OBJECTIVES: To quantify the prevalence of anemia in the long-term care (LTC) setting, and to study the association between anemia and falling in LTC patients. METHODS: Electronic pharmacy consultant charts representing patient Minimum Data Set (MDS; standardized assessment of clinical and administrative information on LTC patients) 2.0 data between February 2005 – September 2006 were abstracted from 26 LTC facilities based in North Carolina, Georgia, and Pennsylvania. Patients were included in the study if they were >=65 years old, resided in the facility for >=6 months, and had the following information available in their record: hemoglobin (Hb) and serum creatinine (Scr) values (for 6 months prior to the most recent MDS 2.0 assessment available), race, and gender. Patients receiving dialysis were excluded from the study. Anemia was defined using WHO criteria (Hb <12 g/dL for women; <13 g/dL for men). All incidents of falls were obtained from the patients' MDS Forms. An odds ratio (OR) was used to determine the association between anemia status and falls. RESULTS: A total of 804 patients met the inclusion criteria. Mean age was 83 years; 81% of patients were female. Over half of all patients studied were anemic (52%), with 55% of anemic patients having a Hb <11 g/dL. At least one falling episode was recorded for 23% (n=181) of the study population. A higher proportion of anemic patients fell compared to non-anemic patients, 59% (n=107) vs. 41% (n=74), respectively. Anemic patients had a 68% higher likelihood of falling compared to non-anemics (OR: 1.68; 95% Confidence Interval: 1.20, 2.36). CONCLUSION: In this large multi-state study of LTC patients, the majority of patients had anemia, which was associated with a significantly higher risk of falling. The results of the relationship between anemia and falls were consistent with recent published data on community dwelling elderly patients.