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A systematic review and meta-analysis of the prevalence and associations of stress and burnout among staff in long-term care facilities for people with dementia

Published online by Cambridge University Press:  13 November 2018

Harry Costello*
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
Sebastian Walsh
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
Claudia Cooper
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
Gill Livingston
Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
Correspondence should be addressed to: Harry Costello, Division of Psychiatry, Faculty of Brain Sciences, UCL, Maple House, 149 Tottenham Court Road, W1T 7NF London, UK. Email:



Care home staff stress and burnout may be related to high turnover and associated with poorer quality care. We systematically reviewed and meta-analyzed studies reporting stress and burnout and associated factors in staff for people living with dementia in long-term care.


We searched MEDLINE, PsycINFO, Web of Science databases, and CINAHL database from January 2009 to August 2017. Two raters independently rated study validity using standardized criteria. We meta-analyzed burnout scores across comparable studies using a random effects model.


17/2854 identified studies met inclusion criteria. Eight of the nine studies reporting mean Maslach Burnout Inventory (MBI) scores found low or moderate burnout levels. Meta-analysis of four studies using the 22-item MBI (n = 598) found moderate emotional exhaustion levels (mean 18.34, 95% Confidence Intervals 14.59–22.10), low depersonalization (6.29, 2.39–10.19), and moderate personal accomplishment (33.29, 20.13–46.46). All three studies examining mental health-related quality of life reported lower levels in carer age and sex matched populations. Staff factors associated with higher burnout and stress included: lower job satisfaction, lower perceived adequacy of staffing levels, poor care home environment, feeling unsupported, rating home leadership as poor and caring for residents exhibiting agitated behavior. There was preliminary evidence that speaking English as a first language and working shifts were associated with lower burnout levels.


Most care staff for long-term care residents with dementia experience low or moderate burnout levels. Prospective studies of care staff burnout and stress are required to clarify its relationship to staff turnover and potentially modifiable risk factors.

Original Research Article
© International Psychogeriatric Association 2018 

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