General introduction 33 1 An assessment is always a compromise between the quantity and quality required. The locus of balance depends on the target population and purpose of the test. The MoCA seems to be a sweet spot for screening cognition in old age psychiatry, but it needs to be validated for this specific setting and its multidimensional population. If we revisit Wilson’s criteria to see what is needed for a good screening, we have to conclude that some of the criteria are not yet optimally met in old age psychiatry in our opinion, especially regarding the MoCA. With our study, presented in the following chapters, we attempt to address some of these voids. Criterion 1 The disease to be detected must be a major health problem. To whom? What is considered a problem and by whom? Loneliness and age-related illnesses, such as mild memory problems, are not considered diseases, but they have a major impact on quality of life. To what extent are these major health problems? There are many hidden health problems or needs for patients in old age psychiatry. These are hidden for different reasons and for different stakeholders. However, being hidden from one person does not mean being equally hidden from another. These shortcomings and needs have different shapes. First, we aimed to understand these needs and unmet needs. Therefore, we had to determine what needs exist, whether they are treatable, what their impact is, and whether they are recognised as the same by all stakeholders involved. Therefore, we screened for patients’ needs and the extent to which they were met. In chapter two, we attempt to address these issues. What are the needs and unmet needs of the patient according to the said patient compared to his practitioner? This study was done specifically in a population of elderly patients with bipolar disorder. This group is known to be different from younger patients with bipolar disorder. In doing so, we looked at ‘The care needs of older patients with bipolar disorder’. Do those needs include the same items in older individuals as those in younger adults, and are they perhaps just more of the same? Alternatively, are they different needs altogether? Asmentioned in the paragraphs above and confirmed in Chapter two, cognitive impairment is a major issue in old age psychiatry, especially when doctors are not aware of its presence among patients either in the present or in the near future. It influences not only the patients’ needs or quality of life but also the quality of treatment. Altered compliance was one of the most prominent in pharmacotherapy, as shown by the example in the Why section. Therefore, this dissertation focuses on cognitive impairment in old age psychiatry and how to make this more visible or aware, taking the Wilson and Jungner criteria into account.
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