Chapter 7 166 in typical old age issues like memory, eyesight, mobility and continence, and leaving out ‘typical’ younger adult issues like dependents (children), drugs, sex, education and digital communications. One can argue that views to replace these latter issues have changed since the CANE was introduced by Reynolds in 2000, as some items can also affect the lives of older patients. These differences must be considered when comparing CAN and CANE results. The results of our bipolar patient cohort are consistent with those obtained in the literature on older patients using the CANE and showed that the needs reported most by the patients were also reported most by the staff (Walters et al., 2000; Arvidsson, 2001; Hancock et al., 2003; Meesters et al., 2013). Patients are referred to our hospital for health issues and the staff tries to meet their needs. We speculate that caregivers could also observe these needs on a daily basis in their private lives among community-dwelling older adults. It may be a stereotypical thought of older ‘dependent’ persons having needs in household skills, next to physical health and medication, but it seems there is some truth in it. This could be a reason why the staff (and often next of kin) are aware of these needs and, therefore, also contribute to the fact that these needs are mostly met even though they are often present. This reasoning does not hold true for physical health, and a substantial percentage of needs remain unmet. Again, we can speculate with common sense that with older patients, physical health will deteriorate and hence create more needs. As the CANE scores a need as unmet when a function falls below ‘some minimum specified level and if a potentially effective remedy existed’. The latter, particularly for the item ‘physical health’, is important. However, age does not seem to be a major contributor to needs, especially unmet needs, although this seems counterintuitive. Our study, as well as others, found no correlation between age and unmet needs as scored by patients as well as staff (Lloyd, King and Moore, 2010) and some studies with even older patients (mean age 80 years) reported (50%) fewer needs and unmet needs. Could this be because of the latter criteria stating that a potentially effective remedy should exist for a need to be judged as unmet? It is known that older patients tend to accept burdens as a fact of life. These latter criteria seem to introduce some subjectivity. How and who is to decide if a remedy exists for the physical burden that comes with ageing? Amajor findingof this studywas that the total number of unmet needswas underestimated by the staff. However, more importantly, most of these poor agreements were in the social domain and, to a lesser extent, in the psychological domain. In absolute numbers, they may seem to be a minor problem, but expressed as a percentage of the reported unmet needs from the patients’ view, there is a substantial disagreement on these unmet needs. This seemingly ‘blind spot’, even though the absolute numbers are low, comes with a chain reaction of consequences and it needs the attention of staff or at least their
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