Abstract Unintentional falls at home are a common cause of admissions to hospital amongst young and middle-aged adults. This population-based study investigated the longer-term health, physical and psychological outcomes following such injuries, and the predictors of these sequelae. Method Individuals aged 25–60 years admitted to hospital in the Auckland region between July 2005 and June 2006 following an unintentional fall at home were interviewed soon after the injury (baseline) and 15-months following the injury. Information collected at baseline on pre-injury status was analysed in relation to changes in general health and functioning, psychological outcomes, and role limitations at follow-up. Results Of the 328 participants eligible for study, 251 (77%) completed the follow-up interview. Reductions in general health and overall functioning (compared with pre-injury status) were reported by 25% and 43% of participants, respectively. In multivariate analyses, predictors of specific adverse outcomes at follow-up included increasing age (reduction in functioning), lower limb injuries (reductions in general health and functioning); female gender (psychological sequelae); injury severity score ≥9 (anxiety and depression); and length of hospital stay (fear of falling and post-traumatic stress symptoms). Conclusions The significant longer-term reductions in health and levels of functioning reveal the importance of strengthening efforts to prevent falls amongst young and middle-aged adults, and identifying groups at increased risk of longer-term disability who could benefit from targeted interventions.