The old age psychiatrists are frequently asked to assess increasingly diverse elderly patients’ competency. Often they are not sufficiently equipped to understand and assess such patients. Frequently patients’ different health-illness beliefs and world view are marginalized or not addressed. There is an increasing need to develop culturally sensitive standards of such assessment.

The author believes that deep discussion to redefine the psychiatrist's role and expectations including increasing demands and pressure is urgently needed.

In this presentation, cognitive factors involved in medical information processing and decisions making are going to be discussed. Specific challenges to assess above factors in elderly population would be addressed. Literature regarding decision making and aging will be reviewed.

The focus will be on two points:

1. 1. How are the patients’ and assessors’ values and cultural background relevant to proper assessment of competency

2. 2. How recent sociological changes in modern societies (such as globalization, multicultural, aculturalisation, isolation, terrorism) influence emergence and evolution of the competency concept.

Finally limitations and ethical challenges with assessing elderly patients’ competency in clinical settings will be discussed. The presentation will be based on personal clinical experience of a sole psychiatrist working with elderly patients in two medium size hospital boards in New Zealand.