Characterization of self-reported communication disorders in elderly women living in Manaus, state of Amazonas, Brazil

OBJECTIVES: Characterize self-reported communication disorders highlighting the association between variables of health conditions, socio-demographic factors, lifestyle, hearing loss and diseases in an elderly group. METHODS: Cross-sectional study conducted from August to December 2012, with 159 women aged 60 or more, recruited at UnATI/UEA (University of the Third Age, University of the State of Amazonas), Manaus, Amazonas State, Brazil. The subjects were interviewed and asked for self-reported communications disorders. Descriptive analysis was performed using central tendency and dispersion measures for continuous variables and frequency distributions for categorical variables and the prevalence of self-reported language disorders was estimated. To verify the presence of statistically significant differences it was used χ2, considering the significance level of 5% (p≤0.05). RESULTS: Communication disorders were reported by 8.18% of elderly women. The following deficits were reported: intelligibility (6.92%), oral comprehension (10.69%), lexical access (10.69%), and recent memory (38.36%). Reading and writing difficulties were informed by 5.66% and 6.92%, respectively. Among the illiterate group, 20% declared communication disorders, while the literate group, 8.44%. Statistical association was verified between communication disorders and self-reported hearing loss (p=0.03). Association was not detected between communication disorders and diseases. CONCLUSIONS: Considering the diversity of communication disorders within this population, further studies are needed to assess if changes occur at the aging process and how they work so that possibilities for prevention can be discussed.


Artigos originAis / originAl Articles
Characterization of self-reported communication disorders in elderly women living in Manaus, state of Amazonas, Brazil

INTRODUCTION
Communication is an essential activity in the life of the human beings, as it allows establishing social bonds, interaction, knowledge acquisition, expression, comprehension and information exchange, helping increase autonomy, independence and well-being. 1 The act of communication involves sensorial, motor, cognitive and linguistic abilities, and any limitation that affects one of these parameters may impair language functionality. 2 Although communication disorders can affect people of any age, deficits are observed with increasing age, resulting from organic and functional changes that occur in the natural aging process. 3,4However, studies of linguistics and communicative manifestations of elderly describe, mostly, the sequelaes of pathological processes, and there are few investigations describing the language of healthy elderly. 5,6anges in language performance have been noticed in healthy elderly, however, these facts are not significant unless they are related to other pathological processes. 2,6,7Decline, when it occurs, seems to be not homogeneous, and preserve some aspects, while others are modified. 8 Brazil, there are few epidemiological studies that characterize the language of healthy elderly.Considering the diversity it presents in this age group, with many controversies and questions, beyond the inherent difficulties of evaluating the complex system that is language, this field shows lack of research. 5The need to describe and analyze these events, in order to establish a threshold between natural and pathological process of aging communication has been emphasized. 5,8,9ddressing the communication functionality of the elderly may arise more consistent information about these events, increasing the possibilities for prevention.
Therefore, this study aimed to characterize the disorders of self-reported communication (evoked memory, oral and written comprehension, reading and written knowledge, lexical access, speech intelligibility, oral production and spontaneous repetition and hearing loss) highlighting the association between the variables of health condition, socio-demographic aspects, lifestyle, hearing loss and morbidity in a group of elderly women enrolled in UnATI/ UEA (Universidade da Terceira Idade da Universidade do Estado do Amazonas), in the city of Manaus, Amazon state, Brazil.

Study design
A cross-sectional study was conducted with 159 elderly women, aged 60 and over, enrolled in the University of Third Age -UnATI/UEA, in Manaus, state of Amazonas, from August to December 2012.The study was developed based on data from a survey that estimated the prevalence of osteoporosis in 249 women attending the University.This explains the sample being composed only by elderly women.The inclusion criterion for the study in question was the age of 60 years or more, which resulted in 159 participants.
Face-to-face interviews were based on structured questionnaires.Information was obtained through a questionnaire consisting of closed questions mostly, organized in thematic groups: socioeconomic status, health status, physical activity, heath condition, morbid profile, nutritional status and dietary habits, functional evaluation, cognition and mood, language evaluation and self-reported hearing.The instrument was developed by the UnATI team to meet the overall objective of the study to estimate the prevalence of osteoporosis.Issues relating to language addressed the following items: evoked memory, oral comprehension and written language, reading and writing skills, lexical access, speech intelligibility, spontaneous oral production and repetition and finally selfreported hearing loss.The interviews were done by five trained interviewers, all of whom had graduate education.They had previously done field surveys and had experience of face-to-face interviews.

Statistics
Descriptive analysis of the study population was performed using measures of central tendency and dispersion for continuous variables, frequency distributions for categorical variables, and estimated the prevalence of self-reported communication disorders.To verify the presence of statistically significant differences between the study groups, were used t test and χ 2 , considering a significance level of 5% (p≤0.05).Statistical tests were performed using Epi InfoTM, version 7.

Ethical aspects
During preliminary meeting for the research, participants were introduced to the research proposal, received information about the procedures involved and were invited to participate.Participation in the study was formalized through the signing of the consent form.The research design was approved by the Ethics Committee in Research of Fiocruz's National School of Public Health Sergio Arouca (Ensp/Fiocruz -Nº 156/2011).

RESULTS
According to the interviewees residence address, the survey obtained data that revealed that the most researched participants were residents in the urban area of Manaus (figure 1).The south zone was more prevalent (47.79%), as described on IBGE. 10 This indicates a higher concentration of elderly people in the urban area of Manaus (figure 1).
The higher predominance of interviewees (55.98%) lived together and 79.88% in their own homes.The highest concentration of subjects was aged between 60 and 64 years (41.51%) and mean age of 67.6 years, with 62.27% of schooling over eight years and 3.4% illiteracy.The income from one to two minimum salaries (58.49%) was more prevalent, mostly coming from retirement (74.84 %) and belonging to the low income 49.9%, according to the classification of Inter-Union Department of Statistics and Socioeconomic Studies. 11Socio-demographic data are presented in table 1.
The hardship or lexical access was 10.69%.The lack of reading and writing domain was observed in 5.66% and 6.92% of subjects, respectively.The prevalence of recent memory deficit was observed in 38.36%.With regard to the hearing loss, this survey was reported by 17.61% of interviewees.Table 4 presents data related to self-reported hearing.

DISCUSSION
Language is not an isolated mental activity, it gathers different processes, involving sensory skills, motor, cognitive and language skills and any kind of human limitation that affects one of these aspects may compromise its functionality, manifesting itself on speech process.A symptomatic speech can disturb the sense of self-awareness and disorders of speech autonomy in someone, marginalizing him on his social environment.Thus stigmatization and isolation can happen and affect his speech perception. 12e elderly's self-perception on the process of aging and body illness can be influenced by physical, cognitive and emotional health aspects, thus the prevalence of communication disorders found in this study should be considered from this viewpoint. 13In this study, the finding of 8.81% prevalence of self-reported communication difficulty was reported by elderly women, considering the majority aged between 60 and 69 years.
A study found that the functional capacity of elderly participants and language groups of multidisciplinary care detected 10% of language deficit.Findings related to speech deficit on elderly patients with neurological sequelae deficit showed 47.7% of prevalence. 9,140][21] .
Beyond characterization of communication disorders perceived by elderly women, it is worth mentioning that the majority did not point the lack of reading and writing domain, referring difficulty by 8.18% and 5.7%, respectively.Mansur & Garcia 4 assessed communicative abilities in healthy elderly people and observed lowest averages on the field of reading, writing and numbers (5.96%), emphasizing the influence of education on the performance of elderly in assessments of cognition and language.
It was observed in this study, the association between self-reported communication disorder with hearing loss and educational level.Among the illiterate ones, 20% reported communication difficulties, while literate indicated 8.44%.Other studies point to a positive association between the linguistic decline and cognition, educational level, depression, sex and social relations. 3,6,7One study evaluated the influence of educational level and age within adult speech, and verified associations between the study level and the oral comprehension tasks, reading, graphic comprehension, designation, lexical availability, dictation, graphic designation of actions and number reading. 22 the current study, the prevalence of selfreported hearing hardship was 17.61%.In a population inquiry conducted in São Paulo city, the findings of self-reported hearing disorders among elderly people were 17.7%, increasing to 41.4% among the population over 75 years old. 23 study performed in the United States with subjects aged 65 and over detected 42% of hearing problems, 26% with writing problems and 7% with phone talking problems, recognizing the severity of communication disorders related to chronic health problems. 5Our findings did not find association between communication disorders and morbidities referred to elderly women.
The complaint of lexical access difficulty, in other words, how to find the correct word at the right moment, is a constant issue among the elderly, and this issue must be pointed as the most observed difficulty. 24,25The evaluation of statements of elderly identified 11.89% of meaningless statements related to difficulty in searching and evoking the desired word. 26n this study, 10.6% people referred to lexical access difficulty.
Comprehension is one of the most controversial aspects.Sometimes it is postulated as a process that declines with aging, although some studies disagree in pointing speech production as one of the most affected components.Difficulties related to the coordination of concurrent processes in complex linguistic activities, temporary information storage and oversight of these activities have been mentioned as determinants in misunderstandings. 2,27Other studies show significant association between oral speech comprehension outcome with sociodemographic variables: age, educational level and literacy; with the variables of health conditions: hypertension diagnosis, cognitive and mental state; and social relations in self-assessment of comprehension in conversations. 7,28,29Data from this study revealed a prevalence of 10.69% of self-reported difficulty in oral comprehension.
The studies indicate that communication disorders observed in the aging process are mainly caused by motor and sensory impairments, which influence the flexibility and speed of mental processing of information, made up of declines in memory and cognition. 30,31Memory is one of the most studied aspects of the elderly population and the findings are questionable.Research works have shown that there is no effect of age on working memory in healthy elderly. 4,32The analysis of cognitive functions in healthy elderly revealed that younger and female elderly showed better performance in memory and recall tests, concluding that the deficit in memory may be associated with age and language remains intact in all age groups, despite the best performance associated with education. 23,33Authors draw attention to the negative perception that the elderly have on their memory, which can result in low test performance that evaluates this function. 34,35he values found in this study detected a prevalence of 38.36% of memory deficit.
In the results interpretation of the current study it is important to consider some methodological bounds.Measurement was performed by self-perception, and the difficulty of the subjects to realize or admit complaints can overestimate data; moreover, the sample was composed only by women, which does not allow to generalize data on communication disorders, nor conclude on differences in relation to sex, which has been mentioned in the literature.The study also identified the need to prepare speech assessment protocols easily applied to diagnose this situation in epidemiological research.

Table 2 .
Prevalence of self-reported language aspects of 159 elderly women.Manaus-AM, 2012.

Table 3 .
Prevalence of self-reported communication disorders on elderly women according to health status, linguistic and socio-demographics aspects.Manaus-AM, 2012.

Table 4 .
Data related to self-reported hearing of 159 elderly women.Manaus-AM, 2012.