Communication disorders in normal aging and dementia

List of contents

1. Introduction

2. Normal aging
2.1 General facts
2.2 Communication disorders
2.3 Causes

3. Dementia
3.1 General facts
3.2 Communication disorders
3.3. Causes

4. Differences

5. Synopsis and Outlook

6. Bibliography

1. Introduction

This term paper is deals with the communication disorders in normal aging and dementia.

People often do not like to think about the prospects of growing old although everybody will be affected and nobody can evade aging. Because of improved medical care, physical fitness and healthy nutrition the life expectancy of our world population increases. Hence there will be more elderly in the future than ever before. For a long time people wrongly associate aging with disease, and therefore this paper compares health aging with pathological aging, in this case dementia. Even the prevalence of syndromes such as dementia is dramatically increasing worldwide. Patients with dementia are the fastest growing neurobehaviorally disordered population and that is why the subject is very topical and interesting.

First of all the issues normal aging and dementia are explained separately. The different characteristics are investigated on several levels which are general facts, communication disorders and causes. Furthermore a comparison of both issues is given in order to emphasis the differences. As a result follows a conclusion.

2. Normal aging

2.1 General facts

The term aging describes a process which every individual undergo from infancy to death. It is “[a] process of gradual and spontaneous change, resulting in maturation through childhood, puberty, and young adulthood and then decline through middle and late age” (http://www.merck.com/mrkshared/mm_geriatrics/ sec1/ch1.jsp). Every person ages in different rates, it depend on genetic patterns, outer influences and a person’s individual way of life. It can be said that the process of aging accompanies a human being during his or her whole lifetime and terminates in death.

A special aspect is to analyze the aging and physical changes of old people. In the last few decades of life, the term aging signifies a decline in physiologic functions and abilities. “Normal aging is a gradual process that ushers in some physical decline, such as decreased sensory abilities (e.g. vision and hearing) and decreased pulmonary and immune function [...].” (http://www.ship. edu/~cgboeree/genpsyaging.html) Sometimes the boundaries between normal aging and an illness are so close together that wrong assumptions come into being. The reduction of abilities is commonly associated with poor health and accordingly with illness. That is the reason why a large number of people equate aging with an disease although “[n]ot all changes that occur with age [...] are deleterious (eg, gray hair, baldness), and some may even be desirable (eg, increased wisdom and experience)” (http://www.merck.com/mrkshared/ mm_geriatrics/sec1/ch1.jsp) Aging is not an illness, it is the normal way how your body deals with increasing age. “Old age is not a disease, it is strength and survivorship, triumph over all kinds of vicissitudes and disappointments, trials and illnesses.” (Bayles, 1987: 133) Another common assumption is the belief to lose mental abilities as one gets older. Aging has nothing to do with the loss of mental and intellectual abilities. Most of the elderly, who do not suffer from a particular disease are completely in possession of their intellectual abilities without any decline in their mental state. Therefore physical changes are more related to aging than intellectual changes. (cf. Reisberg, 1987: 16) For an old person an important aspect of mental health is to be in possession of his or her intellectual abilities. It is a fact that the life expectancy of our world population increases. Therefore there are and will be more old people than in the past. Because of that it becomes important to get a closer look at different signs of old age. One part of this term paper deals with communication disorders caused by normal aging.

2.2 Communication disorders

Besides the stereotyped physical declines associated with aging it is very interesting how our communicative abilities change through the years. Everybody knows that with age hair thins and turns gray or that our sense organs deteriorate, but nobody expects to have problems in interacting with other people. “One ability that is not part of the ‘declines with age’ stereotype is communicative functioning. We do not expect to be unable to communicate when we are aged, and generally that expectation is valid.” (Bayles, 1987: 133) Communication disorders occur very frequently and are often related to aging. A large number of the elderly suffers from modest communication, and even from speech and language problems. “It is estimated that more than 80% of all persons who possess disorders of communication are past the age of 21 years. [...] According to Carstensen (1978), approximately 70% of older adults [...] possessed speech-language or hearing problems.” (Hull, 1989: 9) These problems occur in some linguistic fields while others seems to be spared.

It would be interesting to know if linguistic knowledge is damaged by aging. “Linguistic knowledge can be defined as an individual’s knowledge of sounds, grammar, and word meaning, and reference and language use.” (Bayles, 1987: 148) Consequently the phonology, the study of how a language uses sounds, the lexicology, the study of words and vocabulary of a lexicon, and grammar, the study of word classes and categories, of normal aging must be analyzed. First it can be said phonological knowledge is spared, which means that rising age does not change that kind of skills. (cf. Bayles, 1987: 148) The way a normally aging person uses sounds and pronounces words, is not impaired. The ability to speak, that is to produce sounds with the particular organs of speech, is not adversely affected by age. Even the speech is not substantially influenced, an old person is able to interact, communicate and to carry on discourse. “Language (‘The words, their pronunciation, and the methods of combining them used and understood by a community’) is modestly affected by aging.” (http://www.cchs.net/health/health-info/docs/3500/3540.asp?index=11826) In discourse the listener does not recognize any decline in communicative abilities but the elderly sometimes break conversational conventions. “These include the self-centeredness in discourse [...] and repeating things one has said before, not remembering one has said them before [...]” (Obler, 1999: 104) Mostly they do not recognize their wrong behavior. In vocabulary only small significant changes occur. “While verbal intelligence (vocabulary) remains unchanged with aging, the speed of information processing gradually slows (such as problem solving)” (http://www.cchs.net/ health/health-info/docs/3500/3540.asp?index=11826) That kind of slow down can be noticed in motion and in cognitive tasks. That is a reason why aging affects verbal fluency, that means it takes longer to get the words out. (cf. http://www.cchs.net/health/health-info/docs/3500/3540.asp?index= 11826) In vocabulary one age difference is found in tasks in which the subjects have to provide definitions for particular words. Young subjects were more frequently to give superior synonyms, old ones were more likely to produce multiword responses, explanations, descriptions and illustrations. (cf. Bayles, 1987: 134) The responses and sentences of the elderly seem to be more elaborate and complicated. To speak in plain terms it becomes evident that the elderly have more problems with expressive skills in contrast to young adults. The particular meaning of a word can be defined, a string of letters can be recognized as a word form and an item of vocabulary is available. On lexical tasks the results of old subjects do not differ from those of young subjects. (cf. Bayles, 1987: 135) So it can be said that lexical knowledge is available. There is an exception called tip-of-the-tongue phenomenon. Although this phenomenon occur in all age groups, elderly individuals after the age of seventy have more trouble finding particular words or remembering names of things than younger adults. (Obler, 1999: 96) If a definition is given first and the subject has to provide the name of the word, a word finding difficulty can emerge. The name of the word does not vanish completely. Sometimes clues are very helpful “in enabling even very old, normal elderly patients to recover the correct lexical item that they can not remember the name of”. (Obler, 1999: 104) The Syntax (construction of words in a sentence) is an important part in grammatical knowledge. “Knowing how to meaningfully combine words in syntactic knowledge, [..] age appears to have little effect on it.” (Bayles, 1987: 148) Therefore, the ability to use syntactic and thus grammatical features is spared. “Language comprehension (understanding the rules of language) is preserved, as are vocabulary (semantic memory) and syntax (the way in which words are put together).” (http://www.cchs.net/health/health-info/ docs/3500/3540.asp?index=11826) Even if aging people have some decline in physiologic functions and a few language difficulties, their communicative capabilities remains. Thus their communication (cognitive process of sharing ideas through language) is not affected while there are some difficulties with speech (motor production of sounds) and language (symbol system by which sound is paired with meaning). (cf. Bayles, 1987: 48)

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