JMIR Publications

ABSTRACT

Background:

Researchers have developed a variety of indices to assess frailty. Recent research indicates that the human voice reflects frailty status. Frailty phenotypes are little discussed in the literature on the aging voice.

Objective:

This study aims to examine potential phenotypes of frail older adults and determine their correlation with vocal biomarkers.

Methods:

Participants aged ≥ 60 years who visited the geriatric outpatient clinic of a teaching hospital in middle Taiwan between 2020 and 2021 were recruited. We identified four frailty phenotypes: energy-based frailty (EBF), sarcopenia-based frailty (SBF), hybrid-based frailty (energy) (HBF-E), and hybrid-based frailty (sarcopenia) (HBF-S). Participants were asked to pronounce a sustained vowel /a/ for approximately 1 s. The speech signals were digitised and analysed. Four voice parameters, the average number of zero crossings (A1) and variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4), were applied to analyse voice changes. Logistic regression was used for the elaboration of the prediction model.

Results:

Among 277 older adults, an increase in A1 values was associated with a lower likelihood of EBF (OR = 0.81, 95% confidence interval [CI] = 0.68–0.96), whereas an increase in A2 values resulted in a higher likelihood of SBF (OR = 1.34, 95% CI = 1.18–1.52). Respondents with larger A3 and A4 values respectively had a higher likelihood of being hybrid-based frail (sarcopenia) (OR = 1.03, 95% CI = 1.002–1.06) and hybrid-based frail (energy) (OR = 1.43, 95% CI = 1.02–2.01).

Conclusions:

Vocal biomarkers might have potential for estimating frailty phenotypes. Clinicians can use two crucial acoustic parameters, namely A1 and A2, to diagnose frailty phenotype that is associated with insufficient energy or reduced muscle function. The assessment of A3 and A4 involves a complex frailty phenotype.