Skip to main content

The needs of older people with mental health problems in a Portuguese psychiatric setting

  • Joaquim Passos (a1), Aníbal Fonte (a2), Cláudia Camila Dias (a3) and Lia Fernandes (a4)

This study aims to identify met and unmet needs, according to the patient, the carer and the staff, and their relationship with socio-demographic and clinical characteristics in elderly people with mental health problems.


A sample of 306 elderly patients ≥65 years, of both sexes, diagnosed with mental illness (ICD-10 criteria), was recruited from inpatient/outpatient settings in a Department of Psychiatry and Mental Health, in northern Portugal. Patients were assessed with the Camberwell Assessment of Need for the Elderly/CANE.


The majority of diagnoses were depression (33.7%), dementia (24.5%), and schizophrenia (12.7%). The patients’ main unmet needs found were psychological distress (15.0%), daytime activities (10.5%), and benefits (6.5%). Patients reported significantly lower unmet and global needs than carers and staff (Z = −8.58, p < 0.001; Z = −11.07, p < 0.001, respectively). A larger number of global needs (met and unmet) were associated with the diagnosis of dementia, followed by schizophrenia, bipolar, and depressive disorder (p < 0.001), with inpatients reporting more needs than outpatients.


Mental disorders were associated with a greater number of needs in elderly patients, which makes this assessment important as it includes the patients’ perspective, when they are the focus of intervention, in order to decrease distress and make more beneficial use of services, especially in inpatient settings. These different perspectives are crucial when assessing and planning psychiatric and mental health services.

Corresponding author
Correspondence should be addressed to: Lia Fernandes, Faculty of Medicine, University of Porto, Al, Hernâni Monteiro, 4200–319 Porto, Portugal. Phone: 00351222052525. Email:
Hide All
Ashaye, O. A., Livingston, G. and Orrell, M. W. (2003). Does standardized needs assessment improves the outcome of psychiatric day hospital care for older people? A randomized controlled trial. Aging & Mental Health, 7, 195199.
Audit Commission (2000). Forget me not-national report on mental health services for older people. Audit Commission for Local Authorities and National Health Service in England and Wales, London.
Ayis, S., Paúl, C. and Ebrahim, S. (2010). Psychological disorders in old age: better identification for better treatment. European Journal of Psychological Assessment, 26, 3945.
Benedetti, T., Borges, L. J., Petroski, E. L. and Gonçalves, L. (2008). Physical activity and mental health status among elderly people. Revista de Saúde Pública, 42, 302307.
Crane-Ross, D., Roth, D. and Lauber, B. G. (2000). Consumers’ and case managers’ perceptions of mental health and community support service needs. Community Mental Health Journal, 36, 161178.
Deck, H. and Machleidt, W. (2004). Relevance and applicability of the CANE in the German health care system. In Orrell, M. and Hancock, G. (eds.), CANE – Camberwell Assessment of Need for the Elderly (pp. 2934). London: Gaskell.
Direcção-Geral da Saúde/DGS (2013). Portugal saúde Mental em Números 2013. Programa Nacional para a Saúde Mental. Lisboa: DGS.
Fernandes, L. et al. (2009). Validation study of the camberwell assessment of need for the elderly (CANE) in Portugal. International Psychogeriatrics, 21, 94102.
Field, E., Walker, M. and Orrell, M. (2004). The needs of older people living in sheltered housing. In Orrell, M. and Hancock, G. (eds.), CANE – Camberwell Assessment of Need for the Elderly (pp. 3544). London: Gaskell.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State”: a pratical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Graffar, M. (1956). Une méthode de classification sociale d‘échantillons de population. Courrier, 6, 455459.
Greaves, S., Bhat, M., Regan, C., Qazi, A., Miranda-Castillo, C. and Orrell, M. (2006). The unmet needs of referrals to old age psychiatry liaison services. Psychogeriatria Polska, 3, 175182.
Hancock, G. A., Reynolds, T., Woods, B., Thornicroft, G. and Orrell, M. (2003). The needs of older people with mental health problems according to the user, the carer and the staff. International Journal of Geriatric Psychiatry, 18, 803811.
Hoe, J., Orrell, M., Lambert, J. and Prettyman, R. (2004). The needs of long term day hospital attenders. In Orrell, M. and Hancock, G. (eds.), CANE – Camberwell Assessment of Need for the Elderly (pp. 5766). London: Gaskell.
Houtjes, W., Van Meijel, B., Deeg, D. J. H. and Beekman, A. T. F. (2011). Unmet needs of outpatients with late-life depression; a comparison of patient, staff and carer perceptions. Journal of Affective Disorders, 134, 242248.
Instituto Nacional de Estatística/INE (2012). Censos 2011. Resultados Definitivos Portugal. Lisboa: INE.
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179186.
Mahoney, F. I. and Barthel, D. (1965). Functional evaluation: the barthel index. Maryland State Medical Journal, 14, 5661.
Mateos, R., Ybarzábal, M., García, M., Amboage, M. and Fraguela, I. (2004). The Spanish CANE: validation study and utility in epidemiological surveys. In Orrell, M. and Hancock, G. (eds.), CANE –Camberwell Assessment of Need for the Elderly (pp. 2128). London: Gaskell.
Meaney, M., Croke, M. and Kirby, M. (2005). Needs assessment in dementia. International Journal of Geriatric Psychiatry, 20, 322329.
Miranda-Castillo, C., Woods, B. and Orrell, M. (2010). People with dementia living alone: what are their needs and what kind of support are they receiving? International Psychogeriatrics, 22, 607617.
Miranda-Castillo, C., Woods, B. and Orrell, M. (2013). The needs of people with dementia living at home from user, caregiver and professional perspectives: a cross-sectional survey. BMC Health Services Research, 13, 110.
Oliveira, C., Rosa, M., Pinto, A., Botelho, M., Morais, A. and Veríssimo, M. (2010). Estudo do Perfil do Envelhecimento da População Portuguesa. Lisboa: Eurotrials.
Orrell, M. and Hancock, G. (2004). CANE: Camberwell Assessment of Need for the Elderly. London: Gaskell.
Orrell, M., Hancock, G. A., Liyanage, K. C., Woods, B., Challis, D. and Hoe, J. (2008). The needs of people with dementia in care homes: the perspectives of users, staff and family caregivers. International Psychogeriatrics, 20, 941951.
Passos, J., Sequeira, C. and Fernandes, L. (2012). The needs of older people with mental health problems: a particular focus on dementia patients and their carers. International Journal of Alzheimer's Disease. Article ID 638267, 1–7.
Paúl, C. (2007). Old-old people: major recent findings and the European contribution to the state of the art. In Fernandez-Ballesteros, R. (eds.), Geropsychology. European perspectives for an Ageing World (pp. 128144). Gottingen: Hogrefe & Huber Publishers.
Reynolds, T. et al. (2000). Camberwell assessment of need for the elderly: development, validity and reliability. British Journal of Psychiatry, 176, 444452.
Shulman, K. I., Shedletsky, R. and Silver, I. L. (1986). The challenge of time: clock-drawing and cognitive function in the elderly. International Journal of Geriatric Psychiatry, 1, 135140.
Sousa, R. M., Scazufca, M., Menezes, R. P., Crepaldi, A. L. and Prince, M. J. (2009). Feasibility and reliability of the elderly version of the camberwell assessment of needs (CANE): results from the São Paulo ageing & health study. Revista Brasileira de Psiquiatria, 31, 48.
Walters, K., Iliffe, S., Tai, S. S. and Orrell, M. (2000). Assessing needs from patient, carer and professional perspectives: the camberwell assessment of need for elderly people in primary care. Age and Ageing, 29, 505510.
World Health Organization/WHO (2010). ICD-10 International Statistical Classification of Diseases and Related Health Problems 10th Revision. Geneva: WHO.
Yesavage, J. A. et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal Psychiatric Research, 17, 3749.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Passos supplementary material
Supplementary Tables

 Word (35 KB)
35 KB


Full text views

Total number of HTML views: 4
Total number of PDF views: 73 *
Loading metrics...

Abstract views

Total abstract views: 405 *
Loading metrics...

* Views captured on Cambridge Core between 8th February 2017 - 24th June 2018. This data will be updated every 24 hours.