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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). [ABSTRACT FROM AUTHOR]

• The quality of staff care has pervasive effects on resident quality of life • Increasing relevance and applicability of staff training and qualifications is key • Staff upskilling is required in empathic care, communication and restraint reduction • Mealtime assistance and increased recreational activities improve QOL • Experienced nurse managers and rotating staff shifts improve QOC : Despite the integral role residential care staff play in the lives of residents with dementia, the mechanisms for supporting staff to bring about good quality of care (QOC) and quality of life (QOL) are poorly understood. This study focused on establishing the key mechanisms to improve QOC and in turn QOL of residents with dementia. : Over a 10-month period we followed: 247 older adults with dementia from 12 not-for-profit residential care facilities, their families/care partners (n=225), managers (n=12) and staff (n=232). Facilities ranged in size from 10 to 137 beds, located across remote, rural and metropolitan areas of NSW/ACT. Measures included: staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. Multilevel Modelling or Generalised Estimating Equations analyses were conducted for each of the 12 QOC variables, with 22 staff and control variables as the predictors, and for each of the 11 QOL variables, with 20 QOC and control variables as predictors. : Analyses established significant associations between a large number of staff and QOC variables and between QOC and QOL variables. : The quality of the care provided to residents has strong, widespread influences on the QOL of residents. The most promising areas for intervening with staff were: increasing the relevance and applicability of staff training and qualifications, upskilling staff in empathic care provision, communication, and restraint reduction, using a mixture of permanent and rotating shifts, prioritising recreational activity provision by all staff and increasing assistance with meals. [Display omitted] [ABSTRACT FROM AUTHOR]

• What staff do and the way they do it has a real impact on the overall quality of life of residents with dementia. • The impact of staff care has a lasting effect on resident quality of life (at least 6 months). • Eradicating physical restraint is a worthwhile, affordable and achievable target in order to improve resident quality of life. • Care staff need to be upskilled to treat and interact empathetically and humanely with residents to improve quality of life. • Ongoing support and mentoring is required in order for any upskilling of care staff to take effect and be sustained. Residential dementia care staff are often the most important people in a resident's social world. It is a symbiotic relationship and the work can involve highly emotional interactions as well as physical and technical demands. This study focused on narrowing down the most useful targets for intervention in quality of care (QOC) in order to improve quality of life (QOL) for people with dementia in residential care. Over six months we followed: 247 older adults with dementia from 12 residential care facilities, their families/care partners (n = 225), managers (n = 12) and staff (n = 232). Facilities ranged from 10 to 137 beds, located across remote, rural and metropolitan areas. Measures: Staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. The QOC provided had an immediate impact on resident's pain, depression, QOL scale score, Body Mass Index, ease/engagement with staff, and food and fluid intake. This influence was still evident six months later, with baseline QOC leading to improved ease and engagement with staff, QOL scores, and fluid intake. Restraint use featured heavily as a predictor of poor outcomes for residents. QOC did not significantly impact agitated behaviours, frailty, nor physical/verbal expressions of well-being. What staff do and the way they do it has a real and lasting impact on the QOL of residents. The most useful targets for improving QOL are: eradicating physical restraint and supporting and upskilling care staff so that they treat and interact empathetically and humanely with residents. [ABSTRACT FROM AUTHOR]