Shingles 101 For Caregivers

Companion Home Care Basics For The Shingles Patient

Nearly one million people every year develop shingles in the United States, and about half of those cases occur in men and women over 60. Shingles is not only a painful and difficult to care for skin disease, but some cases of shingles potentially have serious long-term effects. Depending on the location and severity of the outbreak, shingles sufferers can develop lingering and severe nerve pain, painful eye infections, and in some cases, vision impairment. Also, shingles patients have a high risk of stroke during the first six months after the appearance of shingles symptoms, especially if they are immune-suppressed due to another condition. In rare cases, shingles infections can cause facial nerve paralysis and more commonly hearing and balance problems. Given the potentially severe consequences of shingles, it is surprising that more people over age 60 don’t get the shingles vaccine, which can greatly reduce both the chance of developing shingles, and the severity of symptoms once shingles appear. Early intervention is crucial, and for those seniors living independently, or aging in place, the presence of a private companion who is alert to the initial symptoms of shingles can make the difference between a quick recovery and unpleasant long-term effects.

What are shingles?

Shingles is a painful skin disease caused by the chickenpox virus, characteristically affecting only one side of the body. As described by the NIH Seniors website, shingles usually develop in three phases: severe pain or tingling on or under the skin, a possibly itchy rash, and then blisters that resemble like chickenpox. Shingles can occur spontaneously, but may be provoked by stress, fever, radiation therapy, or immunosuppression. So, many seniors who are already dealing with serious illnesses that suppress the immune system may develop the added complication of shingles.

Who is at risk?

Shingles is a reactivation of the varicella zoster virus left in the body for life after a case of chicken pox. Before the chicken pox vaccine was widely used, almost 90% of children in the US contracted chicken pox. Since the vaccine was licensed for use in 1995, only 10% of today’s population over 60 has never had chickenpox, and isn’t carrying the virus. And 20% of everyone who has had chickenpox is likely to contract shingles at some point. Per the National Institutes of Health, fifty percent of all Americans will have had shingles by the time they are 80. And simply growing old increases the risk, because the strength of our immune system gradually declines, and loses its ability to ward off infection. The dormant shingles virus can take this opportunity to become active, and in fact, by age 85, the chance of getting shingles rises to 50%.

Why is the vaccine recommended?

The pain of shingles can be devastating, and even once the rash heals, severe and long-term pain can persist. This is called post-herpetic neuralgia, and this lasting pain is a common symptom and after-effect in people over 60. When the rash starts on the face or eyes, it can cause vision or hearing problems, to the point of permanent blindness if the cornea of the eye is affected. If the open sores aren’t cared for properly, bacterial infection can result, leading to scarring and other complications. Immune-deficient patients can experience a more extensive than usual spread of the rash, with the rare complication of pneumonia. Most commonly, the excruciating pain, sleeplessness, and the hindrance to performing basic life activities can cause serious depression. According to the CDC, research has found that for those 60 and over, the vaccine reduced the incidence of shingles by about half. For those between 60 and 69, it reduced incidence by 64%. The CDC recommends the zoster vaccine, Zostavax, for adults 60 and older, even if they’ve had shingles already.

What should caregivers know?

First, that shingles is not contagious to those who have had chicken pox. However, caregivers who have never had chicken pox – or can’t remember if they did or not – must avoid anyone who has shingles because the fluid from the blisters is infectious. This exposure would cause chicken pox, though, not shingles. Caregivers who have not had chicken pox should consider the chicken pox vaccine to protect themselves, as chicken pox is quite serious in adults. Fortunately, shingles can only be transmitted through contact with the blister fluid, and once scabs form over the blisters, the contagious period is over.

According to the NIH, the risk of infecting others is low if the patient employs good hygiene and keeps the rash covered. Touching and scratching blisters and not washing hands frequently will spread infectious material to others. Daily bathing can help prevent bacterial infections of the sores, and clean, trimmed fingernails will reduce scratching.
Early diagnosis of any skin rash that may be shingles is crucial, since immediate treatment with antiviral drugs reduces the severity of the nerve damage and encourages fast healing. Consult a healthcare provider within 72 hours of the first sign of the rash to identify and begin treating shingles as quickly as possible.

Home Care

The likelihood of developing shingles increases with age starting at around 50, and the risk increases for the elderly. Half of people living to age 85 have had or will get shingles, and the chance of enduring chronic pain after the rash heals also increases with age. In addition to the vaccine, early detection and intervention, proper ‘wound’ care, and consistent medication are the critical elements to emerging from a case of shingles quickly, with no long-term effects. Home care solutions for patients living alone, or those whose caregivers may not have had chicken pox, are the solution for those who need daily care and attention during a case of shingles. Casa Companion Homecare Solutions, one of the prominent home care agencies in San Diego, offers this type of companion home care. The severity and impact of shingles symptoms can vary widely, but if needed, overnight home care or even 24-hour home care is also available.