The Consumer-Directed Personal Assistance Program (CDPAP), administered by Medicaid, provides resources to qualifying sick, disabled, or elderly Medicaid customers that let them hire the caregiver of their choice, including most family members and friends. The program not only allows people to stay in their homes instead of moving into care facilities, it pays caregivers for their important services.

Below, we’ll discuss just what CDPAP caregivers should know about caring for elderly people who have been exposed to shingles. It’s important to understand what the disease is and how to help prevent it.

What are shingles?

Shingles are a skin condition in which patients develop a painful rash, usually on one side of their face or whole body. This rash can also cause blistering of the skin. However, the blisters tend to scab over in 7 to 10 days.

The infection is not normally life-threatening, but CDPAP caregivers should be on the lookout for symptoms so patients understand what’s going on. 

What causes shingles?

Shingles is a viral infection caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox. It belongs to the herpes family of viruses, but that simply means it shares DNA in common with other herpes infections. It is not otherwise related to the sexually-transmitted disease.

Once a person is infected with the varicella-zoster virus at a young age, it lays dormant in their nervous system for the rest of their lives. Years later, the virus can reactivate and cause shingles. Since most elderly people today had chickenpox as a child, they are susceptible to shingles.

While many of us don’t remember having chickenpox as a child, roughly 99.5% of people born before 1980 in the US have been infected with VZV. That means nearly all older adults in the US are at risk for herpes zoster and approximately 1/3 of Americans will develop shingles during their lifetime.

Doctors don’t yet know what causes VZV to reactivate in some people’s systems. The best guess is that if a person’s immune system is weakened, that gives the virus an opportunity to thrive.

Stress and certain medications can also affect the immune system and reactivate the virus.

Shingles is most common in the elderly because they tend to have lower immunity and are at greater risk of infection in general. Complications from the disease are also much more common in people over age 50. Shingles can also be an issue for those who take drugs designed to prevent rejection of transplanted organs, and those who use steroids, such as prednisone.

Symptoms of shingles

While the condition is painful, shingles typically affect a small area of the body. It can usually be diagnosed based on a visual inspection by a doctor and patients should also be ready to provide their medical history (such as experiences with chickenpox). 

The signs and symptoms of shingles include:

·         Pain, burning, numbness, or tingling in the part of the body affected

·         Skin that is sensitive to the touch

·         A red rash that develops a few days after the initial pain

·         Fluid-filled blisters

·         Itching

Some people also experience more general symptoms, which include:

·         Fever

·         Headache

·         Chills

·         Upset stomach

The first symptom a patient experiences is likely to be localized pain. Because the pain is confined to a specific area, it can often be mistaken for a muscle issue or even an organ problem, depending on where it occurs. For example, some people who get shingles on their chest feel like there might be something wrong with their heart or lungs.

Shingles can also occur on the face or neck. But most commonly it occurs on the torso and the rash and blisters that show up a few days later tend to wrap around one side of the body, sometimes in a line.

If a rash occurs close to the eye or if it is widespread and seems to affect a large area of the body, it’s best to consult a doctor immediately.

How long does shingles last?

From the time a person begins to feel the pain associated with shingles, it can take anywhere from 2 to 6 weeks to fully recover. Recovery time will depend in part on their immune system and how well they’re cared for during their illness. That’s why it’s important for caregivers to understand the disease.

After the pain occurs, the rash usually sets in about a week later. It may take another week for the blisters to pop and crust over, but they may itch for a few weeks after that.

Unfortunately, a person can get shingles more than once because once the virus is in your body, it remains there permanently. That means shingles can flare up during times when a patient is already vulnerable to disease. If the patient experiences the disease more than once they are considered to have “recurrent shingles.” However, getting shingles more than once is rare.

How to stop the spread of shingles?

The varicella-zoster virus is contagious, so people with active shingles infections can pass it on to people who did not acquire the virus in childhood. If a person “catches” the virus as an adult for the first time, they will normally develop chickenpox, not shingles. But that person will carry the virus with them permanently, as everyone else does, and they may develop shingles later in life.

Even if everyone in the home has been exposed to VZV, it’s still wise to take precautions to limit the transmission of infectious fluids. Here are some basic rules of hygiene you should follow if you are caring for someone with shingles:

–          Keep their rashes covered with loose, sterile, non-stick bandages

–          Avoid touching or scratching the rash, and make sure the patient does the same

–          Wash your hands often

–          Apply calamine lotion to rashes and blisters to soothe the itching (ice packs and cool water baths may also help)

Anyone who has shingles should avoid contact with the following people until rashes crust over:

–          Pregnant women who have never had chickenpox or the chickenpox vaccine;

–          Premature or low birth weight infants; and

–          People with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection.

It is still possible to develop chickenpox if you have received the chickenpox vaccine, but it is unlikely. However, if you do develop “breakthrough chickenpox” from the VZV virus, your symptoms will likely be mild. Still, people who are pregnant or immunocompromised should do what they can to avoid the risk.  

Side effects of shingles

People suffering from shingles can also develop other complications. The following are complications from shingles:

Long-term nerve pain called post-herpetic neuralgia (PHN)

This can last for months or years after rashes have gone away. It happens in roughly 10 – 18% of people with shingles and the risk of developing PHN increases with age. Unfortunately, this pain can be debilitating and make everyday activities more difficult, so it may require medication.

Vision loss

When shingles develop near the eyes, it is called herpes zoster ophthalmicus. If a patient develops shingles anywhere on their head or face, it’s important that they get a formal eye exam to assess the possibility of long-term damage to the eyes. This is to prevent the formation of keratitis, which is an inflammation of the cornea.

There is also a specific type of shingles that affects the retina or optic nerve. It rarely causes a skin rash in addition to eye damage, but it can lead to vision loss in those with compromised immune systems.

Stroke

Recent research has shown that shingles may be linked to an increase in strokes (and heart attacks) among patients. Strokes were more common among elderly females who also had risk factors such as high blood pressure, diabetes, and high cholesterol. Shingles may raise the risk of stroke by 35% and the risk of heart attack by 59%.

Dementia

Researchers also believe that if symptoms of shingles remain untreated, it may lead to a higher risk of dementia in patients. (However, a 2021 study performed in Taiwan did not show a correlation.) Those who did not receive antiviral treatment for shingles were more likely to develop dementia later on. It’s unclear how the connection between the two conditions works.

Death

While shingles cannot kill a person, the resulting complications (such as heart attack and stroke) may be fatal. When a patient has shingles, their immune system is working overtime to try and fight the infection. But this means they may also be susceptible to bacterial infections, such as pneumonia.

Other possible complications of shingles include hearing loss (due to Ramsay Hunt Syndrome),

partial facial paralysis, brain inflammation (encephalitis), meningitis, or permanent damage to the nervous system and spine.

Treatment for shingles

There is no cure for shingles, but there are treatments that will reduce the effects of symptoms and possibly shorten the course of the disease so patients can avoid further complications.

The primary treatment for shingles is the prescription of antiviral drugs, including:

–          Acyclovir (Zovirax)

–          Famciclovir

–          Valacyclovir (Valtrex)

Because the pain from shingles can be severe, doctors may also treat patients with pain medication, such as:

–          Capsaicin topical patch (Qutenza)

–          Anticonvulsants, such as gabapentin (Neurontin), to treat nerve pain

–          Tricyclic antidepressants (Specifically, amitriptyline and duloxetine are 2 antidepressants prescribed for post-herpetic neuralgia (PHN)

–          Numbing agents, such as lidocaine

–          An injection of local anesthetics

Because studies have shown the benefits of mindfulness meditation in the treatment of pain, those with lingering symptoms and nerve damage can use it to avoid dependence on prescriptions. More research is required to assess the effects of meditation on post-shingles PHN, but researchers have seen success in using meditation for pain reduction in patients with other chronic conditions, such as fibromyalgia. But it’s also important to note that meditation is free to try for anyone.

How to prevent shingles

There is really only one way to prevent shingles and that’s to get the shingles vaccine. If you were vaccinated in the US between the years 2006 and 2020, you may have received the Zostavax live shingles vaccine (with a weakened form of the virus) injected underneath the skin. However, it is no longer available and has been replaced by a more successful vaccine called Shingrix.

Shingrix is more than 90% effective in preventing shingles. It is a 2-dose vaccine injected into the muscle and contains an inactivated form of the varicella-zoster virus. However, it’s important to keep in mind that the vaccine is for preventing shingles, not for treating active infections or post-shingles complications such as PHN.

The shingles vaccine is not the same thing as the chickenpox vaccine even though both are varicella-zoster vaccines meant to be used against the same virus. The chickenpox vaccine is approved for children over the age of 12 months and the CDC estimates that it prevents 3.5 million cases of chickenpox each year (it’s important to remember that while many of us had chickenpox as children, it can also result in serious side effects and health complications for some young people).

Shingrix was approved by the FDA in 2017 and it offers protection for roughly 5 years. The shingles vaccine is typically given to those over age 50 and you can (and should) receive boosters in consultation with a doctor.  If you are a CDPAP caregiver, you may want to broach the subject of getting the vaccine to the person you care for, if they are able, as well as any other people living in the house. Any inconvenience is certainly going to outweigh the pain and potential aftermath of developing shingles.

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