Abstract
High vacancy and high turnover rates amongst care staff in care homes are associated with poorer quality of care and may be related to stress and burnout. We conducted a systematic review and the first meta-analysis to determine the level of stress and burnout and report its associated factors in staff caring for people living with dementia in 24-hour care settings. We electronically searched MEDLINE, PsycINFO and Web of Science databases from 2009 up to August 2017. Two raters independently graded the validity of studies using standardised criteria. We conducted a meta-analysis using a random effects model to determine the weighted mean burnout scores across comparable studies. We identified 2417 studies of which 17 met our inclusion criteria. Nine studies reported mean burnout scores in care staff working in either nursing or residential care home facilities in eight different countries. Meta-analysis of the four studies of 598 care staff that used the complete 22-item Maslach Burnout Inventory (MBI) found low mean emotional exhaustion levels; mean 15.0 (95% CI 14.5-15.5), moderate depersonalisation; mean 8.3 (95% CI 7.9-8.7) and low personal accomplishment; mean 22.0 (95% CI 21.6-22.4). Care worker factors reported to be associated with higher burnout and stress included: younger age, higher qualifications, not speaking English as a first language, feeling unsupported and rating leadership within the home as poor; there was also an association with caring for residents who exhibited aggressive behaviour. Current evidence suggests that most long-term care staff for people living with dementia do not experience high levels of burnout, but there is a lack of good quality longitudinal evidence with analysis of non-respondents. Further large prospective studies of burnout and stress levels in care staff are required to understand more about potentially modifiable institutional and staff risk factors for burnout and their correlation with staff turnover.
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