Occupational therapist Jeanne Shepard, who teaches the class in the Seattle suburb of Shoreline, believes that water's buoyancy and resistance are natural aides in helping seniors prepare against falls.

"The only way to really improve balance is to challenge it," she says.

Health-care organizations and providers are paying increasing attention to preventing falls as the U.S. population continues to age. The state Office of Financial Management projects that the population of older adults will increase 50 percent by 2020 and double by 2030.

Injurious falls can endanger an older person's independence, even his or her life. And the medical costs associated with their falls total about $19 billion a year nationwide.

In 2007, falls resulted in 12,462 hospitalizations for older adults (65 and older) in Washington. That's more than five times the total number of hospitalizations to occupants, of all ages combined, involved in motor-vehicle crashes in the state that year.

The fear of falling, the stigma of being labeled "old," and concern about the loss of independence leads some older people to believe the safest course is to move less.

But inactivity is wrong choice and will only increase the risk of future falls, say geriatric-medicine experts such as Dr. Elizabeth Phelan, of Harborview Medical Center's Fall Prevention Clinic.

"People who have experienced an injury fall may tend to restrict their activity as a method of self-preservation, but actually that makes them more likely to develop muscle weakness, worse balance and this is turn then increase the likelihood of falling," she says.

Exercise geared toward maintaining lower-body strength and balance has shown to reduce the risk of falling in older adults, Phelan said.

That's one reason she tries to steer older adults away from prematurely relying on walkers, wheelchairs and motorized scooters. Dependence on those sorts of devices may speed loss of a person's strength and balance because he or she may rely on the devices and eschew exercise.

Phelan often recommends Tai Chi and yoga for those advanced enough for that level of activity, but says aquatic work can be helpful for someone beginning a program who enjoys the pool and is properly supervised.

When Shepard was working at a skilled-nursing facility, she realized that most of the people she was helping were there because of an injury fall.

Having a background in water exercise and aquatic therapy, she believes in the rehabilitative properties of water because it can provide resistance, but also support.

She also noticed that many people were more likely to exercise if they were part of a group.

Her program, mimics one created by Mary Sanders, a University of Nevada physiologist, but focuses on balance and lower body strength. She keeps her class to no more than 10 people at a time.

Janet Hetherington, 66, has Parkinson's disease and says she began taking the class because she had fallen twice. The class has helped give her confidence.

"I was scared I was going to fall, so I would shuffle along," she says. "I'm walking better now. My neurologist has been quite pleased."

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FACTS: FALL RISKS

Exercise: Look for programs that increase strength and balance.

Medications: Have them assessed for side effects and interactions.

Vision: Take an eye exam each year.

Home: Make sure lighting is adequate, install handrails, eliminate hazards like scatter rugs.

Shoes: Low-heeled, supportive shoes are best.