Your mother called complaining of a burning pain along one side of her ribs. Two days later, a band of red blisters appeared in the same spot. By the time she saw the doctor, the window for the best treatment was closing. Weeks after the rash healed, she still couldn't stand the feel of a shirt against her skin.
That's a common shingles story in older adults, and much of it can be prevented. This guide explains shingles and what families can do. It's general information; call your parent's doctor if you suspect shingles.
What shingles is
Shingles is a painful rash illness. It happens when the varicella-zoster virus, which causes chickenpox, reactivates in the body years after a person had chickenpox1. The virus stays inactive in nerve tissue for decades, then can travel along a nerve to the skin. More than 99 percent of Americans born before 1980 had chickenpox, even if they don't remember it1, so nearly every older adult is at risk.
About 1 in every 3 people in the United States will have shingles in their lifetime, and an estimated 1 million people get it each year1. Risk and the chance of serious complications rise with age, and with conditions or medicines that weaken the immune system, such as certain cancers, steroids and transplant drugs1. Most people have shingles once, but it can come back1.
Symptoms to recognize
The rash most commonly appears on the left or right side of the body, often as a band around the chest or back, and is usually painful, itchy or tingly1. Before the rash, many people feel pain, burning, tingling or numbness in one area for a few days. Older adults may also feel tired, feverish or achy.
- Pain on one side of the body, sometimes before any rash appears.
- A band or patch of red skin that turns into fluid-filled blisters, which later crust over.
- Itching or sensitivity so that even clothing hurts.
- Rash near the eye or on the forehead or nose. This needs same-day medical care because shingles can lead to vision loss1.
The early pain can be mistaken for a heart problem, a pulled muscle or a kidney stone. If your parent has new one-sided pain followed by a rash, think shingles. A parent with dementia may only show new irritability or guarding of one area. See recognizing pain in older adults.
What to do right away
Contact the doctor as soon as possible if you think it's shingles1. Antiviral medicines, such as acyclovir, valacyclovir and famciclovir, shorten the length and severity of the illness and work best when taken as soon as the rash appears1. Many practices and telehealth services can diagnose shingles from a photo or video visit. Ask about pain control at the same time.
Seek urgent care for a rash on the face near the eye, very severe pain, a widespread rash, high fever, confusion, or a weakened immune system. In an older adult, new confusion during an illness can signal a serious problem; see delirium.
Easing pain and itching at home
CDC notes that pain relievers, over the counter or prescribed, may help, and that wet compresses, calamine lotion and warm oatmeal baths may relieve itching1. Other practical tips:
- Loose, soft cotton clothing over the rash.
- Cool, damp cloths for a few minutes at a time.
- Keep the rash clean and covered with a loose, non-stick dressing.
- Rest and fluids. Shingles is exhausting, especially for older adults.
- Check pain medicines with the doctor or pharmacist to avoid interactions with your parent's other prescriptions. See polypharmacy.
If your parent lives alone, the first week or two may be a good time to check in daily or arrange extra help with meals and bathing.
Can it spread?
You can't catch shingles from someone with shingles. But a person who has never had chickenpox or the chickenpox vaccine can catch chickenpox from contact with fluid from shingles blisters1. People with shingles can't spread the virus before blisters appear or after the rash scabs over1. Until then, CDC advises covering the rash, not touching or scratching it, washing hands often, and avoiding contact with pregnant women who never had chickenpox or the vaccine, premature or low birth weight babies, and people with weakened immune systems1. If your parent lives in a care community, tell staff right away.
Long-term nerve pain
The most common complication of shingles is postherpetic neuralgia, or PHN: long-term nerve pain in the area where the rash was1. It can be severe and debilitating, and can last for months or years after the rash goes away2. Older adults are at higher risk. The pain may be burning, stabbing or aching, and light touch can be painful.
Treatment options include certain prescription medicines, numbing patches and creams. Some nerve pain medicines cause drowsiness or dizziness in older adults, so ask how to start them safely. Chronic pain wears down sleep, mood and independence, so keep the doctor informed if it isn't improving. Our guide to chronic pain in older adults covers more strategies.
The shingles vaccine
Vaccination is the only way to protect against shingles and its complications2. CDC recommends two doses of the recombinant zoster vaccine, Shingrix, for adults 50 and older, given 2 to 6 months apart, and for adults 19 and older with weakened immune systems2. There is no maximum age2.
- Very effective. In clinical trials, Shingrix was 97 percent effective at preventing shingles in healthy adults 50 to 69, and 91 percent in adults 70 and older2.
- Protection lasts. In people 70 and older with healthy immune systems, immunity stayed high for at least 7 years2.
- Even after shingles. Your parent should still get Shingrix if they've had shingles, the older Zostavax vaccine, or the chickenpox vaccine2. Wait until the rash is gone.
- Side effects are common but short. A sore arm, redness, tiredness, muscle aches, headache, shivering or fever, usually lasting 2 to 3 days2. Your parent should still get the second dose2.
Plan the shots for a quiet couple of days in case your parent feels run down afterward. Shingrix can be given at the same time as other vaccines2. See vaccines for seniors for the full list.
How Medicare covers it
Medicare drug coverage, Part D, covers the shingles vaccine, and your parent pays nothing for it if they have Part D3. Part D plans don't charge a copayment or apply a deductible for vaccines recommended by the Advisory Committee on Immunization Practices3. Medicare Advantage plans with drug coverage cover it too. Doctors' offices and pharmacies give Shingrix2; a pharmacy in your parent's plan network is often the simplest place. Medicaid coverage varies, so check with the state program2.
Shingles in care communities
In assisted living or a nursing home, ask whether residents are offered Shingrix, how staff handle a resident with active shingles, and how they protect others. Because people with weakened immune systems are at risk from contact with the rash1, communities should cover the rash and use good hand hygiene. Make sure your parent's vaccine record travels with them when they move. Our moving to assisted living checklist includes medical records to bring.
Recovery and daily life
Most shingles rashes crust over and heal within two to four weeks. Recovery can take longer for frail older adults, who may lose strength and appetite during the illness. Encourage gentle activity as soon as your parent is able, regular meals and fluids, and good sleep. If your parent was already managing other conditions like diabetes, keep an eye on blood sugar and medicines during the illness. After a hard bout of shingles, some older adults need temporary help at home; see home care vs. home health. Afterward, make sure your parent gets vaccinated once the rash has gone, to lower the chance of another episode2.
If your parent is unsure about the vaccine
Some older adults put off Shingrix because they heard the side effects are rough, or because they think shingles only happens to other people. Share what CDC says plainly: the side effects usually last two to three days and are milder than shingles itself2. Offer to drive and to stay nearby the day after. Schedule it alongside a routine visit, such as the Medicare annual wellness visit, or at the pharmacy when picking up prescriptions. If your parent has memory problems, put both doses on the calendar and keep the record in the medical folder, since it's easy to forget the second shot. If your parent has trouble getting to appointments, many pharmacies offer scheduling online, and some home health and community programs can help with transportation; see transportation for seniors.
An example
When Sam's father felt burning pain on his left side and saw a few blisters the next morning, Sam booked a same-day telehealth visit and sent a photo. The doctor prescribed an antiviral that day. They used cool compresses and loose shirts, and Sam's father took a pain reliever the pharmacist confirmed was safe with his blood pressure medicine. The rash healed in three weeks with no lasting pain. Sam's mother, who'd watched it all, got her two Shingrix doses that fall, a few months apart, at their local pharmacy. This is an illustration.
