Supporting the mental wellbeing of aged care workers: A systematic review of factors and interventions.

Background: The aged care sector faces significant challenges due to rising demand from aging populations and chronic diseases, in addition to workforce shortages, contributing to staff stress, burnout, and poor mental wellbeing. In this review, we synthesized quantitative studies on factors and interventions to improve the mental wellbeing of the aged care workforce across indicators and system levels.

Methods: Five academic databases (Medline, Embase, Scopus, PsycInfo, and CINAHL) were searched from January 2014 to May 2024, using keywords related to aged care, care workers, and mental wellbeing. Quantitative studies examining factors or outcomes of interventions related to staff wellbeing were included. Identified factors were classified as micro-, meso-, and macro-level using a combined inductive and deductive approach.

Results: Eighty-nine studies were included: 64 (72%) identified significant factors, and 25 (28%) evaluated interventions aiming to improve workers' mental wellbeing. Almost half concentrated on nursing staff (n = 38, 43%), with others addressing direct care workers (n = 25, 28%) or aged care workers more broadly (n = 19, 21%). From the synthesis, a multi-level model of factors affecting aged care worker wellbeing was developed, comprising 11 themes and 39 sub-themes; 3 micro-level themes (1. personal factors, 2. work engagement, and 3. skills and abilities), 6 meso-level themes (4. job demands, 5. professional relations, 6. job control, 7. leadership, 8. professional development, and 9. workplace resources), and 2 macro-level themes (10. policy and regulation and 11. structure and governance). Among the 25 intervention studies, most entailed micro-level changes (n = 24, 96%), including relaxation, emotion regulation, and behavioral management education training.

Conclusions: Understanding system-level factors is a key to designing comprehensive improvement approaches. Our new model can help guide organizations in developing targeted strategies to promote mental wellbeing and strengthen care delivery. While individual-focused interventions have shown benefits, organizational and broader system-level strategies to improve mental wellbeing are pivotal for achieving sustainable change.