Need assessment 2 47 2.1 Introduction To date, 10-25% of bipolar patients are older than 60 (Sajatovic et al. 2005) and their absolute number will increase substantially in the coming years due to aging of the total population. Research on older bipolar patients is sparse and most existing knowledge is derived from studies in younger adults. However, bipolar disorder among the elderly ismore complex with increasing cognitive decline (Schouws et al. 2010), somatic comorbidities (Lala and Sajatovic 2012) and polypharmacy (Dols et al. 2014). In addition, older bipolar patients receive less social support (Beyer et al. 2003), and aremore dependent on informal care (Keith et al. 1971). To tailor the treatment of older bipolar patients and to optimize their general wellbeing, their needs should be studied. Needs assessments help to highlight specific areas on which health and social services can concentrate their efforts (Reynolds et al. 2000). Meeting unmet needs may lead to a substantial decrease in health expenses (Slade et al. 1999) and is regarded as an essential condition to improve health, wellbeing and quality of life of older people (Field et al. 2002). Disagreement between patients and staff on needs may influence compliance (Stobbe et al. 2013) and hence the experienced quality of treatment (Hancock et al. 2003; Slade et al.1999). Therefore a needs assessment preferably includes views from the patient and the professional caretaker (staff). Reports on needs of older bipolar patients by patients and staff are currently lacking. Studies in older psychiatric patients show that the number of needs is associated with the level of psychiatric and social functioning (Hancock et al. 2003; Houtjes et al. 2011; Kaiser et al. 2010; Meesters et al. 2013; Passos et al. 2012; Sultan et al. 2011; van der Roest et al. 2008; Walters et al. 2000), quality of life (Bengtsson-Tops and Hansson 1999; Slade et al.1999) and motivation for treatment (Stobbe et al. 2014). Our aim was to investigate the needs of patients with bipolar disorder aged 60 years and over from the patient’s and staff’s perspective, using the Camberwell Assessment of Need for the Elderly (CANE) (Reynolds et al. 2000). We examined the number of needs, to what extent they were met, and how they related to several patient characteristics. We hypothesized that patients who report more needs, both met and unmet, have more mood and cognitive symptoms, a lower quality of life, and are less socially integrated. 2.2 Methods 2.2.1 Study sample We identified all patients aged 60 years and older who were in contact with mental health services between 1 January and 31 December 2012, through a search of the computerized patient record system of the mental health institution GGZ inGeest, which offers outpatient and inpatient mental health services in two districts in Amsterdam, The Netherlands.
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