PSYCHIATRIC ANNALS • Vol. 46, No. 2, 2016 127 CME Medical Capacity and Competency in a Geriatric Population: Self-Care and Placement ABSTRACT This article discusses the complexi- ties and ethical challenges for determin- ing medical capacity as it pertains to ability for self-care and independence in discharge planning. Determining ca- pacity for acute and long-term decision making is complicated for geriatric pa- tients whose cognition may fluctuate during the course of an inpatient hospi- tal stay. Balancing respect for a patient’s autonomy and the practitioner’s value of beneficence is an ethical concern. The patient presented in this article is a 72-year-old woman whose cognitive functioning was measured as very im- paired for several weeks but then dras- tically improved over 1 month but she would not accept the safer option of discharge to a residential care facility opposed to her own home. Clinicians struggled to identify when baseline functioning had been truly identified and when maximum capacity could be accurately assessed. Decisions about long-term care need to be based on ex- ecutive capacity as well as task-specific decision-making capacity. [Psychiatr Ann. 2016;46(2):127-131.] T his article examines the com- plexities and ethical challenges for determining medical capacity as it pertains to ability for self-care and independence in discharge planning. Leah N. Clionsky, PhD, is an Assistant Professor, Menninger Department of Psychiatry and Be- havioral Sciences, Baylor College of Medicine. Anu Matorin, MD, is an Associate Professor, Men- ninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Elizabeth H. David, MD, is an Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. John H. Coverdale, MD, MEd, is a Professor, Menninger De- partment of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Asim A. Shah, MD, is an Associate Professor, Menninger Department of Psychiatry & Family and Community Medi- cine, Baylor College of Medicine; and a Clinical Professor, Department of Psychiatry, University of Oklahoma. Address correspondence to Leah N. Clionsky, PhD, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1502 Taub Loop, Second Floor, Houston, TX 77030; email: clionsky@bcm.edu. Disclosure: Asim A. Shah discloses contracted research from Janssen Pharmaceutical Com- panies, Synchroneuron (a biopharmaceutical company), and Assure Pharma. The remaining authors have no relevant financial relationships to disclose. doi: 10.3928/00485713-20160104-02 Leah N. Clionsky, PhD; Anu Matorin, MD; Elizabeth H. David, MD; John H. Coverdale, MD, MEd; and Asim A. Shah, MD © Shutterstock