The review by Bird and colleagues (Reference Bird, Anderson, MacPherson and Blair2016), published in this issue of International Psychogeriatrics, is notable for jointly examining the effect of dementia care interventions on both staff and resident quality outcomes. This is an important contribution to improving dementia care because it recognizes the dynamic and dyadic relationship between residents and their caregivers in residential settings. While evidence exists on the dyadic effect of family caregiver intervention on dementia patient outcomes (Gitlin and Hodgson, Reference Gitlin, Hodgson, Gaugler and Kane2015), less attention has been given to formal caregivers in institutional settings (Dellefield et al., Reference Dellefield, Castle, McGilton and Spilsbury2015).

This research comes at a time when residential settings such as nursing homes are under financial pressures to do more with less. Caregiving staff are often overwhelmed with meeting the needs of increasingly complex residents and too few trained staff have the requisite knowledge and skills. As such, having an understanding of which interventions result in meaningful outcomes for both residents with dementia and their professional caregivers is sorely needed. This rigorous review will help the reader of International Psychogeriatrics critically appraise a broad range of interventions targeting staff quality of care or patient quality of life.

The review included studies published between 1995 and 2015 resulting in 46 papers from 18 different scientific journals. The interventions that demonstrated joint benefits for both staff and residents often involved targeted staff training for a particular quality outcome (e.g. restraint use, staff–resident interactions) and that included hands-on practice. Studies that examined reducing pain or neuropsychiatric symptoms offered promise but were greatly limited by lack of patient follow-up.

The review did not specify the residential care settings of care in which interventions were more effective. In reality, residential facilities are very diverse. Facilities can have dedicated dementia care units with trained staff, or residents with dementia can be dispersed throughout facilities with a diverse skill mix and high turnover. These factors are known to affect quality of care and ultimately patient outcomes.

The authors clearly point to the need for measurement of the changes occurring at the care level that resulted in charges in outcomes for residents. Thus, future research evaluating the joint effect of staff and patient outcomes must consider the “black box” of organizational, cultural, and care-based factors that explain how improvements in quality of care affect resident outcomes (Tolson et al., Reference Tolson2011). This review begins to shed light into this “black box” and offers promise in determining “what works” in residential care settings.

The next challenge for future researchers and clinicians is in scaling up effective interventions so that they become an everyday part of residential care settings. Providing key stakeholders and policy-makers with this evidence is essential to moving the findings with strong support (e.g. interventions for restraint free care) into routine care.