Despite their growing presence in home computer applications and various telephony services, commercial automatic speech recognition technologies are still not easily employed by everyone; especially individuals with speech disorders. In addition, relatively little research has been conducted on automatic speech recognition performance with older adults, in whom speech disorders are commonly present. As one ages, the older adult voice naturally begins to resemble some aspects of mildly dysarthric speech. Dysarthria, a common neuromotor speech disorder, is particularly useful for exploring performance limitations of automatic speech recognizers owing to its wide range of speech expression. This article reviews clinical research literature examining the use of commercial speech-to-text automatic speech recognition technology by individuals with dysarthria. The main factors limiting automatic speech recognition performance with dysarthric speakers are highlighted and extended to the elderly using a specific example of a novel, automated, speech-based personal emergency response system for older adults. (Contains 1 table.)