Speech and Swallowing in the Elderly

Normal speech and swallow depend on the integrity of the oral motor system and the underlying processes of respiration, phonation, sensation, resonance and articulation. A variety of age-related changes occur in the oral peripheral mechanism, some of which affect speech and swallow. Nonpathologic changes in the thoracic and laryngeal structures that serve to reduce the vital capacity of the lungs and produce perturbations in the acoustic signal alter the quality of the aging voice. As one ages, the oral mucosa reportedly thins, salivary flow may be decreased, and the sensory and motor integrity of the tongue musculature is altered. The effect of such changes on speech articulation and voice production in the elderly is discussed. Although not dependent on one another, speech and swallowing use many of the same oral structures and underlying physiologic mechanisms. The anatomic and physiologic changes in the aging pharvngeal area and oral tract that can affect swallowing are reviewd and studies of these changes are discussed. Viewing the oral area and vocal tract has required invasive, cumbersome or dangerous radiographic procedures, thereby limiting the quantity of research in this field. Recent work on the use of real-time ultrasound imaging to view the oral soft tissues and dynamic lingual gestures in vivo during speech and swallow are reviewed and ongoing studies of speech and swallowing performance in normal aging persons using this technique are presented.