University 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 Aug 1;144(8):719-726. doi: 10.1001/jamaoto.2018.0980.
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.
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.
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.
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%).
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.
老年患者在就医时面临独特的障碍，并且存在独特的健康护理需求，其慢性疾病的患病率较高。该群体中有相当比例的人存在嗓音障碍，部分原因是与年龄相关的喉解剖和生理特征的变化。这些疾病极大地增加了医疗保健成本，但仍未得到充分了解。
描述老龄人群嗓音障碍患者的社会人口学特征和治疗反应。
设计、设置和参与者：使用 2012 年全国健康访谈调查的横断面研究，评估了过去 12 个月内报告有嗓音障碍的成年人。分析了自我报告的人口统计学数据以及与嗓音障碍就诊相关的数据。统计分析于 2017 年 3 月 1 日至 2018 年 2 月 1 日进行。
自我报告的嗓音障碍、是否寻求治疗、寻求治疗时所咨询的专业人员类型，以及治疗后嗓音障碍是否改善。
在美国 65 岁及以上的 4170 万成年人中，有 420 万人（10.1%；268.3199 名女性和 1514909 名男性；平均[SE]年龄，74.5[0.3]岁）报告有嗓音障碍。在有嗓音障碍的人群中，有 10.0%（95%CI，8.3%-11.7%）寻求了治疗。在寻求治疗的患者中，22.1%（95%CI，7.9%-36.3%）咨询了耳鼻喉科医生，24.3%（95%CI，10.6%-38.0%）咨询了言语病理学家。在控制种族/民族、收入、性别和地理位置等因素后，与女性相比，男性报告嗓音障碍的可能性较低（36.1%[95%CI，31.7%-40.5%]比 63.9%[95%CI，59.5%-68.3%]；比值比，0.70；95%CI，0.57-0.86）。种族/民族、收入和地理位置与 65 岁及以上人群报告嗓音障碍的可能性无显著相关性。与未寻求治疗的人群相比，寻求治疗的老龄患者报告症状改善的比例更高（32.4%[95%CI，17.9%-47.0%]比 15.6%[95%CI，10.4%-20.8%]）。在接受嗓音障碍治疗的成年人中，与年龄小于 65 岁的成年人相比，年龄在 65 岁及以上的成年人报告治疗后症状改善的比例较低（32.4%[95%CI，17.9%-47.0%]比 56.0%[95%CI，42.5%-69.6%]）。
只有一小部分老龄嗓音障碍患者寻求治疗；寻求耳鼻喉科医生或言语病理学家治疗的患者就更少了。与未接受治疗的患者相比，接受治疗的患者中症状改善的比例更高。这些趋势凸显了为老龄嗓音障碍患者提供更多服务和提高认识的必要性。
