Treatment of dysphonia in older people: the role of the speech therapist.

Abstract

This review addresses speech therapy interventions for older adults experiencing voice impairments. The prevalence, impact, and nature of voice impairments in older people are outlined. Intervention methods and their effectiveness are discussed, with particular focus on behavioral treatments for presbyphonia. The strength of current evidence is discussed and recommendations for future research are presented. There has been a substantial increase in the number of older people seeking voice management over the last 10-20 years. Reduced vocal effectiveness in older people is likely to be multifactorial and associated with normal physiological aging, maladaptive responses to vocal aging, and medical and psychosocial conditions that are common in older age. Although several authors have claimed that behavioral intervention for presbyphonia is effective, few studies were reported until 2008. Since then, 10 studies have been published as to the effectiveness of behavioral interventions for age-related dysphonia. Voice therapy techniques evaluated include vocal function exercises, phonation resistance training exercise, Lessac-Madsen resonant voice therapy, Lee Silverman voice treatment, neuromuscular electrical stimulation, semi-occluded vocal tract, and flow phonation. Findings suggest that behavioral interventions for presbyphonia have the potential to mitigate effects of vocal aging, but the overall evidence base is inadequate to allow definitive conclusions. Because vocal effectiveness diminishes as people age and because diminished vocal capabilities are associated with negative impacts, the importance of establishing whether behavioral interventions are effective is now acknowledged. Although the number of studies on speech therapy interventions has increased, the body of evidence is limited and further research is required.