Summary and general discussion 7 161 the same? Alternatively, if so, do they differ in topics or domains, that is, quality? Narrowing this major question down creates opportunities to study the population in more detail. Our research question focused on the care needs of older patients with bipolar disorder. There are several reasons why this group was specifically chosen, including practical considerations. First, little was known about this group in terms of their needs; they are welldefined, and there is evidence that they differ clinically from patients who experience this disease at a younger age. To be able to compare older and younger patients accurately, data that meet certain conditions are needed. An important condition is that the circumstances of the different patient groups being compared are similar. There were no studies for bipolar disorder (yet) using the CANE or CAN(SAS) to make a good comparison to draw conclusions between young and old patients. This is a disadvantage. However, there have been studies on other diseases and care needs of older patients using the CANE. Here, there was a very big advantage in that these studies had been performed under almost the same conditions as our study. That is, the same research group was in the same region. This minimised or neutralised many variables that could otherwise be of significance. By narrowing the general question down, that is, zooming in, one can see more items in detail, and we were able to obtain information specific to this population. With this, tailoring treatment can be optimised better, which is the main goal of the study. One factor that was not zoomed in on was the subdivision of the various bipolar disorders. Our sample did look at demographics and the DSM-IV subdivision into bipolar I and II disorders. However, no distinction was made between these subtypes or between early- and late-onset. Although our population consisted largely of patients with early-onset bipolar disorder, it is interesting to make this distinction to answer specific questions. Another noteworthy point is that we did not include the perspective of the next of kin, even though this is a feature of the CANE. This could add an important extra perspective on the patients’ needs and is especially interesting in respect of cognitive problems. Unfortunately, most patients did not provide consent to interviewing a family member or informal caregiver. One concern in the design of this study is that the MMSE was used to assess cognitive functioning. There are justifications as to why the MMSE was chosen, especially for a study conducted in 2012. However, in the context of the entire study, not having used the MoCA for this purpose is a missed opportunity. For this particular study, as discussed earlier, the MoCA would also have an advantage, as it is more sensitive to mild cognitive symptoms. This would also allow us to compare the results of specifically this group of
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