Objectives To examine the relationship between frequent falls in older drivers and motor vehicle collision (MVC) involvement. Design Cross-sectional. Setting North central Alabama. Participants Population-based sample of 2,000 licensed drivers aged 70 and older. Measurements Self-reported history of falling two or more times in the prior year was the main predictor. Outcomes were any MVC or at-fault MVC in the prior year. Results Approximately 9% of older drivers reported having fallen two or more times in the prior year. Logistic regression models indicated that frequent falling was associated with having any MVC (crude odds ratio (OR) = 1.53, 95% confidence interval (CI) = 0.77-3.02) and an at-fault MVC (OR = 2.21, 95% CI = 0.97-5.06). Adjustment for the potentially confounding effects of demographic, health, visual, and driving characteristics did not meaningfully affect the association with any MVC, whereas the association with at-fault MVC was weakened (adjusted OR = 2.03, 95% CI = 0.84-4.90). Conclusion Frequent falling was associated with at-fault MVC involvement of older drivers, especially whites. History of falling can be used to identify individuals at risk of MVC involvement and to begin a dialogue about driver safety. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.