Why Is Shingles More Serious in Older Adults?

The clinical term for shingles is herpes zoster. It’s caused by the varicella-zoster virus, the same virus responsible for chickenpox. If you had chickenpox as a child, the virus has remained dormant in some nerve cells. When it becomes activated, the result is shingles.

The typical symptoms of shingles include:

• burning or tingling sensation on the skin in one part of the body
• an itchy rash
• fluid-filled blisters
• skin sensitive to the touch
• fever, nausea, and headaches

A shingles rash usually appears as a band on one side of the body, often the torso or face, which is a helpful clue when diagnosing the condition. Pain may be felt a few days before any blisters or skin irritation appear and linger after the rash has cleared.

All of those symptoms, especially the pain and rash, tend to be much worse among older adults compared to younger people. The pain can become chronic for older adults if the condition isn’t treated early on.

For younger people, a bout of shingles often resolves within a few weeks with a low risk of ongoing problems. That’s not true for many older adults, who can face life threatening complications, even after the rash itself has cleared.

Some of the more serious complications that affect older people include:

Post-herpetic neuralgia (PHN)

Perhaps the most severe shingles complication, post-herpetic neuralgia (PHN) is much more likely to affect older people who develop shingles. It’s a major contributor to disability later in life, affecting every second person aged 85.

PHN is long-term nerve pain in the area where the rash first appeared. The Centers for Disease Control and Prevention (CDC) estimates 10–18% of people with shingles go on to have PHN.

Vision loss

If shingles develop near an eye, early treatment is vital. Shingles in the eye is called ophthalmic herpes zoster, and it can cause scarring and vision loss. As many as 20% of all shingles cases involve one or both eyes.

Stroke and heart disease

A 2017 study found that the odds of having a stroke were significantly higher a year after a person had shingles than in people who didn’t have it.

Similarly, 2022 research has found a greater chance of heart disease in people who have had shingles.

Dementia

The same kind of vascular damage that can disrupt blood flow to the brain and cause a stroke can also affect brain function in a different way. Shingles raises the chance of inflammation of the arteries supplying blood to the brain, which in turn increases the odds of dementia.

A 2017 study found that, after accounting for heart disease and other medical conditions or factors that could affect dementia risk, older adults with shingles of the eye have a nearly threefold greater risk for dementia compared to their peers without shingles.

Death

It’s rare for shingles to directly lead to death. The CDC reports that shingles can be considered the direct underlying cause of death in less than one person per 1 million people in the general population.

While shingles itself isn’t usually a deadly disease, it can lead to conditions such as pneumonia and encephalitis, which can be fatal. This is particularly true for older people whose immune systems have been compromised by treatments for illnesses such as AIDS and cancer.

While shingles can resolve on its own without treatment, the condition should be treated aggressively as soon as it’s diagnosed to prevent complications.

Antiviral medication

The main weapon to fight a shingles outbreak is an antiviral medication. Three types — acyclovir, valacyclovir, and famciclovir — are approved for older adults and younger people, too.

While acyclovir (Zovirax) may be the most effective, it requires five doses a day, which can be a challenge for an older person. Instead, valacyclovir (Valtrex) is the more widely used antiviral for older shingles patients. It requires three doses a day and is generally well tolerated, with few side effects.

Pain medication

Mild pain may be relieved with acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil) or naproxen (Aleve).

More serious pain may require opioid pain relievers or corticosteroids, but the use of these drugs and their potential side effects must be weighed carefully with older adults, particularly those who are taking several other medications that may interact with pain medications.

Anticonvulsant medications

The use of the anticonvulsant drugs gabapentin and pregabalin are sometimes prescribed if other treatments aren’t effective. However, because these drugs can cause dizziness, their use among older people must be monitored carefully. Taking the drugs just before bedtime may lower the risk of a dizziness-related fall.

Mindful meditation

Some pain management may be achieved through the practice of mindful meditation, according to research from 2019.

Shingles typically lasts about 3–5 weeks. The blisters usually start to crust over after a week or so, but the itching and pain can continue for a few more weeks. The sooner you begin treatment with an antiviral medication, the faster the rash and other symptoms will start to dissipate.

If the rash becomes infected, a complete recovery can take a little longer. If PHN develops, the pain of shingles could last from a few weeks to a few years or even for life.

If you take medications and topical treatments as directed and avoid scratching the affected skin, you’re more likely to have a smooth recovery.

The best way to prevent shingles is to get a vaccine. A shingles vaccine called Shingrix is recommended for everyone over the age of 50. It’s administered in two doses several months apart.

Though shingles recurrence is rare, people who have had shingles are still advised to get the vaccine. Research has found it to be 68% effective at preventing shingles in the first year after getting the shot.

If you haven’t talked with a medical professional about the shingles vaccine, be sure to do so soon. You should also consult with a health professional within 72 hours after the first sign of shingles.

Remember, a band of blisters on one side of the face or torso, or on one leg or arm, suggests shingles.

Even if you’re unsure whether it’s shingles or some other condition causing a rash, have it checked out. A medical professional can make an initial diagnosis just by visually inspecting your skin.

A small piece of skin tissue may be removed and sent to a lab to confirm the diagnosis or determine whether it’s something else.

How serious is shingles in the elderly?

One reason is that older people tend to have weaker immune systems than younger people, making it harder to fight an infection of any kind.

Along with the normal age-related decline in immune system strength, other factors, including stressful life events and cancer treatment, can further compromise an older person’s immune system.

What causes shingles in the elderly?

Shingles is caused by the dormant herpes zoster virus. It develops in people who have previously had chickenpox.

What are the chances of an 80-year-old getting shingles?

The CDC reports that about 1 in 3 people will develop shingles at some point in their lives, with the chance of complications climbing significantly after age 40.

Though shingles can affect anyone at any age, it’s much more common among older adults. The virus can also cause more severe symptoms and complications for older people.

To help avoid complications, such as long-term nerve pain, get a diagnosis and begin treatment as early as possible. And if you haven’t gotten your shingles vaccine, ask a healthcare professional about whether you should get it.