Hip fracture rates among long-stay residents in nursing facilities rose slightly after a dip in 2013, bucking a trend toward fewer falls in community settings, according to a new study.

Investigators looked at fracture rates between 2007 and 2015. After a dip in 2013 and despite a decline in long-stay nursing home admissions, hip fracture rates have begun to rise again, reported Sarah D. Berry, M.D., MPH, of Harvard Medical School, and colleagues. In addition, one-year mortality after fracture was high, hovering around 42% in 2007 and 2014.

While fall prevention strategies are available, they’ve apparently been less successful in nursing homes than in the community setting, wrote Berry. “In general, nursing home residents are older and sicker, with more cognitive and functional impairment than community-dwellers. One possible explanation for these high rates is the underutilization of medications to treat osteoporosis,” she said.

Six-month mortality is 36% in nursing home residents with hip fractures, and 17% of ambulatory residents will become completely disabled, according to the researchers. Meanwhile, survivors are likely to suffer infections and pressure ulcers. This can lead to functional decline and a diminished quality of life.

The findings “should prompt widespread interventions to reduce the suffering associated with hip fractures in older adults,” said Berry.

The study was published in the Journal of Bone and Mineral Research.