Summary and general discussion 7 167 awareness of this, given that we found that unmet needs correlate with lower quality of life, poorer social participation according to staff and patients and network size according to the patients. This is in concordance with findings in the literature on unmet needs and reporting impaired quality of life (Field, Walker and Orrell, 2002; Stein et al., 2014), lowering the motivation for treatment (Stobbe et al., 2013), and raising the number of visits to the staff (Goossens et al., 2007). These findings seem to be independent of diagnosis and suggest a key role for social and emotional support (Stein et al., 2014). This was underlined by the findings of our study that company and daytime activities were the most frequently reported unmet needs by both patients and staff. Our study, as well as the literature (Houtjes et al., 2011; Meesters et al., 2013), confirm our hypothesis that patients with more psychiatric symptoms report more needs. Symptoms create needs, but unmet needs can induce symptoms. The starting point in this circle is difficult to distinguish, but it seems that the needs the clinical variables (CES-D, YMRS, GAF, and MMSE) induce are being met, as there are no correlations found with unmet needs. This could be because staffmembers anticipate the needs that come withmore psychiatric symptoms. The more (psychiatric) symptoms one has, the more needs are expected and anticipated. However, this only counts for clinical variables and not social variables (MANSA, network size, social participation, and quality of life). This is in line with the assumption mentioned at the beginning of this paragraph of awareness due to stereotypical thinking and considering social variables not as a core goal of secondary health services. However, the correlations found between the social domains with unmet needs besides total needs also underline the necessity to look beyond the clinical picture of the patient and consider helping with social issues as they affect treatment outcomes and well-being (Valtorta 2012). Is there, in addition to the stereotypical thought of the dependent elderly, (still) a taboo on addressing social isolation? Even though one could consider these variables not to be the main treatment goal of psychiatry, they will affect psychiatric health and should not be ignored. This is an important lesson, for not only clinicians but also policymakers. Nowadays, treatment should be more than clinical recovery, as social, functional, and personal recovery also have a role in patient health. 7.3.2 Considerations of Section B: The MoCA validation in different old age psychiatry settings No matter how much we try to approximate clinical practice in a study population, it will never match reality. Even if we are generally aware of this, we should keep this in mind when using the study data in clinical practice. This immediately brings forth another
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