The nature of head injury in the elderly differs from that in younger adults. Fifty-four consecutive patients, aged 65 years or older admitted to a neurotrauma unit with head injury over a six-month period, were identified to determine the causes and medical and social consequences. Falls accounted for the great majority of cases, and alcohol consumption was an important contributory factor in males, while pedestrian road accidents were responsible for most deaths. A routine investigative screening procedure was evaluated. When visited after discharge, 72% of survivors had experienced a change in functional status with increased family involvement and use of community support services. This group was significantly older (p<0·01) than those whose status had not changed. A third of the survivors had changed their living circumstances at review. It is suggested that such patients could benefit from increased involvement of the geriatric services.