Journal of Research in Rehabilitation Sciences

Voice and Swallowing Changes in Elderly People with and without Depression: A Cross-Sectional Study

Document Type : Original Articles

Authors

1 Rehabilitation Sciences Student Research Committee (Treata) AND Department of Speech Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Speech Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/jrrs.2025.43052.1103

Abstract

Introduction: The natural ageing process can impact the performance of the speech system. Age-related vocal changes, even in the absence of voice disorders, can adversely affect the quality of life (QOL) of elderly individuals. Changes in the vocal tract may also lead to issues such as dysphagia and other oral health concerns. These alterations are particularly significant, as they correlate with diminished communication abilities, a reduced QOL, and an increased risk of depression. Unfortunately, these changes are often overlooked or misdiagnosed. This study aimed to assess age-related variations in voice and swallowing function among Iranian elderly individuals, both with and without depression.
Materials and Methods: In this cross-sectional study, 50 elderly participants from Iran, aged between 60 and 80, were recruited through convenience sampling. All participants reported no history of cognitive, neurological, respiratory, or speech-related disorders, a status confirmed by self-reports and medical records. The assessments utilized included the Mini-Mental State Examination (MMSE), the 15-item Geriatric Depression Scale (GDS-15), the Voice-Related Quality of Life (V-RQOL) questionnaire, and a 7-point Likert scale for swallowing evaluation. The distribution of the data was evaluated using the Shapiro-Wilk test, which indicated a normal distribution; therefore, group comparisons were conducted using the nonparametric Mann-Whitney U test.
Results: The total V-RQOL score was notably higher in the depressed elderly group (82.50) when compared to the non-depressed group (70.21) (P = 0.005). Additionally, the depressed elderly group experienced greater swallowing difficulties, as indicated by their higher scores on the 7-point swallowing Likert scale (1.55) compared to the non-depressed group (1.15) (P = 0.005).
Conclusion: Age-related voice and swallowing difficulties appear to be significantly more pronounced in elderly individuals experiencing depression compared to those who are not depressed. However, it remains uncertain whether these functional impairments contribute to the development of depression or are a result of it. The findings offer preliminary evidence of a potential correlation between depressive symptoms and reduced voice and swallowing function, which may ultimately impact overall QOL. Further research is necessary to gain a deeper understanding of this relationship.

Keywords

Main Subjects

  1. Torre P, 3rd, Barlow JA. Age-related changes in acoustic characteristics of adult speech. J Commun Disord 2009; 42(5): 324-33.
  2. Leongómez JD, Havlíček J, Roberts SC. Musicality in human vocal communication: an evolutionary perspective. Philos Trans R Soc Lond B Biol Sci 2022; 377(1841): 20200391.
  3. Kim MJ, Kim S-J, Ha J-W, Ha S. A Survey of Co-morbidity and Speech-Language Characteristics in Speech Sound Disorders. Commun Sci Disord 2015; 20(3): 446-55.
  4. Sataloff RT. Professional voice: the science and art of clinical care. 4th ed. San Diego, CA: Plural Publishing; 2017.
  5. Cannito MP, Kahane JC, Chorna L. Vocal aging and adductor spasmodic dysphonia: response to botulinum toxin injection. Clin Interv Aging 2008; 3(1): 131-51.
  6. Casper JK, Leonard R. Understanding voice problems: A physiological perspective for diagnosis and treatment. Pennsylvania, PA: Lippincott Williams & Wilkins; 2006.
  7. Patel AK, Mildenhall NR, Kim W, Carroll TL. Symptom overlap between laryngopharyngeal reflux and glottic insufficiency in vocal fold atrophy patients. Ann Otol Rhinol Laryngol 2014; 123(4): 265-70.
  8. Dehqan A, Scherer RC, Dashti G, Ansari-Moghaddam A, Fanaie S. The effects of aging on acoustic parameters of voice. Folia Phoniatr Logop 2012; 64(6): 265-70.
  9. Xue S, Deliyski D. Effects of aging on selected acoustic voice parameters: Preliminary normative data and educational implications. Educ Gerontol 2001; 27(2): 159-68.
  10. Cavallaro G, Fiorella M, Barbara F, Quaranta N, Di Nicola V. Exploring age-related changes in acoustic voice analysis parameters: insights from a study on older people. J Gerontol Geriatr 2024; 72(2): 51-9.
  11. Roy N, Stemple J, Merrill RM, Thomas L. Epidemiology of voice disorders in the elderly: preliminary findings. Laryngoscope 2007; 117(4): 628-33.
  12. Golub JS, Chen PH, Otto KJ, Hapner E, Johns MM, 3rd. Prevalence of perceived dysphonia in a geriatric population. J Am Geriatr Soc 2006; 54(11): 1736-9.
  13. de Araújo Pernambuco L, Espelt A, Balata PM, de Lima KC. Prevalence of voice disorders in the elderly: a systematic review of population-based studies. Eur Arch Otorhinolaryngol 2015; 272(10): 2601-9.
  14. Taylor S, Dromey C, Nissen SL, Tanner K, Eggett D, Corbin-Lewis K. Age-Related Changes in Speech and Voice: Spectral and Cepstral Measures. J Speech Lang Hear Res 2020; 63(3): 647-60.
  15. Smith E. Effect of voice disorders on quality of life. J Med Speech Lang Pathol 1996; 4: 223-44.
  16. Tanner K, Pierce JL, Merrill RM, Miller KL, Kendall KA, Roy N. The Quality of Life Burden Associated With Voice Disorders in Sjögren's Syndrome. Ann Otol Rhinol Laryngol 2015; 124(9): 721-7.
  17. Mahmoud NF, Zahran H, Abdelmonam S. A comparative study of the voice-related quality of life among Egyptian elderly with and without voice complaints. Egypt j otolaryngol 2020; 36(1): 58.
  18. Krischke S, Weigelt S, Hoppe U, Köllner V, Klotz M, Eysholdt U, et al. Quality of life in dysphonic patients. J Voice 2005; 19(1): 132-7.
  19. Naunheim MR, Goldberg L, Dai JB, Rubinstein BJ, Courey MS. Measuring the impact of dysphonia on quality of life using health state preferences. Laryngoscope 2020; 130(4): E177-e82.
  20. Verdonck-de Leeuw IM, Mahieu HF. Vocal aging and the impact on daily life: a longitudinal study. J Voice 2004; 18(2): 193-202.
  21. Tang SS, Mohad V, Gowda M, Thibeault SL. Insights Into the Role of Collagen in Vocal Fold Health and Disease. J Voice 2017; 31(5): 520-7.
  22. Morsomme D, Provin S, Verduyckt I, Jamart J, Remacle M, Editors. Evaluation of the aging patient’s voice by means of the VHI correlated to the DS16 and the SF-36. 37ème Symposium: Care of the professional Voice; 2008; Philadelphia, PA.
  23. Vaca M, Mora E, Cobeta I. The Aging Voice: Influence of Respiratory and Laryngeal Changes. Otolaryngol Head Neck Surg 2015; 153(3): 409-13.
  24. Baba T, Goto T, Fujimoto K, Honda T, Yagi K, Nagao K, et al. Age-related Changes in Geniohyoid Muscle Morphology Predict Reduced Swallowing Function. J oral health biosci 2017; 30(1): 18-25.
  25. Paterson WG. Dysphagia in the elderly. Can Fam Physician 1996; 42: 925-32.
  26. Cavallero S, Dominguez L, Vernuccio L, Barbagallo M. Presbyphagia and dysphagia in old age. Geriatr Care 2020; 6(2).
  27. Senn N, Monod S. Development of a Comprehensive Approach for the Early Diagnosis of Geriatric Syndromes in General Practice. Front Med (Lausanne) 2015; 2: 78.
  28. Ekberg O, Feinberg MJ. Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. AJR Am J Roentgenol 1991; 156(6): 1181-4.
  29. Aslam M, Vaezi MF. Dysphagia in the elderly. Gastroenterol Hepatol (N Y) 2013; 9(12): 784-95.
  30. Sue Eisenstadt E. Dysphagia and aspiration pneumonia in older adults. J Am Acad Nurse Pract 2010; 22(1): 17-22.
  31. Ballesteros-Pomar MD, Cherubini A, Keller H, Lam P, Rolland Y, Simmons SF. Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review. J Nutr Health Aging 2020; 24(6): 576-81.
  32. Yorkston KM, Bourgeois MS, Baylor CR. Communication and aging. Phys Med Rehabil Clin N Am 2010; 21(2): 309-19.
  33. Taraghi Z, Ilali ES. A Comparison of Older Adults’ and Managers’ Attitudes towards Age-Friendly City Indexes. Iran J Ageing 2018; 13(2): 236-49.
  34. Bahramnezhad F, Farokhnezhad Afshar P, Asgari P, Shiri M. A Review of the Iran's elderly status according to the census records. Galen Med J 2016; 5(1): 1-6.
  35. Turley R, Cohen S. Impact of voice and swallowing problems in the elderly. Otolaryngol Head Neck Surg 2009; 140(1): 33-6.
  36. Garcia-Toro M, Talavera JA, Saiz-Ruiz J, Gonzalez A. Prosody impairment in depression measured through acoustic analysis. J Nerv Ment Dis 2000; 188(12): 824-9.
  37. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98.
  38. Carnero-Pardo C. Should the mini-mental state examination be retired? Neurologia 2014; 29(8): 473-81.
  39. Ansari NN, Naghdi S, Hasson S, Valizadeh L, Jalaie S. Validation of a Mini-Mental State Examination (MMSE) for the Persian population: a pilot study. Appl Neuropsychol 2010; 17(3): 190-5.
  40. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. In: Brink TL, Editor. Clinical gerontology. London, UK: Routledge; 2014. p. 165-73.
  41. Malakouti SK, Fatollahi P, Mirabzadeh A, Salavati M, Zandi T. Reliability, validity and factor structure of the GDS-15 in Iranian elderly. Int J Geriatr Psychiatry 2006; 21(6): 588-93.
  42. Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice 1999; 13(4): 557-69.
  43. Moradi N, Saki N, Aghadoost O, Nikakhlagh S, Soltani M, Derakhshandeh V, et al. Cross-cultural adaptation and validation of the voice-related quality of life into Persian. J Voice 2014; 28(6): 842.e1-9.
  44. Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus 2011; 24(7): 476-80.
  45. Madhavan A, LaGorio LA, Crary MA, Dahl WJ, Carnaby GD. Prevalence of and Risk Factors for Dysphagia in the Community Dwelling Elderly: A Systematic Review. J Nutr Health Aging 2016; 20(8): 806-15.
  46. Pizzorni N. Social and Psychologic Impact of Dysphagia. In: Ekberg O, Editor. Dysphagia: Diagnosis and Treatment. Cham, Switzerland: Springer International Publishing; 2017. p. 873-86.
  47. Ko D, Oh J, Joo S, Park JY, Cho MS. Dietary Habits, Food Product Selection Attributes, Nutritional Status, and Depression in Middle-Aged and Older Adults with Dysphagia. Nutrients 2022; 14(19).
Journal of Research in Rehabilitation Sciences
Volume 18, Issue 1
2022