Background The elderly segment of the population is increasing worldwide, and there is wide variation in functional status and fall risk factors among the elderly. The functional status of the elderly living in institutional settings cannot be compared with that of the elderly living in community settings owing to the difference in lifestyle. Studies exploring the functional status and fall risk of the elderly in institutional settings in developing countries are limited. Methods A cross-sectional study of the census approach among institutionalized elderly in a district in southern India was conducted. A validated, structured interviewer-administered questionnaire was used in the study. The level of difficulty for each of the functional tasks was separately analyzed. Descriptive statistics were used to describe the sociodemographic characteristics and fall risk profiles of the respondents. Results Out of 142 elderlies in eight institutional settings,103 (73.57%) participated in the cross-sectional descriptive study. Males were 64 (62.1%), and females were 39 (37.9%). The mean age was 69.7, with a standard deviation 7.9. Nearly 27.2 % of the elderly had difficulty walking indoors, and 35.9 % had difficulty walking outdoors. Around 63.1% of the elderly shared difficulty climbing stairs and 14.6% used assistive aids for ambulation. Institutionalized elderly experienced Vision impairment by 85 (82.5%), and 48.5 % of them were using spectacles. Thirty-five (34 % of them) had hearing impairments, and only 1% were using hearing aids. Around 47 (45.6%) experienced balance issues, and 42 (40.8%) felt balance issues while making turns while walking. Around 44 (42.7%) of the participants experienced dizziness. A history of falling in the past year was reported by 31.1% of the elderly, and 2% had much concern about falling over, 5.8 % were quite afraid of falling over, and a little concern about falling was shared by another 25.2 % of the elderly. Conclusion Functional status and fall-risk profile evaluations should be regularly performed among institutionalized elderly. Prospective follow-up studies need to be conducted among the elderly in institutional settings to understand the progressive changes in the fall risk profile and incidence of falls. The functional status of most of the subjects in the current study was good, and they had better functional independence. Many risk factors were present among the elderly in institutional settings. Visual impairment was the most important one reported. Other risk factors reported were hearing impairment, history of falls, fear of falling, and use of assistive devices.

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