You may remember some of the falls of early childhood: learning to walk, running through the house when you weren’t supposed to, thinking you could fly like your favorite superhero. You survived. But as we age, falling is not child’s play. Fall prevention is serious business.

According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury deaths, and the most common cause of nonfatal injuries and hospital trauma admissions for people 65 years and older. And many who are injured restrict their activities due to their falls.

As the U.S. population ages, the cost of falls is expected to reach $54.9 billion by 2020, according to a study on the economic dimensions of slip and fall injuries published in the Journal of Forensic Science.

“It is a common and serious health problem,” says Judy Stevens, PhD, senior epidemiologist in the Division of Unintentional Injury Prevention at the CDC who specializes in older adult fall prevention. A fall without injury still has a huge impact on quality of life, she says, since falling aggravates a fear of falling, leading people to become inactive, which, in turn, only increases the risk of falling.

What causes so many falls for older Americans? While seniors are as susceptible to slippery floors and path obstructions like toys as younger people, loss of balance in the aging population could be attributed, in part, to age-related changes in their brains. A University of Heidelberg study in Mannheim, Germany, of 638 men and women ages 65 to 84 found that people will severe changes to the white matter in their brains related to gait and balance were twice as likely as those with mild changes to score poorly on walking and balance tests, as well as to have a history of falls. The three-year LADIS (Leukoaraiosis and Disability study was published in the March 18, 2008 issue of Neurology, the medical journal of the American Academy of Neurology.

As seniors age, their muscles can become weaker and their joints less flexible, causing a change in posture. As a result, their balance shifts. Medications can cause dizziness too.

There are many ways to prevent falls, says Betty Perkins-Carpenter, PhD, author of How to Prevent Falls: Better Balance, Independence and Energy in 6 Simple Steps (Senior Fitness Productions Inc., 1999). One way is to keep your toes spread out in your shoes, says Perkins-Carpenter, who has osteoarthritis. “With arthritis, that can be difficult, but it’s important not to curl them. That can make you lose your balance.”

If you have trouble spreading your toes, Perkins-Carpenter suggests rolling your feet over a soup can, or putting your feet in a dishpan of warm water and practicing spreading and curling your toes.

The first step in her six steps – stretching before you get out of bed in the morning – also is key to avoiding falls. If you’re stiff in the morning, start slow.

“You’re in a safe environment, you’re not fighting gravity and therefore you don’t have the fear of falling. Stretching affects your posture, your balance, your gait and your flexibility,” says Perkins-Carpenter. “It broadens the body’s freedom of movement and gives you more control over your body.”

Other steps to prevent falls, according to the CDC, include:

Exercise regularly to increase muscle mass. Programs such as Tai Chi can especially help posture and flexibility.

 Have your doctor or pharmacist review both your prescriptions and over-the-counter medications to check for side effects and interactions.

• Get your vision checked. Falling could be as simple as not being able to see.

 Eliminate home hazards such as loose carpets or clutter on floors, as well as improve home lighting to brighten dark areas in your home.