Why aging increases the risk of shingles
Shingles, or herpes zoster, is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, VZV remains dormant in nerve tissues for years. A healthy immune system keeps this virus in check, but its ability to do so diminishes with age through a process known as immunosenescence.
As the immune system's viral-specific cellular immunity declines, VZV is more likely to reactivate and travel along nerve pathways to the skin, causing the characteristic painful rash. This explains why the risk of shingles increases significantly with age, with a particularly marked rise in incidence after 50. While shingles can occur at any age, older adults are not only more susceptible to the infection but also more prone to its severe and long-lasting complications.
The serious complications shingles can pose to seniors
For older adults, shingles can be far more serious than just a temporary, painful rash. The prolonged duration of the illness and the higher risk of complications can significantly impact an elderly person's quality of life. One of the most feared complications is chronic nerve pain, but others can also be severe.
Key complications affecting older adults
- Postherpetic Neuralgia (PHN): This is the most common shingles complication, affecting 10-18% of people with the virus. PHN is characterized by intense, lingering nerve pain in the area of the healed rash, which can last for months or even years. The likelihood of developing PHN and its severity both increase significantly with age.
- Ophthalmic Herpes Zoster: If shingles affects the facial nerves around the eye, it can cause severe eye pain, inflammation, and potential vision loss. Immediate medical attention is vital to prevent permanent eye damage.
- Neurological Complications: In rare cases, shingles can lead to more widespread inflammation affecting the nervous system. This can result in complications such as facial paralysis, hearing problems, or inflammation of the brain (encephalitis).
- Bacterial Skin Infections: The open, fluid-filled blisters can become a breeding ground for bacterial infections. If not properly treated, this can lead to scarring and more serious complications.
- Increased Risk of Stroke and Heart Issues: Research has indicated an elevated risk for stroke and heart attack following a shingles episode, especially in older adults, likely due to the inflammatory response triggered by the virus.
Prevention and treatment for older adults
The best way for older adults to combat the risk of shingles is to take proactive preventative measures and seek prompt treatment if an outbreak occurs. The most effective tool is vaccination.
Comparing Shingrix and Zostavax vaccines
| Feature | Shingrix (RZV) | Zostavax (LZV) |
|---|---|---|
| Vaccine Type | Recombinant (non-live) | Live attenuated |
| CDC Recommendation | Recommended for healthy adults 50+ | Discontinued in the U.S. (as of Nov 2020) |
| Dosing Schedule | 2 doses, 2-6 months apart | 1 dose (no longer available) |
| Efficacy (50+) | >90% effective at preventing shingles | Efficacy wanes substantially over time |
| Immunity Duration | At least 7 years of strong protection | Short-term protection |
| Immunocompromised Patients | Recommended for adults 19+ | Not indicated due to live virus |
Timely treatment options
If an outbreak occurs, starting antiviral medication within 72 hours of the rash's onset is crucial for reducing severity and preventing PHN. A doctor may prescribe acyclovir, valacyclovir, or famciclovir. Additionally, symptom management can help ease discomfort:
- Pain relief: Over-the-counter pain medication or prescription pain relievers can be used. For severe PHN, anticonvulsants or topical lidocaine patches may be prescribed.
- Topical remedies: Cool compresses, calamine lotion, and colloidal oatmeal baths can all help relieve the itching and pain. It is also recommended to wear loose, soft clothing to avoid irritating the blisters.
- Self-care: Plenty of rest, stress management, and a healthy diet can support the immune system during recovery.
Conclusion
For older adults, the risk of shingles is a significant concern due to the age-related decline of the immune system and the potential for severe complications like postherpetic neuralgia. The most effective way to manage this risk is through the highly effective Shingrix vaccine, recommended by the CDC for everyone aged 50 and over. While the virus can be challenging, timely vaccination and prompt treatment of any outbreak can mitigate the effects and protect quality of life in later years. Talk to a healthcare provider about getting vaccinated to take this important step toward preventative care.
Key takeaways about shingles risk for the elderly
- Age is the primary risk factor: The risk for shingles increases significantly after age 50, with about half of all cases occurring in adults aged 60 or older.
