Stairs of various kinds have been used since ancient times, and since they are inherently dangerous, people have fallen on them, injuring or even killing themselves. Because stairwell accidents may result in serious damage or even death, construction rules for stairs and ramps are understandably stringent. The National Safety Council estimates that approximately 100 people die each year from falls that could have been prevented by safety devices such as guardrails. About one-third of these deaths occur among people over 65 years old; about 20 percent of those deaths involve someone who lived in an assisted living facility. In addition, thousands more are injured. People who fall down stairs often break bones, cut muscles, and tear ligaments. Some suffer severe brain injuries when their skulls hit the floor. Others die from internal organ damage or blood loss. The best protection against falls on stairs is a railing. Handholds should be provided at least every four feet to prevent falls. The tops of steps should be flat or slightly rounded to avoid injury if someone hits their head while walking up them. Narrow steps (less than 36 inches wide) are especially hazardous because it is easy to lose your balance. If you are building or remodeling a home, stairs must be considered during planning stages. The height and design of stairs can affect how people navigate through their homes, so it's important to choose features that will make climbing and descending easier and safer.