evidence: Patients hospitalized with RSV were more likely to receive IMV or die compared with patients hospitalized with influenza (adjusted odds ratio = 2.08; 95% CI = 1.33–3.26). Among hospitalized older adults, RSV was less common, but was associated with more severe disease than COVID-19 or influenza. High disease severity in older adults hospitalized with RSV is important to consider in shared clinical decision-making regarding RSV vaccination. [...] The findings from this study demonstrate that RSV is an important cause of respiratory virus–associated morbidity and mortality in older adults. In this prospective, multicenter analysis in which all enrolled older adults hospitalized in 20 U.S. states during 2022–2023 received testing for RSV, SARS-CoV-2, and influenza, RSV-associated hospitalizations were less frequent than were COVID-19–associated and influenza-associated hospitalizations; however, clinical outcomes in patients hospitalized with RSV were worse than those among patients hospitalized with COVID-19 or influenza. Because RSV disease is less common than COVID-19 or influenza disease among hospitalized patients, clinicians might be less aware of RSV as a serious respiratory pathogen in older adults. [...] These findings suggest that although RSV hospitalizations occur less frequently than COVID-19 or influenza hospitalizations, RSV disease among hospitalized adults aged ≥60 years in the United States during February 2022–May 2023 was more severe than that associated with COVID-19 and influenza. New FDA-approved RSV vaccines for adults aged ≥60 years are expected to prevent lower respiratory tract disease (1). Health care providers and older adults should consider RSV disease severity when making a shared clinical decision about RSV vaccination (1).