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Frailty strongly predicts worse RSV outcomes in older adults, highlighting the need for targeted care as aging populations face rising infection risks.

“Current studies highlight the importance of recognizing RSV as a threat to older adults, especially in nations with an aging population,” researchers wrote in Open Forum Infectious Diseases. “As people age, different components of the innate and adaptive immune systems undergo changes, with some being upregulated and others downregulated, leading to an overall dysregulated response to pathogens. However, the capacity to fight infections varies significantly within the same age group, making frailty a key determinant.”

Frail patients often have compromised immune responses, which increases their vulnerability to infections and reduces their ability to recover from acute respiratory illnesses (ARIs), including influenza and respiratory syncytial virus (RSV), the researchers continued. However, frailty as it relates to RSV infection has not been studied extensively.

Melissa Andrew, MD, PhD, and colleagues assessed data from a severe outcomes surveillance network housed within a larger immunization research network. Data came from the three influenza seasons from 2012 to 2015. The researchers categorized patients as nonfrail, prefrail, and frail and examined associations between frailty and RSV disease severity and outcomes.

Characteristics of Study Population

 The analysis included 365 patients aged 50 to older than 85. The median age was 76 years, with more than half of the patients ranging from 75 to 84 years (27.7%) and 85 years and older (26.3%). Additionally, 63.8% of the patients were women. Most patients (71.0%) had received the current season’s RSV vaccine.

The cohort included never-smokers (45.5%), former smokers (42.7%), and current smokers (10.7%), as well as a small percentage of patients whose smoking status was unknown (1.1%). More than half of patients (61.6%) had one or two comorbidities.

More than half of the cohort (61.1%) was classified as frail, while more than a quarter (28.5%) was prefrail. Only a small percentage—10.4%—was nonfrail.

Severe RSV Outcomes

 The researchers found that severe cases of RSV were more common among patients aged 75 to 84 years (27.4%) and 85 years and older (27.7%) than in patients aged 50 to 74 years. COPD was also significantly more common among patients with severe disease (P<0.001).

In addition, frailty was significantly associated with severe RSV outcomes, including more extended hospital stays and higher rates of ICU admission.

“While RSV types A and B showed no significant differences in clinical outcomes, chronic obstructive pulmonary disease and chronic kidney disease emerged as factors associated with disease severity, alongside frailty,” the researchers wrote.

Incorporating Frailty in RSV Management

 The findings demonstrate that frailty represents “a significant factor influencing adverse outcomes in older adults hospitalized with RSV infection,” Dr. Andrew and colleagues wrote.

“Frail patients with RSV required significantly longer hospitalizations than their nonfrail counterparts,” the researchers noted. “The notable distinction between frail and nonfrail patients underscores the need for targeted health care strategies, particularly in hospitalized populations, where frailty may contribute to prolonged hospital stays, higher resource utilization, and increased risk of complications.”

Further, the results underscore the importance of using frailty assessments in the management of RSV and support interventions to alleviate the disease burden of RSV among frail older adults.

“Implementing these strategies is essential to ease the clinical and logistical challenges posed by RSV in health care systems, especially as the demographic trend toward an aging population continues to grow,” Dr. Andrew and colleagues wrote.