Objective To explore the effect of an interactive fall risk assessment game intervention on improving self-awareness of falls among elderly inpatients. Methods Centered around the daily living activities of the elderly, a gamified fall risk assessment roulette was designed and standardized communication phrases were formulated to conduct fall risk assessment and prevention guidance interactively. A total of 104 elderly patients admitted to the endocrinology department of a grade A tertiary hospital from August 2024 to January 2025 were selected and divided into a control group (n=52) and an intervention group (n=52) chronologically. The control group received routine fall risk assessment and preventive measures, while the intervention group additionally received interactive roulette game-based assessment of fall risks in their daily living activities, followed by targeted health guidance. The incidence of falls during hospitalization was recorded for both groups, and the Self-awareness of Falls in Elderly scale (SAFE) was utilized to compare the self-awareness of falls between the two groups before and after the intervention. Results During hospitalization, two patients fell in the control group, while no falls occurred in the intervention group. After the intervention,the total score of the SAFE and its subscale scores of activity safety and environmental alertness, physical function alertness, medication alertness, and behavioral cognitive alertness in the intervention group were significantly higher than those of the control group (all P<0.05). Conclusion Implementaion of the interactive fall risk assessment game intervention in elderly inpatients can enhance their self-awareness of falls, thereby preventing falls.