0.461, CONCLUSIONS: Analysis of these assessment scales indicates that the Morse Fall Scale exhibits the highest predictive value for falls among older adult inpatients aged 80 years and above. Integration of the Barthel Index may enhance the predictive validity.