br Methods br Results and discussion

Methods
Results and discussion
Conclusions
Acknowledgements The authors thank Dr. Francois Alhenc-Gelas (then INSERM U367, Paris, France), who kindly provided the plasmid for truncated soluble recombinant human ACE – WTΔ, Dr. Elena Arablinskaya (Institute of Phtiziopulmonology, Moscow, Russia) who kindly provided the control SF1670 samples, Dr. V.V. Evdokimov (N.A. Lopatkin Research Institute of Urology and Interventional Radiology, Moscow, Russia) who kindly provided seminal fluid and Dr. Klara Valyi-Nagy (University of Illinois at Chicago Tissue Bank), who kindly provided lung and spleen tissues. We also acknowledge the advice of Dr. Sergei Nikitin (Regional Public Organization “Association of Neuromuscular Disorders Specialists”, Moscow, Russia). This work was partly supported by the Ministry of Science and Education of Russian Federation (grants 02.740.11.5036 and 14.Z50.31.0026), and was carried out (partially) within the state assignment of Moscow University (Russia). OG-A, NT and ES were supported by the Intramural Research Programs of the NHGRI and NIH.
Introduction The geriatric population is at risk for many adverse events during hospitalizations. Falls are one of the most common complications of elderly patients during their stay in acute care settings. Besides minor and major injuries, falls are also associated with increased hospital length of stay, fear of immobilization, and inability to return home quickly, leading to increasing healthcare costs.1, 2, 3, 4, 5, 6, 7 Patient falls during hospitalizations are common and have been estimated at 3.56 falls/1000 patient-days for adult patients (21 years old and older). In elderly patients, many factors contribute to a higher incidence of falls, including immobilization and starting o new medications. In addition, falls in the elderly are associated with significant mortality and morbidity. For example, accidental falls in institutional care could result in hip injury, with an estimated incidence rate of 20 per 1000 person-years. Moreover, elderly patients experience delayed recovery and more long-term physical and psychological effects as a result of falls than their younger counterparts. Hence the importance of preventing falls in this age group is paramount. The Joint Commission International emphasizes fall risk prevention among hospitalized patients. Fall prevention is now a cornerstone in the hospital accreditation process. The Centers for Medicare and Medicaid Services (CMS) have labeled falls during the hospital stay as preventable events that should not occur. Consequently, CMS is not reimbursing for healthcare costs associated with hospital falls. To decrease the incidence of falls and other adverse outcomes in the elderly while in the hospital, special units have been designed and named Acute Care for the Elderly (ACE) units. These ACE units are specially designed to provide better care and to improve clinical outcomes in elderly patients. After comprehensive geriatric assessment with the complementary principles of quality improvement, ACE units were developed in 1990. This system is based on four main elements: patient-centered care, a specially designed environment, review of medical care, and planning for discharge to help patients maintain or achieve independence in basic activities of daily living.13, 14 A systematic review by Fox et al. showed geriatric patients in ACE unit had almost 50% fewer falls than their peers in usual care units. Another study in 2011, however, showed no statistically significant difference in the risk of falls, with a fall rate of 4.8 falls/1000 patient-days in the ACE unit compared to 6.7 falls/1000 patient-days in the usual care unit (see discussion). The primary aim of this study was to evaluate whether an ACE unit at a community-based teaching hospital decreased the risk of falls in patients ages 65 years old and above during their hospital stay. The secondary aims were to evaluate the effect of age, sex, length of stay, use of psychotropic and hypnotic medication and Morse Fall Score on the incidence of falls in the geriatric population during their hospital admission.