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Original Investigation
August 2018

Sociodemographic Characteristics and Treatment Response Among Aging Adults With Voice Disorders in the United States

Author Affiliations
  • 1University of Southern California Voice Center, Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Otolaryngol Head Neck Surg. 2018;144(8):719-726. doi:10.1001/jamaoto.2018.0980
Key Points

Questions  What are the sociodemographic characteristics and treatment characteristics and response among adults 65 years or older with voice disorders?

Findings  In this cross-sectional database study, 4.2 million of 41.7 million adults 65 years or older (10.1%) reported voice disorders; of these, only a small percentage sought treatment, and a minority of individuals were evaluated by either an otolaryngologist or a speech language pathologist. Adults who seek treatment are significantly more likely to report improvement in their symptoms; however, fewer adults 65 years or older who were treated for a voice disorder improved relative to adults younger than 65 years.

Meaning  Many older adults with dysphonia are not treated by the appropriate health care practitioners; outreach efforts should be directed at increasing access to, and awareness of, services available from otolaryngologists and speech language pathologists.

Abstract

Importance  Aging adults face unique barriers to care and have unique health care needs with a high prevalence of chronic conditions. A high proportion of individuals in this group have voice disorders, in part due to age-related changes in laryngeal anatomy and physiologic features. These disorders contribute significantly to health care costs and remain poorly understood.

Objective  To describe sociodemographic characteristics and response to treatment among aging adults with voice disorders.

Design, Setting, and Participants  A cross-sectional study using the 2012 National Health Interview Survey was used to evaluate adults who reported voice disorders in the past 12 months. Self-reported demographics and data regarding health care visits for voice disorders were analyzed. Statistical analysis was conducted from March 1, 2017, to February 1, 2018.

Main Outcomes and Measures  Self-reported voice disorders, whether or not treatment was sought, which types of professionals were seen for treatment, and whether or not the voice disorder improved after treatment.

Results  Among 41.7 million adults in the United States 65 years or older, 4.20 million (10.1%; 2 683 199 women and 1 514 909 men; mean [SE] age, 74.5 [0.3] years) reported having voice disorders. Of those with voice disorders, 10.0% (95% CI, 8.3%-11.7%) sought treatment. Of individuals seeking treatment, 22.1% (95% CI, 7.9%-36.3%) saw an otolaryngologist and 24.3% (95% CI, 10.6%-38.0%) saw a speech language pathologist. By controlling for race/ethnicity, income, sex, and geography, it was found that men were less likely than women to report voice disorders (36.1% [95% CI, 31.7%-40.5%] vs 63.9% [95% CI, 59.5%-68.3%]; odds ratio, 0.70; 95% CI, 0.57-0.86). Race/ethnicity, income, and geography were not significantly associated with the likelihood that an individual 65 years or older reported voice disorders. A greater percentage of elderly adults seeking treatment than not seeking treatment reported improvement in symptoms (32.4%; 95% CI, 17.9%-47.0% vs 15.6%; 95% CI, 10.4%-20.8%). Among adults treated for a voice disorder, a lower proportion of adults 65 years or older reported improvement in symptoms with treatment compared with adults younger than 65 years (32.4%; 95% CI, 17.9%-47.0% vs 56.0%; 95% CI, 42.5%-69.6%).

Conclusions and Relevance  A small percentage of older adults with voice disorders seek treatment; even fewer are treated by an otolaryngologist or a speech language pathologist. A greater percentage of those who undergo treatment experienced symptomatic improvement compared with those who did not undergo treatment. These trends highlight the need for greater access to and awareness of services available to older adults with voice disorders.

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