Need assessment 2 57 with activities of daily living. The findings among residential home individuals (van der Ploeg et al. 2013) further support this as individuals diagnosed with dementia reportedmore needs compared to individuals without dementia in the same setting. Other studies in mixed older psychiatric populations (Hancock et al. 2003; Passos et al. 2012; Slade et al. 1999; Sultan et al. 2011) reported more needs and more unmet needs than our study. As patients with bipolar disorder were a minority in these studies, factors other than psychiatric diagnoses could explain these differences. Although the number of needs, and particularly unmet needs, was higher in a study including patients 75 years of age and older (mean age 81.5) attending a general practitioners office (GPO) (Walters et al. 2000), there was no correlation between the number of needs with age in our and other studies (Lloyd et al. 2010). A study of Stein et al. (2014) among older patients (mean 80 years, range 68-98) from GPO without severe illness or dementia (mean MMSE 27), support our findings as their needs were less than in our study with respectively 2.51 needs and 0.25 unmet needs. This suggests that age is not a major contributor to the needs, however the literature is contradictive on this matter. In our study the number of unmet needs correlated with a lower quality of life and poorer social participation. Company and daytime activities were the most frequently reported unmet needs by both patients and staff suggests that efforts aimed at improving social functioning of older patients with bipolar disorder are warranted and may result in better quality of life and fewer needs. As these results were also found in a study of relatively healthy elderly primary care patients (Stein et al. 2014), the findings appear to be independent of diagnosis and suggest a key role for social and emotional support. Generally, staff are aware that patients with more psychiatric symptoms have more needs. As psychiatric symptoms are usually the core focus of treatment, the staff may anticipate these specific needs. Needs regarding social functioning may be equally important from the patients’ view but appear to be noticed or fulfilled less by staff. Good social functioning is important for quality of life (Valtorta and Hanratty 2012) in general, not just for psychiatric patients. One can debate whether social functioning of psychiatric patients is the sole responsibility of mental health organisations or a joint responsibility with public health organisations and politics. The results of our study should be considered in the light of several strengths and limitations. To the best of our knowledge, for the first time, the met and unmet needs of older bipolar patients from the perspective of the patients and staff were systematically investigated. A strength of the study is that only one patient was excluded from the study
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