For three decades, the intense stress faced by professional dementia caregivers in residential aged care facilities (RACFs) has gone largely unreviewed, leaving a critical gap in supporting a workforce battling a global crisis.
These caregivers navigate relentless challenges: crushing workloads, aggressive behaviours from residents, and the quiet grief of losing those they care for deeply.
Yet, a groundbreaking Australian-led systematic review, has uncovered a surprising antidote: positive interactions with residents. Synthesising 52 studies from 21 countries, involving 1,121 RACFs and 16,372 caregivers, the research reveals that shared moments of joy like singing, gardening, or simply sharing a laugh act as a “stress anaesthetic,” offering a powerful path to relief.
Lead researcher Hayley Antipas, a registered music therapist and PhD candidate, drove this effort to map the complexities of caregiver stress. “I realised we didn’t really understand caregivers’ experience,” she says. “We couldn’t know if we’d improved their experience because we didn’t understand the pain points in the first place.”
With no comprehensive review since the mid-1990s, Antipas’s passion for empowering caregivers through tools like music therapy led to the development of a Conceptual Ecosystem that redefines how we understand and mitigate stress in this vital workforce.
The magic of shared smiles
The study’s most striking finding is that positive interactions with residents, moments of connection such as storytelling, reading together, or walking to a rhythmic beat, can significantly ease caregiver stress.
“When caregivers share positive experiences with residents, like seeing them have joy or a moment of connection, that’s the gold,” Antipas explains. These Occupational Stress Mediating Events (OSME) act as a balm, counteracting the emotional and psychological toll of the job.
The research found that non-pharmacological interventions, where caregivers actively participate with residents, leverage these relational dynamics to reduce stress, unlike interventions delivered by external teams, which showed little impact on caregivers.
“It surprised me how strongly the relational component came through,” Antipas reflects. “Humans are relational; that’s part of our nature.” The study highlights that positive interactions with residents and their families don’t just alleviate stress but can “anaesthetise” it, restoring caregivers’ sense of purpose.
For instance, Antipas’s expertise as a music therapist underscores the value of simple strategies, like using rhythm to aid a resident’s movement. “The connection between auditory and motor systems is phenomenal,” she says, describing how a steady beat can “prime the brain” for engagement, fostering meaningful moments that benefit both resident and caregiver.
“It’s all about sharing moments together,” she adds, a reminder of the human essence at the heart of caregiving.
Untangling the web of stress
The study frames caregiver stress as a dynamic, non-linear interplay of psychological, physical, and relational factors, identifying eight interconnected components: poor job satisfaction, declining health, cynicism, depersonalisation, maladaptive coping, mental health issues like depression and anxiety, emotional exhaustion, and low self-efficacy.
These factors feed into each other, creating a cycle where stress compounds over time. Constant stressors, or Constant Occupational Stress Activators (COSA), such as understaffing, excessive workloads, and role ambiguity, erode caregivers’ sense of control.
Meanwhile, negative encounters, like resident aggression or criticism from families (Occupational Stress Activating Events, OSAE), intensify strain.
Physically, the toll is stark. “We’re seeing back injuries, physical injuries, people being sick, not sleeping,” Antipas notes, highlighting how stress dysregulates the body’s response systems, leading to tangible health impacts.
Relationally, caregivers face unique challenges, such as unprocessed grief. Antipas recalls caregivers expressing, “They felt like they just had to keep going,” unable to process residents’ deaths due to workplace demands. This echoed a caregiver’s plea on an aged care support group: “I’m grieving these people like crazy, does this get better?”
The study also found that cultural barriers, like speaking English as a second language or being younger, can heighten stress, underscoring the need for tailored support.
When quick fixes fizzle out
The review examined 29 interventions, from caregiver training to non-pharmacological activities like music or doll therapy. A key insight is that siloed approaches often fail.
Training caregivers to manage residents’ distress, for example, can backfire if they lack the time or autonomy to apply new skills. “Siloed approaches just won’t work,” Antipas asserts. “If we train people but don’t give them the cultural conditions to practice that new knowledge, it can sometimes increase their stress.”
Caregivers may feel guilt or frustration when unable to deliver the quality of care they aspire to, particularly when trained in best practices but constrained by systemic issues like understaffing.
Holistic interventions, combining training with supportive leadership, decision-making authority, and coworker collaboration, are most effective. The study found that organisational interventions, such as team meetings or one-on-one coaching, can enhance self-efficacy and reduce burnout when implemented with a multidisciplinary approach.
However, the research also highlights the need for more robust studies to confirm these effects, as many interventions showed mixed results due to inconsistent implementation or resource constraints.
Non-pharmacological interventions involving caregivers, like multi-sensory stimulation or storytelling groups, also showed promise by fostering shared positive experiences. “When caregivers see a resident experiencing joy, that’s when we see those stress-anaesthetising effects,” Antipas says, emphasizing the power of relational care.
Rethinking how we measure stress
Current tools, like the Maslach Burnout Inventory, fall short in capturing the nuances of caregiving stress.
The inventory measures emotional exhaustion, personal accomplishment, and depersonalisation, but Antipas argues it oversimplifies the experience.
“Depersonalisation is seen as a risk factor, but in caregiving, it’s more complex,” she explains. “It can be protective when a resident is declining quickly, but it can also signal that a caregiver isn’t coping well.”
The study calls for a new, tailored tool to capture the psychological, physical, and relational dimensions of stress through a systems-thinking lens. “We probably need something more specific,” she says, noting that current measures fail to account for the unique complexities of this role.
Charting new horizons
The review identified critical gaps, notably the lack of research on personality types and coping styles. “That was missing,” Antipas notes. “It’s a huge area that needs to be explored for this population.”
Grief also emerged as a subtle but significant issue, with caregivers often denied the space and permission to process loss. The study urges further exploration of primary and tertiary interventions, such as targeted support for high-risk caregivers or treatments for stress-related health conditions.
Antipas is already building on these findings, with a forthcoming music therapy-based trial. “I’ve been looking at how we can leverage these learnings to build music therapy-based trials that address stress-activating components and enhance mitigating factors,” she shares, excited about embedding strategies like singing or rhythmic cues in aged care settings.
A blueprint
With Australia’s aged care sector facing a workforce shortage, the study offers a roadmap for change.
Facilities must foster environments where caregivers can share positive moments with residents, supported by clear direction, adequate staffing, and space for emotional processing.
Systemic issues, like chronic understaffing and financial constraints, must be addressed to reduce stress activators. Antipas’s passion shines through: “I’m passionate about care staff feeling confident to use simple strategies, like singing or providing a beat, as tools in their bag,” she says, envisioning interventions that empower rather than burden.
For policymakers, the study underscores the urgency of investing in high-quality, methodologically robust research to refine intervention strategies and develop tailored tools for measuring caregiver stress. By prioritising relational connections and holistic support, facilities can help caregivers thrive, not just survive, ultimately improving care for residents with dementia.
As Antipas puts it, “It’s all about sharing moments together,” a beautiful reminder that human connection is the heart of healing.
Yes. When you have a quiet 16minutes or so it is lovely to spend quality time with residents particularly on Demenia specific wards. I love that time spent with them. A bit easier at the earlier part of night shift. Once 3.00 o’clock comes around it is impossible as you are going from one resident to the other right up until finish time when am staff arrive. Showers and washes don’t stop. Computer work is often not able to be completed until after handover. I never leave at 6.30. Mostly after 7.00am. No extra pay. No nothing! Continence cares and behaviour cares right till 6.30 until AM staff come in. Nice to have these people come up with ‘extra’ care time to spend with residents when it does not exist. Keep up the fantasy because in reality AINs are already over worked!