Acute respiratory infections are a common problem in the general population, particularly during the winter months. Nonbacterial causes such as viruses, mycoplasma, and Chlamydia predominate,’ but with the exception of influenza virus, comprehensive studies are lacking that define the impact of these agents on the elderly. The institutionalized elderly represent a special subgroup of older persons who are prone to excess morbidity and mortality with respiratory infections. Each year, many residents of long-term care facilities become ill with respiratory illnesses not proven to be influenza, either by culture or serology. Recent studies have demonstrated the importance of a variety of viruses, including respiratory syncytial virus and parainfluenza, which can cause significant disease in this high-risk population. This article will review several of these epidemiologic studies and discuss in detail a number of viruses that are emerging as significant pathogens in the long-term care facility, with attention to modes of transmission and infection control.