Constipation is not a glamorous topic, but it's certainly important, especially in older adults. As anyone who has experienced occasional or even chronic constipation can tell you, it can really put a damper on quality of life and well-being. Constipation can also cause more substantial problems, such as: * Severe abdominal pain, which can lead to emergency room visits * Hemorrhoids, which can bleed or be painful * Increased irritability, agitation, or even aggression, in people with Alzheimer's disease or other forms of dementia * Stress and/or pain that can contribute to delirium (a state of new or worse confusion that often happens when older adults are hospitalized) * Fecal incontinence, which can be caused or worsened by having a hard lump of stool lodged in the lower bowel * Avoidance of needed pain medication, due to fear of constipation Fortunately, it's usually possible to help older adults effectively manage and prevent constipation. This helps maintain well-being and quality of life, and can also improve difficult behaviors related to dementia. The trouble is that constipation is often either overlooked or sub-optimally managed by busy healthcare providers who aren't trained in geriatrics. They are often focused on more "serious" health issues. Also, since many laxatives are available over-the-counter, some providers may assume that people will treat themselves if necessary. Personally, I don't like this hands-off approach to constipation. Although several useful laxatives are indeed available over-the-counter (OTC), I've found that the average person doesn't know enough to correctly choose among them. Also, although in geriatrics we often do end up recommending or prescribing laxatives, it's vital to start by figuring out what is likely to be causing or worsening an older person's constipation. For instance, many medications can make constipation worse, so we usually make an attempt to identify and perhaps deprescribe those. In short, if you're an older adult, or if you're helping an older... How long does it take a person to get evaluated for constipation? A. probably less than an hour B. not enough information C. probably less than 4 hours D. probably about 2 hours
A

The sighting of a killer whale (or orca) can be rare, but they do love to hunt and play in the waters between Vancouver and Seattle, so one of the activities we absolutely wanted to do (in addition to the harbour seaplane flight) was to go whale watching. Just South of Vancouver, in the quaint Historic fishing village of Steveston we hopped aboard our boat, and spent the day on the water cruising the coast looking for whales, other marine mammals and seabirds. The regular chug-chug-chug of the boat motor for a couple of hours lulled me into a meditate state as we sped our way over the State line from Vancouver, back down to the waters of Washington State. The shimmer of the water all dappled in the sunlight, the slow, measured tones of our guide and snuggling into my warm jacket against the sharp breeze off the coast was just enough to make me forget my worries, and zone out from all of my modern day dilemmas. Honestly, it needs to be prescribed on the NHS. Forget hauling yoga mats and sitting in sweaty concrete rooms with patterns trying to hide the utilitarian backdrop, just hop on a boat out from Vancouver. Not having much success closer to the British Columbia shores, our captain decided to head south past the Canadian/American border. Incredibly, the resident killer whales of the San Juan Islands are the most studied whales in the world; they, in turn, have observed humans for at least six thousand years. Stable family groups, called pods, represent several generations and include grandmothers (the pod leaders), adolescents, infants, and huge bulls. Each family member is recognized by its distinctive markings and can live as long as a human. Much of what is known about the orca whale's highly-organized social life has been learned from the resident pods in the San Juan Islands of Washington. Who had modern day dilemmas? A. the author B. not enough information C. the killer whales D. the grandmothers (pod leaders)
A

But corrected figures, provided by the U.S. military and published Tuesday by SIGAR, suggest that the actual decline was 17,980. Pentagon officials acknowledged originally providing inaccurate figures to SIGAR because of a failure "to account for the transfer of most of the Afghan Border Force from the Afghan National Police to the Afghan National Army," according to a SIGAR statement. According to the new figures, there were 313,728 members of the Afghan defense forces as of January 31, 2018. That compares to a total of 296,409, as previously reported. "SIGAR receives all of the (Afghan National Defense and Security Forces) personnel strength numbers published in the quarterly report from USFOR-A and has no means of independently verifying them," the statement added. The new figures still amount to a sharp decline. Afghan forces suffered unprecedented casualties in 2017, reportedly losing about 10,000 personnel, according to reports. SIGAR has been unable to publicly disclose the exact number of Afghan forces killed, because that information continues to be classified by Washington and Kabul. The violence has led to increased reports of Afghan military desertions, but that information too has been classified. Senior U.S. military officials repeatedly have acknowledged the nearly 17-year-old conflict remains a stalemate, even while touting some successes under the new strategy announced by President Donald Trump in August. Those success include the increasing capability of the Afghan military, which began conducting airstrikes two years ago. The Afghan air force carries out between four to 12 airstrikes every day, according to the Afghan Ministry of Defense. But the Kabul government controls just over half of the country's districts, SIGAR says. Trump's strategy appeared to commit the U.S. to Afghanistan indefinitely. It involves pressuring Pakistan to end its support for Afghan militants, supporting Kabul's effort to engage the Taliban in peace talks, and dropping more bombs on the country. The U.S.-led... What is the reason that many Afghan soldiers now deserting the army? A. not enough information B. Because Kabul has already engaged the Taliban in peace talks so there is no reason to stay C. Because they have been ordered to join the Afghan Police Force instead D. Because of an increase in casualties
D