Spencer Eth, MD

Mrs E, who is 80 years old, lives in the community with the help of a 24-hour-a-day home health aide. She is forgetful and requires assistance with many activities of daily living.

The United States Census Bureau projects that by 2010 nearly 13% of the US population will be over the age of 65. The elderly are one of the most rapidly growing segments of the US population and are expected to account for more than 20% of the total population by 2050.1 In 2001, the prevalence of dementia in North America was 6.4%. A 49% increase in the number of people with dementia is expected by 2020, and a 172% increase by 2040.2 Patients with dementia may lack the capacity to consent to treatment. The need to evaluate capacity to consent to treatment will therefore increase as the aging population grows.

In 1980 DSM-III created a new diagnostic entity-posttraumatic stress disorder (PTSD). Although this condition had been described for centuries, it was always within the context of a particular stressor, most often war. The term shell shock was applied to World War I soldiers who seemed to have been struck senseless in the heat of battle. The horrors of World War II produced not only robust psychiatric morbidity in its combatants but also devastating emotional symptoms in the civilian victims of concentration camps and atomic bombs.