Every winter, respiratory syncytial virus (RSV) is estimated to cause 600,000 medical visits and 117,000 hospitalizations among United States patients aged 60 and older. Approximately as many as 17,000 deaths from RSV also occur in this population. Few studies, however, have addressed the long-term impact of RSV-related hospitalizations on functional status in older adults.
To address this research gap, Angela R. Branche, MD, and colleagues examined functional changes associated with RSV hospitalization among older adults. Published in Influenza and Other Respiratory Viruses, the study enrolled 302 patients aged 60 and older who were hospitalized with laboratory-confirmed RSV at 3 hospital systems.
The study was conducted during three winters, from October 15, 2017, to March 27, 2020. They examined functional status at 2weeks before hospitalization (based on patient recollection), enrollment, hospital discharge, and 2, 4, and 6 months after discharge. Specific assessment tools included the Lawton-Brody Instrumental Activities of Daily Living index (IADL; scale, 0-8), the Barthel ADL Index (scale, 0-100), the MRC Breathlessness score (range 1-5), and the Mini-Cog, a screening for among older adults.
RSV Hospitalization Results in ‘Significant Morbidity’
The investigators reported that RSV-associated hospitalization led to an acute functional loss. From before hospitalization to admission, median IADL (5 vs 3; P<0.0001) and ADL (90 vs 70; P<0.0001) scores decreased significantly, and the changes persisted at discharge. No statistically significant differences were seen between the prehospitalization score and the scores at 2, 4, and 6 months. Approximately one-third of the patients, however, had decreased IADL and ADL scores at 6 months, and 14% of patients needed a higher level of care at discharge.
This functional decline may continue for an extended period in some patients, according to Dr. Branche and colleagues.
“Our study shows that hospitalization for RSV can lead to significant morbidity, including a requirement for a higher level of care and a loss of the ability to perform independent activities of daily living, which may be exacerbated by underlying medical conditions,” says Dr. Branche. “Physicians need to be aware of the threat that RSV can pose,
particularly in frail patients.”
Housing Status Prior to Hospitalization Impacts Outcomes
The researchers also found that a patient’s living situation prior to hospitalization may be indicative of future outcomes (Figure).
“In looking at changes in functional scores from baseline to 6 months, we noted a significant decline in patients admitted from a skilled nursing facility, and a less profound but still significant decline in those living in the community with assistance,” says Dr. Branche. “Importantly, there was no change seen among subjects living independently.”
Stratification based on pre-hospitalization living situation highlighted a decrease in IADL scores of 66% from pre-hospitalization through 6 months for those in a skilled nursing facility before admission (median score, 3 vs 1; P=0.001). ADL scores also fell by 36% in this group during the same period (median, 75 vs 50; P=0.056). In those living in the community with assistance, declines in IADL scores were significant but less dramatic. Scores improved slightly in patients who had been living completely independently for both the IADL (14% increase) and the ADL (5% increase).
“Although there are no treatments specifically for RSV, it is important for clinicians to make the diagnosis in older patients in the inpatient or outpatient setting,” Dr. Branche says. “If they have a higher index of suspicion for it in this population, they will be less likely to order unnecessary tests and better able to manage patient expectations about an infection that can last 2 to 6 weeks and leave a person weak for another several months.”
Dr. Branche also notes that a study with age-matched controls and refined measurement tools is needed.
“There is a huge gap in knowledge in terms of the actual burden of disease in outpatient and inpatient settings,” she says. “We need to explore attack rates and routes of transmission so that when a vaccine becomes available, we can use it effectively to prevent disease and preserve QOL in at-risk populations.”