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This scenario happens more than 340,000 times a year in America: an elderly person falls, breaks a hip, and life is changed forever. One in four such patients die within a year. About 4% don't survive the first hospital treatment, usually dying of pneumonia.

For those who make it to rehabilitation, about half never recover the ability to walk alone. About 40% must move into a long term care facility.

It is, says Dr. Allen Morris, a St. Louis orthopedic surgeon, a grim picture for the nation's elderly and a shameful record for the U.S. health care system.

"This is a near epidemic type of situation," said Morris. "The problem is a matter of money and a problem with the system."

Right now, the direct and indirect costs of hip fractures in the U.S. is about $12.6 billion a year. With the graying of America, the number of fractures is expected to reach more than 650,000 by the year 2050, and the cost will more than double.

Morris, representing the American Academy of Orthopedic Surgeons, is co-chairman of a conference of 40 national health organizations meeting this week in Washington to draw up an action plan to revolutionize the way elderly hip fracture patients are treated in the U.S.

Among the issues being studied by the group:

• Federal Medicare funding now severely limits the days a hip fracture patient can spend in the hospital. Often a patient must leave before he or she is ready. Often, no effort is made for a smooth transition of care — from the hospital to a rehabilitation center or a nursing home.

"These patients often fall through the cracks and don't get the care they need," Morris said. This is one reason so many die in the first year, he said.

• Many patients are denied access to federally funded rehabilitation facilities because they fail to meet the minimum physical standards.

Morris said to be admitted to such centers, patients must be strong enough to perform three hours of rehab exercises a day.

"For many frail hip fracture patients, three hours is simply more than they can do, so that rehab care is denied them," he said.

• Prevention measures are not being addressed sufficiently.

The vast majority of hip fractures are among women who have osteoporosis, the brittle bone disease. This suggests that health care givers need to do more to prevent and control osteoporosis through programs of diet, medication and exercise. Stronger bones would mean fewer broken hips.

Another problem is fall prevention.

Morris said the elderly should be more closely screened for the tendency to fall. Such screening is frequently ignored, he said. Once a patient is evaluated, then there are ways to limit the risk of falls.

• Find ways to improve the quality of life for the patients and their families.

"The impact on a family that is suddenly confronted with caring for an elderly hip fracture patient can be an extreme physical and financial burden," said Morris.

• Address the psychological changes from the effects of a hip fracture.

"The sudden loss freedom is devastating to a person psychologically," said Morris. "The incidence of depression is extraordinarily high among these people because of the sudden changes in environment and the loss of independence."