Chapter 7 156 Section B: Validating theMoCA in an old age psychiatry setting. Is theMoCA reliable for distinguishing MCI from dementia and from those without cognitive problems (especially when all of them are referred to an old age psychiatry setting)?. Would the MoCA be suitable as a screener in old age psychiatry? Is the MoCA able to discriminate in a memory clinic setting where the entire tested population is suspected of having cognitive disorders? Can the MoCA be used as a triaging test in a memory clinic? Section C: How to use and improve the MoCA in clinical practice? Can the MoCA, with a double threshold, help improve its use in old age psychiatry for patients with a subthreshold state? 7.1.2 Main findings of Section A: Unseen needs The aim was to gain insight into the needs and unmet needs of patients in old age psychiatry, particularly those with bipolar disorder. For this purpose, we used data collected from patients with bipolar disorder aged older than 60. The numbers of ‘needs’ were examined and how many of these were ‘unmet’ was determined. The relationships between different patient characteristics were also examined. It was hypothesised that patients with higher numbers of ‘needs’, whether met or not, would have a poorer outcome on the parameters of general functioning, mood, cognitive functioning, IADL, quality of life, and social cohesion. These different parameters were measured with appropriate instruments such as the GAF, CES-D, YMRS, MMSE, GARS, MANSA, and the number of contacts that the patient maintained. The results of our study with respect to bipolar elderly patients, as described in Chapter 2, showed that the mean number of ‘Total Needs’ 4.31 (SD 3.48) reported by patients corresponded to the number scored by the clinicians (4.4 SD 3.56). This showed that most needs occurred in the areas of physical health, housing skills, and mediation. This is in line with the literature on older patients and their needs, which were scored using the CANE (Walters et al., 2000; Arvidsson, 2001; Hancock et al., 2003;Meesters et al., 2013) andalsowith our expectations. This was also reflected in the fact that the practitioners also recognised these needs as the most common, and that they had also largely been accounted for. The number of total mean ‘Met Needs’ scored by the patients and the therapists differed little, 3.50 (SD 2.81) versus 3.95 (SD 3.18) and should be regarded as not significant.
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