Abstract
Common sense suggests and research indicates relationships between staff factors in residential dementia care and the quality of life for residents, with poor care increasing resident suffering. However, we do not have a coherent picture of which interventions with staff have a sustained impact on quality of care and consequent resident quality of life. From a comprehensive search of published peer-reviewed literature from the last 20 years, only 44 studies met the inclusion criteria. Conclusions from these limited data are further compromised because a quarter of the studies failed to measure effects on residents and only half overall assessed effects after the project team withdrew. Of those that did, excellent studies produced change over the medium or longer term, including reduction in challenging behaviour and restraint use but this applied only to a significant minority. A number of studies failed to measure effects on quality of care, limiting conclusions about the mechanisms underlying change. Generally, level of intervention required depended on the target. For outcomes like restraint use, structured education sessions with some support appear adequate. For complicated issues like challenging behaviours, detailed, long-term, supportive, on-site interventions are required. The most promising findings were improvements in restraint and staff/resident interactions.