Here’s how your voice changes as you age

By Erin Blakemore

May 31, 2024

Do you sound…old? If you’ve noticed your voice changing as you age, you’re not alone. Vocal changes are common in aging adults—but while some voices ripen and mellow with age, others are dismayed to find themselves warbling, whispering, or struggling to speak. Here’s why our voices change as we get older, and when it may be time to check with your doctor.

Physical changes

As we age, reductions in muscle mass and changes in posture can make it harder to produce the same sounds that came easily in the past. Singers report deepening or tremulous voices; speaking volume can also decline, especially in people suffering from swallowing disorders or neurological issues like Parkinson’s disease. The vocal folds or cords, the complex structure that vibrates to produce the voice, can lose tone and elasticity—bowing, shrinking, or forming gaps that will change your speaking tone.  

“The cellular makeup on the vocal folds actually also changes,” says James Curtis, a speech-language pathologist at Weill Cornell Medicine. Combined with the weakening of breath capacity, along with changes in muscle tone and posture, this “is a recipe for disaster in terms of a smooth voice quality and a voice that isn't breathy, rough, strained, or gravelly.”

Though the vocal folds are essential in voice production, however, they’re not always the main culprit in an “old” voice. In fact, many of the inconveniences that accompany aging can damage the voice, too. So it’s no wonder that up to one in three older adults reportedly experiences dysphonia, or an alteration in “normal voice quality.” Though symptoms vary widely, the most common voice issues in older adults are a decrease in loudness; a hoarse, raspy, or gravelly vocal quality; and vocal fatigue.

A matter of perception

These changes usually come on slowly, with presbyphonia, or “aging voice,” striking some as early as their fifties. Not everyone experiences voice changes with age, but those that do notice. So do their friends, children, and acquaintances.

While recent research suggests that people identify older voices with wisdom and good storytelling skills, study participants consistently assign negative connotations to older voices. Some view older voices as proof an individual is less flexible or cogent, playing into worn stereotypes about the abilities and worth of elderly people.

Sex and the aging voice 

Women are especially prone to such stereotyping, and the vagaries of biological sex don’t help. Voice experts have long attributed vocal changes in women to the hormonal fluctuations of the female reproductive cycle. In the 19th century, female opera stars were regularly put on vocal rest during their periods, and opera singers still complain of premenstrual vocal changes; in Ukraine, some opera companies even offer their female singers paid leave during menses.

So it might not come as a surprise that menopause is also blamed for some vocal changes— particularly differences in pitch and vocal power. Dryer mucous membranes due to falling estrogen could be to blame, as could increased androgens, the same hormones that deepen the male voice. As a result, some patients use hormone replacement therapy to delay or prevent voice changes in menopause.

But research on sex differences in the aging voice is still in its infancy, and researchers lament the dearth of studies devoted to maintaining the voice in menopausal women. “There’s a growing interest in this area,” says Curtis. “But it shouldn’t be a growing interest. It should be well established.”

Treating voice disorders in aging adults 

Nonetheless, the vast spectrum of factors that contribute to age-related voice changes is still being plumbed by researchers eager to understand the effects of everything from genetics to career on the aging voice. And because of the sheer number of factors that go into producing words, says Curtis, that research can be slow going. “These changes are multifactorial,” he explains. “Our voice is a whole-body behavior.”

As a result, treatments that preserve or improve vocal function for aging adults vary widely. There’s medication like hormone replacement therapy or thyroid medication targeted at reducing an enlarged thyroid, which can cause vocal changes. But the front-line treatment is usually non-invasive voice therapy, a personalized physical therapy prescribed and facilitated by speech-language pathologists. Usually, such training includes a regimen of vocal, breathing, and even postural exercises designed to maintain vocal range, preserve volume, and tackle individual issues.

Overall, write geriatric voice specialists Robert T. Sataloff and Karen M. Kost, “Surgery is unnecessary for the vast majority of patients with age-induced dysphonia.” But there are a variety of procedures designed to pinpoint more severe vocal problems. Vocal fold injections, an outpatient procedure in which a filler is injected into one or both vocal folds, can shore up deteriorating or paralyzed vocal cords, strengthening the voice and helping them function better. In thyroplasty, the vocal cords are repositioned with the help of a mesh implant that’s inserted via a small hole in the neck, improving the voice and restoring function to weak or paralyzed vocal folds. Chronic hoarseness can sometimes be treated with surgeries that pinpoint the laryngeal nerves. And the list goes on.

That said, many voice problems can be avoided. “We need to be thinking about our voice just like any other part of our body and trying to take care of it,” says Curtis. And surprisingly, some of the most effective voice preservers have little to do with the mouth or throat.

Keeping active and fit as you age can help preserve muscle mass, strength, and stamina and benefit the respiratory system, while good oral health can forestall issues with saliva and mucous membranes. Voice experts also stress the importance of nutrition and hydration, suggesting older adults drink plenty of water, eat healthy foods that can help maintain cellular function, and consider using a humidifier at home. And while researchers may disagree on the role various factors play in voice preservation, they’re unanimous on one point: Smoking not only irritates the voice, but can cause sometimes-fatal cancer in the very organs that produce your speech.

The psychological ramifications of unwelcome voice changes can also lead to other health problems, says Curtis, who says some older adults fall into a “vicious cycle” after losing confidence in their voice. “If an individual is feeling like their voice is changing, and it's impacting their ability to participate in personal, professional, or social endeavors, [they] can start to withdraw socially and become depressed,” he says. That leads to reduced physical activity and increases isolation and frailty, reducing quality of life and even endangering the health of older adults. 

Is self-acceptance part of the solution? Possibly. Older adults who fear stigma or who have trouble coming to terms with their age-related voice changes can miss out on effective interventions, recent research suggests. Add ageism to the mix—consider, for example, the plethora of demeaning “old lady voice” filters available to video producers—and the picture gets even more complicated.

But researchers are increasingly trying to reframe many “disorders” of the aging voice as neutral realities that simply reflect the passage of time. And, it turns out, older adults may be following suit: Up to 80 percent of older adults with dysphonia actually decide to skip treatment, studies have found.

Nonetheless, says Curtis, there’s no shame in seeking out help. He advises that individuals who have experienced drastic or sudden changes and those who notice impacts to their ability to participate in their personal, social, or professional endeavors to talk to a doctor. “Our voice is very personal,” he says. At any age, he emphasizes, “It’s really about the patient.”

Link to Article: 

https://www.nationalgeographic.com/premium/article/voice-change-aging-sp...