Elder Speech, Language And Swallowing

Front 1

Speech Production

Back 1

Resistant to aging.
Manner of production may be different. (atrophy of jaw, tongue, and facial muscles.)
Severity and length of significant hearing loss.
Notable differences b/w young and old considered normal variations rather than pathological.

Front 2

Phonemic Production

Back 2

Centralize vowels.
Decrease in formant frequency of vowels.
Acoustic changes related to changes in vocal tract (lowering of larynx. Muscle atrophy that decreases muscle mass in pharynx and tongue.)

Front 3

Articulatory timing/ Voice Onset Time.

Back 3

Distinguishes voiced and voiceless cognate stop phonemes.
Increased variability w/ age related to diminished coordination/neuromuscular control.
Elders normally produce vowel and consonant segments that are longer.
For longer utterances, tend to reduce the duration of the phoneme segments.

Front 4

Fluency

Back 4

Generally increases from PreK to early adult years.
Disfluencies may increase later in life.
Elders tend to have slower speech rates.
Speak 20-25% slower and 55% more variable than younger adults.
Longer, more freq pauses.
Reduced velocity of articulatory movements.
Longer speech sound durations
Produce fewer syllables per second.

Front 5

Majority of Elder errors

Back 5

Interjections.
Revisions/incomplete phrases.
More likely to be disfluent under stress.

Front 6

Speech and Voice Production

Back 6

Result of complex cooridination of sensory and motor processes that depends on effective and efficient neural transmissions b/w the central and peripheral nervous systems.

Front 7

Respiratory

Back 7

Decreased rib movement.
Increased thorax stiffness.
Increased residual lung volume: decreased lung recoil and diaphragmatic strength.

Front 8

Oral-Phrayngeal Mechanisms: Structural changes.

Back 8

Tooth loss and/or compromised dentition.
Epithelium of tongue, pharynx, and soft palate atrophies along with other connective tissue.
Oral mucosa becomes thinner and drier.
Decreased salivary flow.
Changes in sensory ability.
Reduced lingual sensation.
Reduced ability to perceive pressure on tongue.

Front 9

Larynx: Factors accounting for senescent voice.

Back 9

Ossification of thyroid, cricoid, and arytenoid cartilages.
Erosion and calcification of laryngeal cartilage joints.
Changes in mucosa of the vocal folds.
Muscular atrophy.
Incomplete vocal fold approximation.
Glottal gaps or reduced glottal resistance.
Good physical condition tends to mitigate effects of chronilogical age.

Front 10

Aging larynx and phonation: structural changes.

Back 10

Laryngeal glands
Lubricate vocal fold mucosa.
Changes could result in dehydration of epithelial lining of the vocal folds.
May be responsible for excessive throat clearing.
Vocal folds.

Front 11

Aging larynx and phonation: functional changes-voice quality

Back 11

Great variablilty due to highly variable rate in onset and progression of physiological aging.
Described as: hoarse, tremulous, weak, altered pitch.
Changes in vocal fold tissue may introduce vibratory irregularites that contribute to voice quality deviations.
Jitter (small cycle to cycle variations in vibratory freq.)
Shimmer (cycle to cycle amplitude perterbations.)
Integrity of laryngeal control appears to be associated more with health than chronological age.

Front 12

Aging Larynx and phonation: functional changes- Vocal intensity.

Back 12

Depends on sublottal pressure which is determined by efficiancy of the respiratory power supply and by laryngeal valving.
Vocal pitch: changes in laryngeal anatomy and physiology as well as the respiratory/supra-glottal systems cause gradual decrease in pitch from infancy to early adulthood where it becomes stable.
men-pitch increase
women- pitch decrease.

Front 13

Aging Larynx and Phonation: Functional changes- Fundamental frequency.

Back 13

Contradictory findings in aging population.
Trend to increase slightly in males and decrease in females as a funciton of normal aging.

Front 14

Dysphagia

Back 14

Estimated 6-10 million people have swallowing difficulties.
However, most elderly eat without significant difficulty.
Difficult to distinguish normal aging effects from sub-clinical disesase or the early stages of degenerative disease.

Front 15

Dysphagia Complications

Back 15

Dehydration
Malnutrition
Aspiration
Pneumonia
Depression
Death.

Front 16

Dysphagia: Effect of Secondary Aging- Common Etiologies associated with Dysphagia

Back 16

CVA
Arthritis
Progressive Neuromuscular Disorder
Dementia

Front 17

Dysphagia: Effects of secondary aging- Those not directly related to aging

Back 17

Head trauma
Carcinoma/Irradiation
Head and Neck Surgery
Motor and sensory impairments
Loss of dentition or saliva

Front 18

Dysphagia: Effects of Tertiary aging

Back 18

If motivation to eat or enjoyment of eating is diminished, potential for malnutrition.
Some eating and swallowing problems are associated with depression.
May not be able to afford foods for proper nutrition or be able to prepare them.
Malnutrition can result in dysphagia.

Front 19

Esophagus Diseases

Back 19

GERD
Displacement or compression by a tortuous thoracic aorta.
Obstruction.

Front 20

Importance of Sensory Innervation for Swallowing

Back 20

During the voluntary stage, conveys important information about bolus: consistency, density, and position in oral cavity.
Helps to determine chweing force and peri-oral movements for the bolus preparation and transportation.

Front 21

Dysphagia: Aging Effects

Back 21

Bolus held more posteriorly in oral cavity.
Bolus velocity is slower during transport.
Alterations in timing of swallowing appear at about age 45 (duration increase with age)
Delays in timing of upper esophageal relaxation.
Lower resting esophageal sphincter.
Increased prevalence of incomplete upper esophageal relaxation.
Decreased negative pressure resulting from opening of the esophageal sphincter.
Reduced sensitivity in oral and pharyngeal cavities.

Front 22

Dysphagia: Assessment

Back 22

Swallowing problems often overlooked in elderly due to other health problems being more prominent.
Questionnaires to screen.
Case history
Video fluorography to view all stages of swallowing.

Front 23

Dysphagia: Intervention

Back 23

Balance medical/physical needs with quality of life issues.
Prevention may be limited to minimizing symptoms and preventing unnecessary medical complications.
Clinicians should review recommendations frequently.

Front 24

Strategies to inhibit further problems from Secondary aging (dysphagia.)

Back 24

Regular dental checks.
Avoidance of food w/ extreme temperatures.
Avoidance of sweets.

Front 25

Language Aspects Preserved

Back 25

Highly over-learned language functions (hi how are you.)
Passive vocab and other basic lexical and semantic skills.
Phonological and morphological elements and rule systems.

Front 26

Discourse

Back 26

Basic unit of social communication.
Reflects complex interaction of cognitive and linguistic skills and world knowledge.

Front 27

Discourse problems can lead to...

Back 27

Social Isolation.
Lowered self-esteem.
Increased stress.
Reduced social power.
Restricted social networks.
Limitations of social activities.

Front 28

Language and Discourse comprehension

Back 28

Slight but consistent decline in language comprehension from 30s to 70s associated with any added stresses on cog/linguistic system.

Front 29

Language Comprehension Stress.

Back 29

Presence of any kind of noise (acoustic or cognitive), reduction in redundancy, organization and plausibility, and/or increasing cognitive demands, particularly involving working memory.

Front 30

Language and Discourse Comprehension: Semantics.

Back 30

More vulnerable to chronological aging than syntax and phonology.
Passive vocab w/ fixed meanings, remain intact.
Influenced by health, education, and chron. age.
Changes at the word and sentence lvl tend to be associated w/ generalized, but inconsistent decline in word-finding skills.
Reduced word fluency skills.
Slower confrontation naming and more errors.
Few use of proper nouns and more high freq. nouns.
Decrements primarily seen when speed and generative naming functions are required.

Front 31

Language and Discourse Comprehension: Syntax

Back 31

Reduced complexity with age.

Front 32

Language and Discourse Comprehension: Informational Content.

Back 32

Slight decline in amount, type, and efficiency of info communicated across life span.
Old people produce less overall info in discourse than younger-old.

Front 33

Verbosity

Back 33

Used to describe elaborations in some older adults.

Front 34

Off-target Verbosity

Back 34

Failure to maintain focus on conversational stimulus and the degree of digression present.
Loosely associated verbalizations that stray more and more from original topic.
May turn into a monologue if at high lvls.
Content consists of material associated with, but irrelevant to, the topic of dicussion.
May turn into a reminiscence of speakers past presented as a disjointed series of events.
Must be copious and lack coherence to be OTV.

Front 35

Language and Discourse Comprehension: Conversation

Back 35

Tend to use longer pauses during conversational turn.
Skilled at using references in their past and to common events to intergrate elements of the conversation.
Use different topic switching strategies than younger adults.

Front 36

Language and Discourse Comprehension: Communicative Interactions

Back 36

Younger adults tend to devalue communication w/ older adults.
Attitudes toward aging and the elderly can lead to use of different styles of communcation w/ older adults.
Reflect under or over accommodation to the older partner's real or perceived attributes.

Front 37

Accommodation

Back 37

changes in speech style made to acknowledge the partner and enhance communicative success.

Front 38

Under accommodation

Back 38

Occurs when perspective-taking that is required for successful communication is reduced or eliminated.
Suggests younger partner's disinterest in communicative interaction resulting in a predictable breakdown in interaction.

Front 39

Over accommodation

Back 39

when one modifies speech-style to a stereotypical perception of the older partner (shouting)