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Do interventions with staff in long-term residential facilities improve quality of care or quality for life people with dementia? A systematic review of the evidence

Published online by Cambridge University Press:  21 July 2016

Mike Bird ,
Katrina Anderson ,
Sarah MacPherson  and
Annaliese Blair
Mike Bird
Affiliation:
Dementia Services Development Centre, Bangor University, Bangor, Gwynedd, UK NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia
Katrina Anderson*
Affiliation:
NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, New South Wales, Australia Australian National University, Canberra, Australian Capital Territory, Australia
Sarah MacPherson
Affiliation:
NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, New South Wales, Australia Australian National University, Canberra, Australian Capital Territory, Australia
Annaliese Blair
Affiliation:
NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, 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: Katrina.Anderson@gsahs.health.nsw.gov.au.
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Abstract

Background:

Common sense suggests and research indicates relationships between staff factors in residential dementia care and quality of life (QOL) for residents, with poor care increasing suffering. However, we do not have a coherent picture of which staff interventions have an impact on quality of care (QOC) or resident QOL.

Methods:

A comprehensive search of 20 years’ peer-reviewed literature using Medline, PsycINFO, Embase, PubMed, CINAHL, and the Cochrane, Campbell Collaboration identified 4,760 studies meriting full text review. Forty-six met the inclusion criteria, namely interventions in long-term facilities helping staff develop their capacity to provide better care and/or QOL for residents with dementia. Thirty-five other papers comprised an associated predictor review.

Results:

Conclusions from these limited data are further compromised because nine studies failed to measure effects on residents and only half assessed effects after the project team withdrew. Of these, excellent studies produced change over the medium (3–4 months) or longer term, including reduction in challenging behavior and restraint use but this applied only to a minority. A number of studies failed to measure effects on QOC, limiting conclusions about mechanisms underlying change.

Conclusion:

In general, level of intervention required depended on the target. For outcomes like restraint use, structured education sessions with some support appear adequate. Programs to reduce pain require more support. For complicated issues like challenging behavior and increasing co-operation in showering, detailed, supportive, on-site interventions are required. Improvements in restraint and staff/resident interactions were the most promising findings. (Review registration number: PROSPERO 2014:CRD42014015224).

Keywords

dementiaresidentialinterventionsstaffquality of carequality of lifesystematic reviewvsp
Type
Review Article
Information
International Psychogeriatrics , Volume 28 , Issue 12 , December 2016 , pp. 1937 - 1963
Copyright
Copyright © International Psychogeriatric Association 2016 

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Footnotes

#

KA and MB contributed equally to this work.

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