title: Perceived disability from hearing and voice changes in the elderly.
abstract: OBJECTIVE
  Dysphonia and hearing loss are underestimated conditions in the elderly, despite their significant prevalence (18% and 50%, respectively) and their sociopsychological implications. Previous studies have shown that the reason for this lack of consideration is related to the general misconception of a simple age-related issue, as well as to the reduced communication requirements of this population, which can result in infrequent requests/supply of care. The purpose of the present study was to evaluate, within an elderly population, the subjective perception of hearing and voice dysfunctions, the resulting changes in communication skills, and the perception of handicap and disability.
  
  
  METHODS
  Four anonymous questionnaires were administered to 400 participants (218 men, 182 women) aged older than 65 years, some of whom (276) were hospitalized and some of whom (124) were outpatients. The questionnaires consisted of questions regarding age-related changes in voice, multiple-choice questions on the qualitative characteristics of the voice, questions regarding verbo-acoustic communication (hearing), the Voice Handicap Index, and the Self Assessment of Communication regarding the perception of hearing loss-related handicap and disability. Statistical correlations were calculated for voice dysfunction between the perception of disability and the clinical assessment of voice quality obtained by the Grade, Roughness, Breathiness, Asthenia, Strain scale, and between the perception of disability and the demand for care.
  
  
  RESULTS
  More than half of the elderly patients reported not perceiving voice changes throughout their lives. Most of the participants were satisfied with their own voices, although 65% of them judged them to be qualitatively altered, and in 31.5% of the participants, pathology was found on phoniatric evaluation. Low scores for vocal handicap (Voice Handicap Index) were found, and the type of perceived disability was mainly physical, although the association between Voice Handicap Index scores and Grade, Roughness, Breathiness, Asthenia, Strain was statistically significant. A total of 62% of the patients perceived hearing changes over their lifetimes not related to previous ear infections, but significantly correlated with a family history of hearing problems and with the need for specialist consultations. However, the perception of hearing loss handicaps and disability showed lower mean values, showing that older patients recognized dysfunction, but did not consider it to be a disability.
  
  
  CONCLUSIONS
  The present study showed that, despite the relevant incidence of hearing and voice disorders among the elderly population, the implications for communication abilities seems to be underestimated. Hence, it appears to be extremely important to undergo specialist screening consultations to detect eventual voice and hearing alterations, and to correct them with appropriate therapeutic strategies.
authors.affiliation: Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Rome, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Monini
authors.forename: Chiara
authors.initials: C
authors.lastname: Filippi
authors.forename: Rossella
authors.initials: R
authors.lastname: Baldini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Barbara
mesh_terms: D000368:Aged; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D055154:Dysphonia / Q000453:epidemiology*; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology*; D006801:Humans; D008297:Male; D019986:Persons with Hearing Disabilities; D011795:Surveys and Questionnaires
keywords: Voice Handicap Index; elderly; hearing handicap inventory; presbycusis; presbyphonia