Change in functional status associated with respiratory syncytial virus infection in hospitalized older adults

Abstract

Background Respiratory syncytial virus (RSV) causes severe respiratory illnesses in infants and older adults. Older adults are frequently hospitalized with RSV illness and may experience loss of function. This study evaluated longitudinal changes in function associated with RSV hospitalization in older adults. Methods Adults ≥60 years hospitalized with laboratory‐confirmed RSV were enrolled (N = 302). Demographics and comorbidities were collected. Functional status was assessed 2 weeks pre‐hospitalization by recall, at enrollment, hospital discharge and 2, 4, and 6 months post‐discharge using the Lawton–Brody Instrumental Activities of Daily Living (IADL) (scale 0–8) and Barthel ADL Index (scale 0–100). Results RSV‐associated hospitalization resulted in acute functional loss. Median IADL (5 vs. 3, p < 0.0001) and ADL (90 vs. 70, p < 0.0001) scores decreased significantly from pre‐hospitalization to admission and remained decreased at discharge. There were no statistically significant differences between pre‐hospitalization and 2‐, 4‐, or 6‐month scores. However, 33% and 32% of subjects experienced decreased 6‐month IADL and ADL scores, respectively. Additionally, 14% required a higher level of care at discharge. When stratified by pre‐hospitalization living situation, 6‐month IADL scores declined significantly for those admitted from a skilled nursing facility (3 vs. 1, p = 0.001). In multivariate analysis, male sex and diabetes were associated with a 6‐month decline in ADL score of ≥10. Conclusions Older adults hospitalized with RSV demonstrate acute functional decline that may become prolonged. Pre‐hospitalization living situation may predict patient outcomes. Further study is needed with hospitalized age‐matched controls and refined measurement tools to better define the specific impact of RSV on function.

RSV vaccination in older adults: Addressing vaccine hesitancy using the 3C model

“…7 Beyond hospitalization, complications from RSV can persist, with 23% of older adults requiring a higher level of care after discharge. 35 This is in comparison to research from California that has found a lower 1-year survival rate after admission for RSV than for influenza (74.2% versus 81.2%, p < 0.001). 36 Each year, 7 in 10 Canadian older adults choose to be vaccinated against influenza, 37 an indication that the majority view the consequences of influenza to be a greater risk than the potential for any adverse events associated with vaccination.…”

Estimation of the number of RSV-associated hospitalisations in adults in the European Union

“…Indeed, taking the estimates for children aged 0-4 years into account; we estimate that 39% (145 604 out of 371 299) of the annual number of RSV-associated hospitalisations in the EU occurred in persons aged 65 years and older. With the changing demographics across Europe where elderly populations are increasing in size and considering the fact that RSV hospitalisation in adults can lead to acute functional decline and reduced quality of life [26], there is a need to get better data and estimates of the true burden of RSV in this age group.…”

The respiratory syncytial virus prefusion F protein vaccine attenuates the severity of respiratory syncytial virus‐associated disease in breakthrough infections in adults ≥60 years of age

“…In this study, during the RSV‐ARI episode, placebo recipients experienced a decrease of approximately 10 points from baseline in their SF‐12 PF score. Branche et al reported that some older adults with RSV, in particular hospitalized individuals, demonstrate acute functional decline that may become prolonged 8 . The difference in SF‐12 PF LSMean estimates between groups during the RSV‐ARI episode was seven points, suggesting that the impact of RSV on PF was lower in the vaccinated group.…”

“…7 Some older adults with RSV infection, especially hospitalized individuals, demonstrate acute functional decline that may become prolonged and can result in higher level of care at discharge and loss of previous independence. 8 The GSK RSV candidate vaccine for older adults (RSVPreF3 OA) is a combination of the RSVPreF3 antigen, a recombinant F protein antigen engineered to preferentially maintain its prefusion form, and GSK's Adjuvant System 01 E (AS01 E ), an adjuvant system that promotes induction/boosting of antibody and cellular responses to overcome age-related decline in immunity. 9 The recombinant RSVPreF3 OA vaccine had 71.7% efficacy (VE) against RSV-ARI and 82.6% VE against RSV-LRTD in adults aged ≥60 years in a phase 3 clinical trial (AReSVi-006/NCT04886596).…”