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Protecting Vulnerable Older Patients During the Pandemic

ABSTRACT: At a time of need, these organizations fostered trusted relationships with patients through proactive outreach and support, initiated a comprehensive virtual-care program, and provided home-based care services to protect them against the infection and its effects. Summary Older people (?70 years of age) with multiple chronic conditions have the highest risk of being hospitalized and dying from COVID-19. The current pandemic has highlighted how a strong primary-care system can play an important role in protecting this group of people. The ways in which innovative primary-care organizations have adapted their approach to the pandemic may offer important lessons, not only for future health crises but also for redesigning post-pandemic health care. We studied four primary care organizations that specialize in the care of vulnerable older patients (Iora Health, Oak Street Health, ChenMed, and Landmark Health) and assessed their responses to the COVID-19 crisis. Based on our analysis, we identified three key lessons for health-care systems: (1) the importance of fostering trusted relationships with vulnerable older patients to identify and address their clinical and non-clinical needs in a timely fashion, (2) the rapid implementation of a comprehensive virtual care approach to facilitate frequent touchpoints between the patient and the care team, and (3) the delivery of home-based health-care services to ensure health-care access during the pandemic.

SUBMITTER: Ikram U

PROVIDER: S-EPMC7498139 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Project description:Environmental insults such as oxidative stress can damage cell membranes. Lysosomes are particularly sensitive to membrane permeabilization since their function depends on intraluminal acidic pH and requires stable membrane-dependent proton gradients. Among the catalog of oxidative stress-responsive genes is the Lipocalin Apolipoprotein D (ApoD), an extracellular lipid binding protein endowed with antioxidant capacity. Within the nervous system, cell types in the defense frontline, such as astrocytes, secrete ApoD to help neurons cope with the challenge. The protecting role of ApoD is known from cellular to organism level, and many of its downstream effects, including optimization of autophagy upon neurodegeneration, have been described. However, we still cannot assign a cellular mechanism to ApoD gene that explains how this protection is accomplished. Here we perform a comprehensive analysis of ApoD intracellular traffic and demonstrate its role in lysosomal pH homeostasis upon paraquat-induced oxidative stress. By combining single-lysosome in vivo pH measurements with immunodetection, we demonstrate that ApoD is endocytosed and targeted to a subset of vulnerable lysosomes in a stress-dependent manner. ApoD is functionally stable in this acidic environment, and its presence is sufficient and necessary for lysosomes to recover from oxidation-induced alkalinization, both in astrocytes and neurons. This function is accomplished by preventing lysosomal membrane permeabilization. Two lysosomal-dependent biological processes, myelin phagocytosis by astrocytes and optimization of neurodegeneration-triggered autophagy in a Drosophila in vivo model, require ApoD-related Lipocalins. Our results uncover a previously unknown biological function of ApoD, member of the finely regulated and evolutionary conserved gene family of extracellular Lipocalins. They set a lipoprotein-mediated regulation of lysosomal membrane integrity as a new mechanism at the hub of many cellular functions, critical for the outcome of a wide variety of neurodegenerative diseases. These results open therapeutic opportunities by providing a route of entry and a repair mechanism for lysosomes in pathological situations.

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Protecting Vulnerable Older Patients During the Pandemic

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