Respiratory failure: the hidden factor weighing on patients and hospitals

Respiratory failure in hospitalised elderly is a well-known clinical problem, but rarely measured systematically. Yet, according to some estimates, it may affect more than 40% of elderly patients admitted from the emergency room to geriatrics and internal medicine wards, significantly affecting mortality, length of stay and use of healthcare resources. For the first time in Italia, a large multicentre study tries to quantify its real weight. It is called Hypoxia Day and is the first national observational study dedicated to hypoxemia - the reduction in oxygen levels in arterial blood - in hospitalised patients over 55. The initiative is promoted by the Italian Society of Hospital and Territorial Geriatrics (SIGOT) and coordinated by the Complex Operative Unit of Geriatrics of the Hospital of Cosenza and the Scientific Direction of SIGOT.

On 14 January 2026, on a single survey day, around 40 acute hospital wards - including Geriatrics and Internal Medicine - distributed throughout the country evaluated more than 700 patients aged 55 and over. The aim was not to test new treatments, but to accurately 'photograph' daily clinical practice: how much respiratory insufficiency there really is in Italian hospitals, what it depends on and what consequences it has on health outcomes.

Respiratory insufficiency is not an autonomous pathology. It is a syndrome, i.e. the pathophysiological consequence of conditions that are extremely frequent in the elderly, such as heart failure (the first cause in all cases), pneumonia, acute bronchitis, flare-ups of chronic bronchitis or pulmonary emphysema, pulmonary embolism, infections, pleural effusions of various kinds, sepsis, cerebrovascular events, tumours, up to severe trauma and the bedridden condition itself. Often, more than one of these pathologies coexist in the same patient and contribute to the lowering of oxygen in the arterial blood, i.e. respiratory insufficiency. Not infrequently, this syndrome manifests itself in mild, asymptomatic forms, which can only be identified by careful, daily monitoring. But even in mild forms, it represents an independent risk factor for mortality and prolonged hospitalisation, with direct effects on bed occupancy and care costs.

Respiratory failure is extremely frequent in elderly hospitalised people, but is still not recognised as a central problem, especially when it does not manifest itself in a severe form. With Hypoxia Day we wanted to provide a solid scientific basis for the appropriate use of hospital resources, starting with the distribution of acute beds.

In recent years, the focus of hospital geriatrics has increasingly shifted towards transversal syndromes - such as delirium, frailty, malnutrition, anaemia - which affect outcomes more than single diagnoses. Hypoxemia fits into this picture as a possible 'new geriatric syndrome', with an impact that goes beyond the clinical aspect and involves the organisation of care.