MORGANTOWN -- Many families have experienced the heartbreak of the fall from which Grandpa never fully recovered.

It's a pattern Mary Carter of the Department of Community Medicine at West Virginia University believes the health care industry could improve on.

Carter's research looks at older adults' month-to-month Medicare spending before, during and after treatment for an injury, using spending as a measure of access to and need for the health care system.

One of her findings is in line with common wisdom: Medicare spending never returns to the level before the injury.

She described a hypothetical 85-plus-year-old individual with a typically complex set of ongoing medical needs.

If that person breaks a bone, Medicare spending spikes, Carter said. And when the cast is off and physical therapy is over, spending drops -- but never as low as before.

"We're back to just treating the heart disease and diabetes that existed prior to the injury," she said, "but we find now we're spending more to treat the same diseases that were there before."

At the same time, some of what Carter has found in the data goes against common wisdom: The spending returns to its original rate of increase -- it doesn't assume a new, ever-rising rate.

That, she said, surprised her.

Medicare spending for older, uninjured adults naturally increases about 14 percent a year, she said.

Post-treatment for an injury, the spending baseline shifts up about 20 percent and then resumes its 14-percent-a-year rise.

To Carter, that suggests the baseline may not have to shift up -- maybe health care practitioners could do more to prevent injury or to help their patients recover more fully.

That idea squares with what she sees as a less proactive attitude in general in the medical world toward the health of older adults.

"People with congestive heart failure, they struggle with fatigue often," she suggested as an example. "Are they more apt to have falls? Are we doing enough to strengthen them? For a long time, we pretty much didn't encourage people with (weak hearts) to exercise, and it's very difficult for them because it's uncomfortable.

"It may be that not finding ways for people to be active ... predisposes them to medical injuries."

Medicare reinforces this attitude.

To reimburse physical therapy, she said, Medicare requires a continued expectation of improvement -- maintenance is not enough.

"But it may be for an older person, where muscle mass loss occurs more quickly than in a younger person," she said, "that little extra that it takes to get the person physically mobile again is really important in terms of health care outcomes."

Carter is principal investigator in a three-year study to understand the long-term consequences of injury among older adults, a study she is conducting with Frank W. Porell of the University of Massachusetts with funding from the Centers for Disease Control and Prevention.

To put their ideas to the test, the researchers want to do several things in the remaining two years of the study.

First, they plan to break the aggregate group down to discover whether some specific injuries -- hip fractures, for example -- might be driving the overall statistics.

Second, they plan to look at the types of facilities where patients are treated to find out if that affects outcomes.

And they would like to look at those rare individuals who do return to their previous level of health care spending.

If the research finds that certain patterns of treatment result in better outcomes, Carter said, it could both bring better quality of life for patients and save the system money.