WASHINGTON (AP) - It happens more than 340,000 times a year in America: an elderly person falls, breaks a hip and their life is changed forever.

Often, a hip fracture ``is a major life event that may spell the beginning of the end'' for an elderly patient, said Dr. Joseph Zuckerman, a New York bone specialist.

One in four such patients die within a year. About 4 percent 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 and about 40 percent must move permanently into a long-term care facility.

Highlighting the growing concern about these injuries, the American Academy of Orthopedic Surgeons, at a meeting this week, are drawing up an action plan aimed at revolutionizing the way elderly hip fracture patients are treated.

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 United States 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 and Zuckerman, a professor at the New York University Hospital for Joint Disease, are co-chairmen of a conference of 40 national health organizations meeting this week to draw up the action plan.

Zuckerman outlined the major points to be covered in the consensus recommendations to be released on Friday:

-Establish a national campaign to treat and control osteoporosis, the brittle bone disease that Zuckerman said is not now managed well by doctors and is a major cause of hip fractures.

-Establish routine screening tests for the elderly to identify those at risk of falling. Such patients could then take measures, such as canes, walkers or wheelchairs, to lower that risk.

-Determine the appropriate length of hospital stays for these patients. Federal Medicare funding now severely limits the days a hip fracture patient can spend in a hospitals and they often are discharged with no continuing care plan. ``Right now, the discharge follows no rhyme or reason,'' said Zuckerman.

-Establish a critical care pathway that would encompass a coordinated program of treatment, from the initial hospital stay to rehabilitation.

-Address the psychological changes that may result from the hip fracture trauma.

``The sudden loss of freedom (from a hip fracture) 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.''

The doctors said a recovery plan should include teams of specialists, from bone doctors to psychologists, to deal with the wide variety of problems that hip fracture patients must face in their recovery.

``These patients often fall through the cracks and don't get the care they need,'' said Morris.

Copyright 2001 The Associated Press. All rights reserved.