This blog post is inspired by one of my favorite patients. At age 75, she sings well, and gets paid for it. And she is not alone – there is a great number of successful singers who continue to perform well past menopause and into what used to be considered old age.
I often joke that the word “old” has somehow dropped out of our vocabulary. People just stay “older”, until they are suddenly “elderly”. And the older singer often continues to have a career which, with appropriate modifications, can continue for years.
Aging and the Voice
Aging is a complex process that affects all parts of the body. Rates of aging and its effects vary, depending on your genes as well as many environmental factors. While we have no control over our genes, we can significantly influence and slow the rate of gradual deterioration by taking control of our environment.
There are a number of ways that the aging voice can be identified. They include decreased ability to power and sustain, loss of color and projection, and decreased neuromuscular control. II will address each of these areas in turn.
Maintaining Vocal Power
The ability to power and sustain depends on the flexibility and capacity of the lung and thorax, as well as strength and control of the abdominal and pelvic muscles. This is an area that can significantly improved and maintained with aging by some simple measures. I refer to exercise, diet, and weight control. Exercising the abdominal and pelvic muscles is different from aerobic exercise, and involves stretching and slow contraction of the muscles. Deep breathing exercises, such as with yoga, keep the thorax and its muscles flexible.
The abdominal muscles and the postural muscles of the back can be strengthened by sit ups, leg raises and crunches, adjusted to the strength and ability of the individual. The muscles of the pelvic floor can be strengthened by Kegel exercises, which lift the floor of the pelvis. Slow exercises are the best, since these muscles normally contract slowly, and we are interested not only in strength but also in mindful control of both contraction, relaxation, and moment to moment position. The purpose of exercise is to retain muscle mass and control over contraction, thereby providing a good power source for the voice.
Another important aspect is the ability to approximate the vocal folds, and maintain resistance against the upward pressure and flow of air from the lungs. Loss of muscle mass and flexibility also affects the vocal folds.
As the folds decrease in substance, there is a tendency to overly approximate them (hyperadduction), in order to achieve an adequate degree of closure. This requires greater muscular effort and neuromuscular tone, and may exaggerate vocal tremor and wobble. Loss of color is commonly seen in older singers. This is due to a combination of changes affecting the vocal folds and the supraglottic resonators. Loss of tissue substance and tone changes the acoustic characteristics of these areas. The hyperadduction needed to approximate the vocal folds may have an unintended effect of reflexively approximating the false folds. It stands to reason that a constricted supraglottis might alter the resonance immediately above the vocal folds, where the “ring” ( singer’s formant) is normally generated. Another potential side effect of greater muscle effort is elevation of the larynx, which in turn not only changes the shape and resonant frequencies of the pharynx, but can also impair the ability to smoothly negotiate the passaggio.
The aging vibrato has specific characteristics, including wider excursion, loss of control, and loss of a tonal center. Since all of these vary with the amount of neuromuscular effort, it would make sense that the louder and more effortfully one sings, the more these characteristics are exaggerated. The sound can additionally be affected by an underlying tremor which is unrelated to singing and can manifest with any muscular activity (benign essential tremor).
Sing for Longer than You Think
We hear in the aging voice the tendency towards decreased power and projection, decreased ability to sustain, decreased color and flexibility, and a deteriorating vibrato. Since different parts of the vocal tract deteriorate at different rates, the sum total of these effects will vary from singer to singer as aging continues.
What to do? Actually, there is a great deal that can be done to prolong your vocal career. Here are some thoughts, from my experience, and more importantly, from my patients.
In general, be vigilant in terms of general health issues which may affect your voice but are mistaken for aging. Two important ones are mild and subclinical hypothyroidism, and mild cases of Parkinsonism. These often manifest early in the voice, and can be medically treated. If you develop medical conditions that require multiple medications, always consider the potential side effects of these on the voice.
As already mentioned, maintaining muscular tone and neuromuscular control will delay some aging changes. Exercises for your core (abdomen and pelvis), breathing and vocal exercises will keep your vocal tract toned ( and tuned!) into older age. While cardiac fitness is generally healthy, exercises which strengthen the slow-contracting muscles are especially relevant. Yoga and Tai Chi strengthen not only muscles but also the conscious control of the brain over your body.
Diet Considerations
What about diet? A healthy weight is important. Try to avoid rapid or significant weight loss, since the muscles are now less able to adjust, and will contract less effectively against the decreased resistance. Maintaining the normal weight of past years is ideal in this regard. As muscles inevitably weaken, it is actually easier to support with a bit of extra abdominal bulk. The French laryngologist Jean Abitbol has suggested that in women a bit of extra fat (what he calls the Rubens vs the Modigliani body type) actually slows the loss of hormones after menopause, and protects the voice.
As you adjust your diet (we typically burn, and need, less calories as we age), make sure to eat healthy foods, a good mixture of fresh fruits and vegetables, adequate roughage, and less simple carbs. Vitamins may help, but supplements are just that- supplemental, not a replacement, for good food. In this regard, I find the current advertising trend to promote protein shakes as an alternate food source to healthy people ridiculous: just eat your food and move your bowels. It is better for you, and pushing on the toilet may even improve your support!
And now we come to the most important area which is the brain, both as the control center for all neuromuscular activity and the seat of intelligence, general and musical. Even as we age, the brain has a tremendous amount of plasticity and reserve. This means that it can learn new ways of achieving tasks, and resourcefully work around deficits.
On a conscious level, we need to accept the reality of an aging voice. But those with determination and musical intelligence can see this as a positive challenge. A meaningful work of art need not be an epic poem, it can be haiku. A small painting with a subtle color palette can be just as evocative as a heroic canvas that covers the wall. And who is to say that Turandot torturing Calaf with her questions is greater art than Gretchen torturing herself at the spinning wheel?
Use Ingenuity and Determination
So the wisdom of acceptance is the necessary first step. But this is followed by the ingenuity and determination that takes the voice in new directions. The intelligent singer is the one who, while relishing the memory of past glories, takes a clear-eyed stock of the present, and uses all of her abilities, technique, anatomy, experience, intelligence, to continue to perform.
Once a singer has a clear inventory of his or her resources, the next step is to adjust the repertoire to make use of those considerable abilities. For singers who have spent their lives working up to certain roles, this is a paradigm shift: increasingly, you no longer fit the voice to the role, but the role to the voice. An older bass-baritone patient of mine had developed a wobbly vibrato with some loss of tonal center, but he has continued to give fine performances of buffo roles and patter arias. These minimize his weakness, the long sustained notes which would reveal some loss of color or controlled vibrato. Rather, they emphasize his strength: text, articulation and artistic interpretation, – all unimpaired. Singers specializing in contemporary music might also find that their career can continue beyond the limits imposed by bel canto repertoire.
Finally, a story can be well told in many ways. A few weeks ago I had the pleasure of attending a performance by jazz pianist and singer Barbara Carroll. At 88 years of age, she not only played extremely well, but sang wonderfully. The tale, told half in words, half in song, was articulated with finesse, intimacy, and always with a twinkle in her eye. None of us in the audience felt like we had to cut her any slack or to indulge her with deference to her age. She just had all of us in the palm of her hand.
Aging is a reality, and the aging of the voice is a gradual and inevitable process that the older singer faces daily. But can we look at this as a challenge? With good general health care to keep the vocal tract strong and flexible, and the intelligence and curiosity to keep reinventing your performance, the pleasure of singing will be part of your life for a long time- not just as a wistful memory but as a vital and relevant gift.
Dr. Jahn is an internationally renowned otolaryngologist based in Manhattan with a sub-specialty interest in the professional voice. His practice includes classical and popular singers. He holds academic appointments at Mount Sinai School of Medicine and Westminster Choir College in Princeton. He is Medical Director at Jazz at Lincoln Center, and former Director of Medical Services at the Metropolitan Opera in New York. Dr. Jahn has published several books for vocalists, including “Vocal Heath for Singers” (Singdaptive) and “The Singer’s Guide to Complete Health” (Oxford University Press).
