QUESTION: Now that the presidential candidates have been decided, can you provide me with details about their positions on long-term care?
ANSWER: How to best finance and organize a comprehensive long-term care system is a hot issue that will get more so as Election Day approaches.George Bush:
-Supports research for treatments to eliminate major causes of long-term, chronic disability, such as osteoporosis, Alzheimer's disease and strokes.
-Favors enacting cost-effective measures to reinforce the current system of home care, under which families of disabled older people provide long-term care for aging relatives.
-Says there must be more flexibility in the Medicare and Medicaid (Medi-Cal in California) systems so that benefits are not denied in situations of non-institutional care.
-Says catastrophic-care legislation doesn't address the long-term care problem, which the next administration must make a priority.
-Believes federal, state and local responsibilities must be balanced with appropriate contributions from the individual and his family, with a goal of offering long-term care insurance at the lowest cost.
-Emphasizes access and prevention.
Do you have ideas you'd like to share with the candidates? Send them to Vice President George Bush, 733 15th St. NW, Suite 800, Washington, D.C. 20005; and Gov. Michael Dukakis, 105 Chauncy St., Boston, Mass. 02111.
QUESTION: My 73-year-old mother recently contracted shingles and is in great pain. What causes this skin disease and can anything be done to relieve the symptoms?
ANSWER: Shingles is a skin infection due to the varicella-zoster virus, the same virus that causes chicken pox. Zoster infection, which causes shingles, is believed to be a reactivation of the virus that has remained dormant in the nerve root after an episode of chicken pox. Most people acquire chicken pox in childhood, and shingles commonly occurs in later life, so the virus frequently remains dormant for decades.
The reason for the reactivation is not clear. The theory that shingles was a sign of hidden cancer is no longer believed to be true. More likely, the disease represents a decline in the body's defense against viral infection.
Elderly people with shingles are more likely to have pain than afflicted younger individuals (90 percent of the elderly have pain acutely and in 70 percent the pain lasts longer than one month). A syndrome called post-herpetic neuralgia may also occur, in which pain may persist after the initial episode, occasionally lasting longer than a year.
Like chicken pox, zoster may spread to other parts of the body, with serious ramifications, including pneumonia and eye damage. People with diseases that impair immune function, such as cancer, and people who are on long-term steroid treatment are most susceptible to complications.
Two new drugs, acyclovir and vidarabine, are available for treatment of zoster infection. If started soon after symptoms begin, both reduce the time for healing, the likelihood of spread to other organs and the amount of acute pain. Because of the expense of giving these medicines and the potential for side effects, these drugs are generally reserved for persons with conditions that impair immune function. Steroid medicines such as prednisone have been used to prevent post-herpetic neuralgia, but recent studies have questioned their effectiveness.
Should you develop a rash or pain that you think may be shingles, see your doctor. Remember that children and adults who have not yet had chicken pox may get it from exposure to someone with shingles.
Send questions about growing older to On Aging, P.O. Box 84256, Los Angeles, Calif. 90073. Questions of general interest will be answered in the column; individual answers cannot be provided.