Lithium and the Brain-Bone Axis: A Bridge between Osteoporosis and Alzheimer's Disease.

Hearing loss (HL) is a chronic condition that negatively affects the health and well-being of adults across the United States. In general, nearly 15% of the adult population age 18 and older report some form of hearing impairment, and with age, the prevalence and burden of HL increases as nearly 70% of adults over the age of 70 have some form of HL [–]. HL impacts numerous aspects of life, including social and familial relationships, employment, emotional and mental wellness, financial welfare, and general communication [–]. Issues with interpersonal communication associated with hearing impairment and HL undoubtedly precipitate difficulties in relationships with family members and friends, which can contribute to social withdrawal and feelings of depression in some adults [, ]. Beyond the psychosocial ramifications, hearing impairment and HL can give rise to occupational limitations, restricting career opportunities [, ]. Elderly adults with HL experience improved quality of life when treated with hearing aids as significant, positive changes in psychosocial function, communication, cognition, and depression occur in this patient population []. The notable burden of HL on many facets of livelihood and the efficacy of treatment on improving ones quality of life warrants prompt intervention and diagnosis for adults with suspected HL or hearing impairment. Unfortunately, many factors complicate the accessibility and utility of hearing healthcare services. Place of habitation, namely rural versus urban, has a marked influence on one’s ability and decision to seek and utilize hearing healthcare services []. Hearing impairment has been shown to be more prevalent in rural adult populations than among adults in urban areas [] due to the increased likelihood of participation in both occupational and recreational noise exposure activities [, , ]. HL progression has been associated with risk factors such as hypertension and diabetes, noise exposure, and smoking; such characteristics are more common among a rural population as compared to their urban counterparts []. Access to general healthcare in rural areas is also affected due to increased transportation difficulties, fewer providers, and financial constraints [–]. Delays in diagnosis and treatment of HL tend to be greater in rural communities as compared to urban communities []. There is a need to assess the perceptions of rural adults regarding the impact and causes of hearing loss along with the barriers that affect access to hearing healthcare. This study, therefore, seeks to gain a more thorough insight into hearing healthcare disparities for a rural population using a qualitative approach. By exploring the perspectives of rural inhabitants directly, targeted measures to improve access to hearing healthcare for adults in rural areas may be determined. The institutional review board of the University of Kentucky approved this study. Participants were identified from a rural primary care research network facilitated by the University of Kentucky Center of Excellence in Rural Health (CERH). An interviewer trained in the protection of human subjects recruited participants seeking primary care from the waiting area of primary care clinics using the following inclusion criteria: (1) adults (≥ 50) residing the rural Appalachian region of Kentucky; (2) seeking primary care from a primary care provider; and (3) English speaking. Participants were eligible whether or not they had previously sought hearing healthcare services, including otolaryngology or audiological services. Informed consent was obtained from each participant, and face-to-face interviews took place in a private space at the clinic. Recruitment continued until theoretical saturation occurred.