Home Health Care Professionals' Newsletter

A Vaccine to Prevent Shingles in the Elderly?

It starts with a little tickling sensation and can escalade to excruciating pain. Shingles, or herpes zoster, is an acute painful inflammatory infection of the nerve structure caused by a virus.

Latent Virus

In a person, the same virus that caused chickenpox and became latent in cranial nerve and dorsal root ganglia, can reactivate years later to produce shingles. It is not exactly known what causes the re-activation of the virus, but it is understood that people whose immunity is compromised, like with HIV infection or cancer, are more at risk than the general population.

In the United States 10 to 20% of the that population, especially 50-70 years old, and up to 50% of 85 years old and older are affected. About 12% of older people with shingles experience pain (postherpetic neuralgia) lasting for 3 months or longer, sometimes years! Possible complications also include secondary infections, which could be very serious in immuno-suppressed patients, and eye infection, scarring.

Disease Management

The general management of the disease include antiviral agents, systemic corticosteroids, analgesics and pain management, along with topical treatments like Burow’s solution (See article at right). However, note that steroids, antidepressants and anticonvulsants that are sometimes used as treatment are usually not recommended for the elderly. These persons are often left with pain they cannot manage.

New Hope

A 10-year study has been testing an experimental vaccine aimed at preventing shingles, using a more potent version of the vaccine currently used to immunize children against the chickenpox virus.

This vaccine would not prevent shingles entirely but the episodes generally would be far milder than they otherwise would have been.

In April 2005 the Food and Drug Administration received a license application from the manufacturer for that zoster vaccine. If approved for use, the vaccine has the potential to prevent up to 250,000 cases of shingles in the United States each year and significantly reduce the severity of the disease in another 250,000 cases.

There will be more trials before the vaccine is on the market, but new hope has emerged for a new generation of potential shingles sufferers.

Prevention

Patients can prevent shingles by decreasing their body’s susceptibility to it:

Eat a well-balanced diet
Obtain adequate rest
Exercise regularly

References: “Herpes Zoster, or Shingles, is Painful” - Mary Ann E. Zagaria, MS, RPH, CGP, PharmD candidate—2004. www.nih.gov/news/pr/jun2005/niaid-01a.htm M. N. Oxman et al.—“A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.” - The New England Journal of Medicine—352(22):2271-84(2005).

Recipe Corner: Crunchy Waffles

Ingredients
	1 1/2 cups whole wheat flour	1 tsp ground ginger
	1 1/2 cups buttermilk	1/4 vegetable oil
	Strawberry-banana sauce	2 tsp non-alum baking powder
	2 eggs	1/4 cup maple syrup or honey
	1/2 cup finely chopped pecans	Plain yogurt

Directions
Combine dry ingredients; stir well. Beat eggs. Add flour mix, buttermilk, syrup and oil. Beat until smooth. Cook on hot, lightly oiled waffle iron, sprinkling the top with chopped pecans before cooking. Serve with toppings and yogurt.
Strawberry-banana Sauce
1 1/2 cup maple syrup	2 cup cut strawberries	1 cup sliced bananas
Combine all ingredients in a heavy saucepan. Cook over medium high heat 10 minutes, stirring occasionally. Serve warm.

Source: Arrowhead Mills “The Natural Way to Start the Day.”

In-services Update

SCHEDULE	DATE	TIME	CREDITS
Multiple Sclerosis	7/17/06	12:30PM	2.0
Mark Hassel—ASCENT O&P	7/31/06	12:30PM	PT ONLY
Depression, dementia & Alzheimer’s	9/11/06	12:30PM	2.0
Susan Zekert, OT—Eye On Living	9/25/06	12:30PM	2.0
Security for the Elderly: Prevention	10/11/06	12:30PM	2.0

Steps for Getting Your Affairs in Order

Gather everything you can about your income, investments, insurance, and savings.
Put your important papers and copies of legal documents in one place. You could set up a file, put everything in a desk or dresser drawer, or just list the information and location of papers in a notebook. If your papers are in a bank safe deposit box, keep copies in a file at home. Check each year to see if there is anything new to add.
Tell a trusted family member or friend where you put all your important papers. You don’t need to tell this friend or family member your personal business, but someone should know where you keep your papers in case of emergency. If you don’t have a relative or friend you trust, ask a lawyer to help.
Give consent in advance for your doctor or lawyer to talk with your caregiver as needed. There may be questions about your care, a bill, or a health insurance claim. Without your consent, your caregiver may not be able to get needed information. You can give permission in advance to Medicare, a credit card company, your bank, or your doctor. Sometimes you can give your OK over the telephone. Other times you may need to sign and return a form.

Personal Records

Full legal name, Social Security number, Legal residence, Date and place of birth
Names and addresses of spouse and children (or location of death certificates)
Location of “living will” or other advance directives
Location of birth certificate and certificates of marriage, divorce, citizenship, and adoption
Employers and dates of employment
Medications you take regularly
Education and military records, Memberships in groups and awards received
Your religion, name of church or synagogue, and names of clergy
Names and addresses of close friends, relatives, doctors, clergy, and lawyers or financial advisor

Financial Records

Sources of income and assets (pension funds, IRAs, 401Ks, interest, etc.)
Information about insurance policies, bank accounts, deeds, investments, and other valuables, such as jewelry or art
Social Security and Medicare information
Investment income (stocks, bonds, property) and stock brokers’ names and addresses
Insurance information (life, health, long-term care, home, and car) with policy numbers and agents’ names
Name of your bank and bank account numbers (checking, savings, and credit union)
Location of safe deposit boxes
Copy of most recent income tax return
Copy of your will
Liabilities: What you owe, to whom, and when payments are due
Mortgages and debts: How and when paid, Location of deed of trust and car title
Credit card and charge account names and numbers
Property tax information
Location of all personal items, such as jewelry and family treasures

Source: National Institute on Aging.

From the Library

A king reminder that there are booklets that you can borrow. We have a few of the special health report series from Harvard Medical School that may be of interest to you. Don’t hesitate to check them out.

Stress Management: Techniques for preventing and easing stress.
Better Bladder and Bowel Control.
Foot Care Basics: Preventing and Treating Common Foot Conditions.