The impact of respiratory viruses on older adults in long-term care facilities: a scoping review

Abstract

Background: Evidence on the clinical impact of seasonal respiratory viruses in long-term care facilities (LTCFs) is limited.

Objectives: To provide an overview of the evidence available on the clinical impact of seasonal respiratory viruses on older adults in LTCFs worldwide.

Data sources: Medline (OVID Medline ALL) and Embase (Embase.com) until 13 May 2025.

Study eligibility criteria: Original research articles involving LTCF residents with at least one laboratory-confirmed viral respiratory tract infection (RTI), excluding SARS-CoV-2 and pandemic influenza, reporting any RTI-associated clinical outcome.

Participants: LTCF residents (mean or median age >60 years).

Methods of data synthesis: An evidence gap map was created to visualise the distribution of evidence across viruses and outcomes. Where possible, outcome proportions (defined as the number of cases with the outcome divided by the total number of cases) were extracted from the included studies. These were summarised and visualised in dot plots with medians and interquartile ranges (IQRs) per virus.

Results: 117 studies were included. The majority of the studies focused on influenza viruses and conventional outcomes including attack rate, lower respiratory tract infection (LRTI), hospitalisation, and mortality. Evidence was limited for human rhinovirus, parainfluenza viruses, enterovirus, adenovirus, and endemic human coronaviruses, as well as for outcomes such as aggravation of underlying diseases and patient-centred outcomes, including quality of life and functional status. Human metapneumovirus (hMPV) was associated with the highest rate of LRTI (median 0.50; IQR 0.45-0.75) as well as the highest mortality rate (median 0.17; IQR 0.10-0.37) found in this study, although based on small numbers of confirmed.

Conclusions: Substantial knowledge gaps remain regarding the impact of seasonal respiratory viruses on older adults in LTCFs. In order to inform decision-making regarding viral RTI management in this population, future studies should prioritise underrepresented viruses including hMPV and incorporate patient-centred outcomes.

Keywords: Clinical impact; Long-term care facilities; Older adults; Respiratory tract infections; Respiratory viruses; Scoping review.