Adults aged 60 and older are one of the largest growing populations in the world, and will double in number by 2050. During aging, individuals experience both physical and mental changes, with patterns of age-related changes varying by person. Common changes that older adults report are cognitive symptoms such as increased memory difficulties, and physical symptoms related to increasing age-related health issues such as heart problems and diabetes. These types of changes are likely familiar to older adults and their families, but there are other changes that come along with aging that may not be as obvious or well-known, but can be equally as important.

One area of change in thought processes during aging is language use and comprehension. In particular, pragmatic language abilities tend to decline during aging. Pragmatic language is the social use of language, and includes many different aspects of communication that are used every day. It includes verbal and nonverbal language aspects, such as staying on topic during conversation and eye contact, respectively. In addition, the different stresses placed on syllables and intonation are aspects of pragmatic language. It also includes the use and comprehension of metaphors, idioms, proverbs, sarcasm, and aspects of humor. Although not every individual will experience the same trajectory of changes, declines in these abilities can result in communication lapses or disconnection in social communication.

As we get older, pragmatic language ability can decline due to the aging of the mirrored halves of the brain, called cerebral hemispheres. In particular, pragmatic language abilities have been associated with the right cerebral hemisphere. This hemisphere is responsible for the synthesis of verbal and nonverbal information, among other functions. The left hemisphere is the more analytical processor, enabling the linguistic aspects of language such as words to be sequentially processed. The two hemispheres are joined by the brain's largest white matter tract, the corpus callosum, which allows these different types of language-related information to be relayed between both hemispheres.

Because older adults often find themselves having increasingly frequent visits to health care providers, patients' age-related pragmatic language changes can affect the patient-provider relationship. If there is a lapse in communication due to misunderstanding from pragmatic changes, important health-related information may not be relayed. Future research on pragmatic language changes in aging adults should focus on awareness programs for individuals and their families. In addition, continued education and training for health care providers about the age-related changes that can affect communication will be important for the growing number of older adults that providers will encounter.

Dr Rachel Messer is author of the recently published paper Pragmatic Language Changes During Normal Aging: Implications for Health Care, available for download now in Healthy Aging & Clinical Care in the Elderly.