Hostname: page-component-745bb68f8f-f46jp Total loading time: 0 Render date: 2025-01-13T14:36:46.962Z Has data issue: false hasContentIssue false
  • English
  • Français

How do staff influence the quality of long-term dementia care and the lives of residents? A systematic review of the evidence

Published online by Cambridge University Press:  15 April 2016

Katrina Anderson ,
Mike Bird ,
Sarah MacPherson  and
Annaliese Blair
Katrina Anderson*
Affiliation:
Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, New South Wales, Australia NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia Australian National University, Canberra, Australian Capital Territory, Australia
Mike Bird
Affiliation:
NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia Dementia Development Services Centre, Bangor University, Bangor, Gwynedd, UK
Sarah MacPherson
Affiliation:
Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, New South Wales, Australia NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia Australian National University, Canberra, Australian Capital Territory, Australia
Annaliese Blair
Affiliation:
Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, New South Wales, Australia NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia Australian National University, Canberra, Australian Capital Territory, Australia
*
Correspondence should be addressed to: Katrina Anderson, Aged Care Evaluation Unit, PO Box 1845, Queanbeyan, NSW 2620, Australia. Phone: +61 2 6124 9905. Email: [email protected].
Get access

Abstract

Background:

Research suggests and common sense indicates that there are relationships between staff variables in residential dementia care and the quality of life (QOL) of residents, with poor care due to staff factors increasing resident suffering. Despite these indications, we do not have a coherent picture of these relationships, which variables are important, and where to intervene in order to minimize suffering for people with dementia.

Methods:

This systematic review examined associations between staff variables, quality of care (QOC), and QOL for residents, using published peer-reviewed literature from the last 20 years. A comprehensive search was conducted using an exhaustive list of search terms, leading to the identification of 33,204 unique papers, which was reduced to 35 on-topic papers.

Results:

In the main, we were able to provide collective evidence to suggest there are relationships between potentially adjustable staff variables and QOC on to QOL. When staff treat and interact empathetically and humanely in care, there is a relationship with better mood for residents, delayed functional dependence and better food intake. Where staff are more skilled and educated, there is less psychotropic medication use. Unlimited empathy about the risk of residents falling or being in pain is not enough; staff need to know about the dangers of restraint.

Conclusions:

Confidence in these indicative links is weakened by a lack of high-quality prospective longitudinal studies focusing on potentially adjustable staff variables, with a bias towards cross-sectional studies including only variables that are fixed or unlikely to change. (Review registration no. PROSPERO 2014:CRD42014015224).

Keywords

Dementiaresidentialstaffquality of carequality of lifesystematic reviewlong-term
Type
Review Article
Information
International Psychogeriatrics , Volume 28 , Issue 8 , August 2016 , pp. 1263 - 1281
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

*Amella, E. J. (1999). Factors influencing the proportion of food consumed by nursing home residents with dementia. Advancing Geriatrics Nursing Practice, 47, 879–885.Google ScholarPubMed
Anderson, K., Bird, M., MacPherson, S. and Blair, A. (2014). Improving quality of residential dementia care and promoting change by supporting and caring for staff. PROSPERO 2014:CRD42014015224. Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014015224 Google Scholar
Australian Institute of Health and Welfare (2012). Dementia in Australia. Canberra: Australian Institute of Health and Welfare.Google Scholar
*Bahareethan, M. and Shah, A. (2000). Aggressive behaviour, staff attitude and staff perception of patients on two continuing care psychogeriatric wards. Aging and Mental Health, 4, 66–71.CrossRefGoogle Scholar
*Ballard, C. et al. (2001). Quality of life for people with dementia living in residential and nursing home care: the impact of performance on activities of daily living, behavioral and psychological symptoms, language skills, and psychotropic drugs. International Psychogeriatrics, 13, 93–106.Google Scholar
Beck, C., Ortigara, A., Mercer, S. and Shue, V. (1999). Enabling and empowering certified nursing assistants for quality dementia care. International Journal of Geriatric Psychiatry, 14, 197–212.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
*Beer, C. et al. (2010). Factors associated with self and informant ratings of the quality of life of people with dementia living in care facilities: a cross sectional study. PLoS One, 5, e15621.Google Scholar
*Beerens, H. C. et al. (2014). Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare study. Journal of the American Directors Association, 15, 54–61.Google Scholar
Berg, A., Hallberg, I. and Norberg, A. (1998). Nurses' reflections about dementia care, the patients, the care and themselves in their daily caregiving. International Journal of Nursing Studies, 35, 271–282.CrossRefGoogle Scholar
Bird, M., Anderson, K., Macpherson, S., and Blair, A. (2015). Do interventions with staff in long-term residential facilities improve quality of care or quality for life for people with dementia? A systematic review of the evidence. Manuscript Submitted for Publication.Google Scholar
*Bravo, G., De Wals, P., Dubois, M. F. and Charpentier, M. (1999). Correlates of care quality in long-term care facilities: a multilevel analysis. Journal of Gerontology: Psychological Sciences, 54B, 180–188.Google Scholar
*Chang, C. C. and Roberts, B. L. (2011). Malnutrition and feeding difficulty in Taiwanese older with dementia. Journal of Clinical Nursing, 20, 2153–2161.Google Scholar
*Chappell, N. L. and Reid, R. (2000). Dimensions of care for dementia sufferers in long-term care institutions: are they related to outcomes? Journal of Gerontology: Social Sciences, 55, S234–S244.Google Scholar
Cochrane Consumers and Communication Review Group (2013). Data Extraction Template for Cochrane Reviews [Online]. Available at: http://cccrg.cochrane.org/author-resources; last accessed 1 December 2013.Google Scholar
*Crespo, M., Hornillos, C. and De Quirós, M. B. (2013). Factors associated with quality of life in dementia patients in long-term care. International Psychogeriatrics, 25, 577–585.CrossRefGoogle ScholarPubMed
Critical Appraisal: Notes and Checklists (2015). Available at: http://www.sign.ac.uk/methodology/checklists.html; lastAccessed 17 April 2015.Google Scholar
Daly, T. and Szebehely, M. (2012). Unheard voices, unmapped terrain: care work in long-term residential care for older people in Canada and Sweden. International Journal of Social Welfare, 21, 139–148.CrossRefGoogle ScholarPubMed
*De Roo, M. L. et al. (2014). When do people with dementia die peacefully? An analysis of data collected prospectively in long-term care settings. Palliative Medicine, 28, 210–219.CrossRefGoogle ScholarPubMed
*Dobbs, D. et al. (2005). Characteristics associated with lower activity involvement in long-term care residents with dementia. The Gerontologist, 45, 81–86.CrossRefGoogle ScholarPubMed
Edberg, A.-K., Bird, M., Richards, D. A., Woods, R., Keeley, P. and Davis-Quarrell, V. (2008). Strain in nursing care of people with dementia: nurses' experience in Australia, Sweden and United Kingdom. Aging and Mental Health, 12, 236–243.CrossRefGoogle ScholarPubMed
*Edvardsson, D., Petersson, L., Sjogren, K., Lindkvist, M. and Sandman, P. O. (2014). Everyday activities for people with dementia in residential aged care. International Journal of Older People Nursing, 9, 269–276.Google Scholar
*Edvardsson, D., Sandman, P. O., Nay, R. and Karlsson, S. (2008). Associations between the working characteristics of nursing staff and the prevalence of behavioral symptoms in people with dementia in residential care. International Psychogeriatrics, 20, 764–776.CrossRefGoogle ScholarPubMed
*Fitzgerald, T. G., Hadjistavropoulos, T. and Macnab, Y. C. (2009). Caregiver fear of falling and functional ability among seniors residing in long-term care facilities. Gerontology, 55, 460–467.Google Scholar
Hawes, C., Morris, J. N., Phillips, C. D., Fries, B. E., Murphy, K. and Mor, V. (1997). Development of the nursing home Residents Assessment Instrument in the USA. Age and Ageing, 27, 19–25.CrossRefGoogle Scholar
Holst, G., Edberg, A.-K. and Hallberg, I. (1999). Nurses' narrations and reflections about caring for patients with severe dementia as revealed in systematic clinical supervision sessions. Journal of Aging Studies, 13, 89–107.CrossRefGoogle Scholar
*Huizing, A. R., Hamers, J. P., De Jonge, J., Candel, M. and Berger, M. P. (2007). Organisational determinants of the use of physical restraints: a multilevel approach. Social Science and Medicine, 65, 924–933.Google Scholar
*Isaksson, U., Aström, S., Sandman, P. O. and Karlsson, S. (2009). Factors associated with the prevalence of violent behaviour among residents living in nursing homes. Journal of Clinical Nursing, 18, 972–980.CrossRefGoogle ScholarPubMed
Jordhøy, M. S., Kaasa, S., Fayers, P., Ovreness, T., Underland, G. and Ahlner-Elmqvist, M. (1999). Challenges in palliative care research; recruitment, attrition and compliance: experience from a randomized controlled trial. Palliative Medicine, 13, 299–310.CrossRefGoogle ScholarPubMed
*Karlsson, S., Bucht, G., Eriksson, S. and Sandman, P. O. (2001). Factors relating to the use of physical restraints in geriatric care settings. Journal of the American Geriatrics Society, 49, 1722–1728.Google Scholar
*Kim, H. and Whall, A. L. (2006). Factors associated with psychotropic drug usage among nursing home residents with dementia. Nursing Research, 55, 252–258.Google Scholar
*Kleijer, B. C. et al. (2014). Variability between nursing homes in prevalence of antipsychotic use in patients with dementia. International Psychogeriatrics, 26, 363–371.Google Scholar
Kovach, C., Griffie, J., Muchka, S., Noonan, P. E. and Weissman, D. E. (2000). Nurses’ perceptions of pain assessment and treatment in the cognitively impaired elderly. It's not a guessing game. Clinical Nurse Specialist, 14, 215–220.Google Scholar
*Lin, L. C., Watson, R. and Wu, S. C. (2010). What is associated with low food intake in older people with dementia? Journal of Clinical Nursing, 19, 53–59.Google Scholar
*Lin, P. C., Lin, L. C., Shyu, Y. I. and Hua, M. S. (2011). Predictors of pain in nursing home residents with dementia: a cross-sectional study. Journal of Clinical Nursing, 20, 1849–1857.Google Scholar
*Mcgilton, K. S., Sidani, S., Boscart, V. M., Guruge, S. and Brown, M. (2012). The relationship between care providers' relational behaviors and residents mood and behavior in long-term care settings. Aging and Mental Health, 16, 507–515.Google Scholar
*Miu, D. K. Y. and Chan, K. C. (2014). Under-detection of pain in elderly nursing home residents with moderate to severe dementia. Journal of Clinical Gerontology and Geriatrics, 5, 23–27.Google Scholar
*Mjørud, M., Røsvik, J., Rokstad, A. M., Kirkevold, M. and Engedal, K. (2014). Variables associated with change in quality of life among persons with dementia in nursing homes: a 10 months follow-up study. PLos ONE, 9, e115248.CrossRefGoogle ScholarPubMed
Mody, L. et al. (2008). Recruitment and retention of older adults in aging research. Journal of the American Geriatrics Society, 56, 2340–2348.Google Scholar
Moons, K. G. M. et al. (2014). Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS Checklist. PLoS Medicine, 11, e1001744.CrossRefGoogle ScholarPubMed
*Reed, P. S., Zimmerman, S., Sloane, P. D., Williams, C. S. and Boustani, M. (2005). Characteristics associated with low food and fluid intake in long-term care residents with dementia. The Gerontologist, 45, 74–80.CrossRefGoogle ScholarPubMed
*Reid, R. C. and Chappell, N. L. (2003). Staff ratios and resident outcomes in special care units: do activity aides make a difference? Journal of Applied Gerontology, 22, 89–103.CrossRefGoogle Scholar
Rosewarne, R., Bruce, A. and Mckenna, M. (1997a). Dementia programme effectiveness in long term care. International Journal of Geriatric Psychiatry, 12, 173–182.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
Rosewarne, R., Opie, J., Bruce, A., Doyle, C., Ward, S. and Sach, J. A. (1997b). Care needs of people with dementia and challenging behaviour living in residential facilities. Resident profile survey. Working paper No. 1. Canberra: Commonwealth Department of Health and Family Services, Office for the Aged.Google Scholar
*Schreiner, A. S., Yamamoto, E., and Shiotani, H. (2005). Positive affect among nursing home residents with Alzheimer's dementia: the effect of recreational activity. Aging and Mental Health, 9, 129–134.Google Scholar
*Sjögren, K., Lindkvist, M., Sandman, P. O., Zingmark, K. and Edvardsson, D. (2013). Person-centredness and its association with resident well-being in dementia care units. Journal of Advanced Nursing, 69, 2196–2206.CrossRefGoogle ScholarPubMed
*Slaughter, S. E., Eliasziw, M., Morgan, D. and Drummond, N. (2011a). Incidence and predictors of eating disability among nursing home residents with middle-stage dementia. Clinical Nutrition, 30, 172–177.Google Scholar
*Slaughter, S. E., Eliasziw, M., Morgan, D. and Drummond, N. (2011b). Incidence and predictors of excess disability in walking among nursing home residents with middle-stage dementia: a prospective cohort study. International Psychogeriatrics, 23, 54–64.Google Scholar
*Slaughter, S. E. and Hayduk, L. A. (2012). Contributions of environment, comorbidity, and stage of dementia to the onset of walking and eating disability in long-term care residents. Journal of the American Geriatrics Society, 60, 1624–1631.Google Scholar
Sloane, P. D. et al. (2004). Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. Journal of the American Geriatrics Society, 52, 1795–1804.Google Scholar
*Sloane, P. D., Mitchell, C. M., Preisser, J. S., Phillips, C., Commander, C. and Burker, E. (1998). Environmental correlates of resident agitation in Alzheimer's disease special care units. Journal of the American Geriatrics Society, 46, 862–869.Google Scholar
*Van Beek, A. P., Wagner, C., Frijters, D. H., Ribbe, M. W. and Groenewegen, P. P. (2013). The ties that bind? Social networks of nursing staff and staff's behaviour towards residents with dementia. Social Networks, 35, 347–356.Google Scholar
Wells, D. L., Dawson, P., Sidani, S., Craig, D. and Pringle, D. (2000). Effects of an abilities focussed program of morning care on residents who have dementia and on caregivers. Journal of the American Geriatrics Society, 48, 442–449.Google Scholar
Wood-Mitchell, A., James, I. A., Waterworth, A., Swann, A. and Ballard, C. (2008). Factors influencing the prescribing of medications by old age psychiatrists for behavioral and psychological symptoms of dementia: a qualitative study. Age and Ageing, 37, 547–552.CrossRefGoogle ScholarPubMed
*Zuidema, S. U., De Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2010). Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia. International Journal of Geriatric Psychiatry, 25, 14–22.Google Scholar
*Zuidema, S. U., De Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2011). Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians' prescription behavior. International Psychogeriatrics, 23, 1632–1639.Google Scholar
*Articles included in the review.Google Scholar
Supplementary material: File

Anderson supplementary material

Anderson supplementary material 1

Download Anderson supplementary material(File)
File 23.8 KB
Supplementary material: File

Anderson supplementary material

Anderson supplementary material 2

Download Anderson supplementary material(File)
File 61.3 KB