Risk is frequently invoked in contemporary accounts of ill health, but its construction is often constrained by a rationalist perspective that focuses on physical causes and functional outcomes, and that presents risk as external to the self and predictable. This paper describes an empirical study of the ways in which risk was realised and managed in a day hospital for older people. An ethnographic approach, with participant observation and semi-structured interviews, and discourse analysis were used to explore these issues with the staff and fifteen users. Whilst the service providers were orientated to the management of physical risk, as through the regimes for administering medication and their attention to risk reduction in the physical environment, the service users were more concerned with the risk to their personal and social identities, and they more frequently described its manifestations in inter-personal exchanges, sometimes as infantalisation and stereotyping. The paper develops this understanding of the potential for falls among older people to elucidate a broader interpretation of risk, and reveals that it is commonly constructed as a challenge to a person's self-image and identity. Such constructions help to explain older people's responses to complex health problems and to the services and treatments that attempt to solve them.