RSV Pneumonia Leads to Elevated ICU Admissions and Mortality in Older Adults

A recent analysis of hospitalizations in Colorado between 2016 and 2023 sheds light on the serious clinical burden of respiratory syncytial virus (RSV) pneumonia in adults aged 50 to 88 years. The findings reveal that RSV leads to significantly high rates of intensive care unit (ICU) admissions and mortality. 

Among 2210 hospitalized patients with RSV pneumonia, 35% required ICU admission and 9.3% died—rates that are on par with or exceed those of influenza (32.5% ICU admission; 7.6% mortality) and human metapneumovirus (HMPV) (27.5%; 5.9%). These numbers indicate RSV is a critical pathogen in older adults and should not be dismissed as a disease affecting only infants and young children. 

The study also highlighted varying risk factors that elevated the odds of ICU admission depending on the viral etiology. For RSV, dementia was the most prominent predictor of ICU admission, with an adjusted odds ratio (aOR) of 4.2 (95% CI, 1.34-13.18). This contrasts with chronic pulmonary disease being most predictive for influenza (aOR, 2.99), and chronic obstructive pulmonary disease (COPD) without asthma for HMPV (aOR, 5.04). 

Mortality risk increased significantly in patients with multiple comorbidities. Notably, chronic pulmonary disease (CPD) and COPD independently conferred more than a twofold increase in mortality risk across RSV, influenza, and HMPV infections. 

The study emphasizes that the accumulation of comorbidities is a key determinant of poor outcomes. Pharmacists can play an essential role in comprehensive medication management and adherence counseling to minimize risk associated with uncontrolled chronic diseases. 

Older age remained a consistent risk factor for mortality in RSV and influenza pneumonia. However, even among patients aged 50 to 64 who may not perceive themselves as “high-risk,” ICU admission and death were not uncommon. This suggests pharmacists should advocate for broader RSV vaccination uptake and early symptom recognition, especially in patients with cognitive decline or multiple chronic illnesses. 

For pharmacists, this study reinforces the need to approach respiratory virus season with a multifactorial lens. It is essential to promote RSV vaccination where indicated, particularly among older adults with dementia, chronic pulmonary disease (CPD), or chronic obstructive pulmonary disease (COPD), as these populations face heightened risks of severe outcomes. During medication reviews, pharmacists should identify patients with multiple comorbidities and flag them for closer monitoring throughout peak respiratory illness seasons. Additionally, educating both caregivers and patients about early signs of respiratory deterioration is crucial—especially for individuals with cognitive impairment or underlying pulmonary conditions—to support timely intervention and reduce the likelihood of ICU admission or mortality. 

Reference 

Simões EAF, Suss RJ, Raje DV. Human metapneumovirus, respiratory syncytial virus and influenza associated pneumonia hospitalizations in colorado adults aged over 50 years: 2016-2023. J Infect Dis. 2025 Jul 21:jiaf381. doi:10.1093/infdis/jiaf381