Annals of Long Term Care

Introduction
Herpes zoster (shingles) is a common disease among older adults that can cause considerable suffering from acute and chronic pain, or postherpetic neuralgia (PHN). The incidence of herpes zoster in persons over age 65 years is more than 11 per 1000 person-years, with an estimated several hundred thousand cases occurring in older adults each year in the United States.^1,2 Older adults with herpes zoster are at much higher risk than younger individuals for developing PHN.

The main goal of the treatment of herpes zoster in older adults is the reduction or elimination of acute pain and the prevention of PHN. Antiviral therapy with acyclovir, famciclovir, or valacyclovir reduces acute pain and the duration of chronic pain in older patients with herpes zoster who are treated within 72 hours of rash onset.³ The benefits of treating patients with herpes zoster who present more than 72 hours after rash onset are unknown. Acute herpes zoster pain management requires the use of standardized pain measures, scheduled analgesia, and consistent follow-up to adjust therapy.^3,4 Patients with mild pain may be managed with acetaminophen or nonsteroidal agents. Patients with moderate-to-severe pain usually require treatment with a strong opioid analgesic (eg, oxycodone). A recent randomized clinical trial in 87 older adults with herpes zoster compared antiviral treatment with famciclovir in combination with 28 days of treatment with either oxycodone, gabapentin, or placebo. Oxycodone, but not gabapentin, significantly reduced acute shingles pain.⁵ If antiviral and analgesic therapy does not adequately control the patient’s pain, then the clinician can consider the addition of corticosteroids, a tricyclic antidepressant (TCA), or a neural blockade.³ None of these approaches have been shown to prevent PHN, but they may be useful in reducing acute pain.

The frequency with which herpes zoster and PHN occur in elderly persons implies that many older adults who have not had herpes zoster would likely know someone who experienced this condition. The more familiar lay term for herpes zoster is shingles. Health education efforts, such as the National Institute on Aging’s “Age Page” on shingles,⁶ may familiarize older adults with the disease and its painful consequences. These phenomena suggest that older adults may be knowledgeable about shingles, but there is no information about shingles knowledge in older adults.

Knowledge and attitudes regarding shingles in older adults may influence health behaviors. Investigations of other common conditions in older adults indicate that disease knowledge positively affects health behaviors and health outcomes.^7,8 With the availability of treatment in the form of early antiviral therapy and prevention in the form of the zoster vaccine, shingles knowledge is important for older adults.^3,9 Similarly, ascertaining the amount and type of knowledge of shingles among older adults is important for determining the level and content of public education efforts regarding this disease. We collected information to determine the level of knowledge of shingles among older adults in a nationwide, random sample of older adults who have not had shingles.

Shingles Survey
The information was collected as a telephone survey among a national probability sample of English-speaking adults age 50 years and older between August 16, 2005 and September 20, 2005, using random digit-dialing (RDD) sampling.¹⁰ The survey had quotas of 400 completed interviews with persons age 50-59 years; 400 completed interviews with those age 60-69 years; 300 completed interviews with those age 70-79 years; and 100 completed interviews with those age 80 years and older. The national telephone survey, data collection, and analysis were conducted by Schulman, Ronca & Bucuvalas, Inc.