The effectiveness and economic evidence of organizational and management interventions to promote mental wellbeing and resilience in elderly care workers and informal caregivers: a systematic review

Background: The increasing number of older adults presents significant challenges for healthcare systems. Elderly care workers, leaders and informal caregivers are facing challenges impacting their mental wellbeing and resilience, necessitating targeted organizational and management interventions. This systematic review aims to evaluate the effectiveness and economic evidence of organizational and management interventions designed to promote mental wellbeing and resilience among elderly care workers, leaders, and informal caregivers. Methods: A systematic search was conducted on the CINAHL, PsycINFO, Scopus, Web of Science, and PubMed databases. We included all management and organizational intervention studies focusing on elderly care workers and informal caregivers, and aiming to promote their mental wellbeing and resilience. We included randomized controlled trials and observational studies with both intervention and comparison groups, and studies with an economic outcome that combines costs and consequences. The methodological quality of the studies was assessed using Cochrane risk of bias tools and Consensus Health Economic Criteria. Results: The final searches yielded altogether 5,700 articles, from which 15 studies were included in this review. Of those, seven explored elderly care workers interventions and eight explored informal caregiver interventions. Most interventions were targeted at individual workers rather than organizational practices. Among the elderly care worker interventions summarized, only a few demonstrated a positive effect on promoting mental wellbeing. Notably, mindfulness, breathing exercises, and Acceptance and Commitment Therapy (ACT) were found to be beneficial for promoting wellbeing, although there are limitations to consider when interpreting the results. In contrast, a higher proportion of informal carer interventions showed positive outcomes related to mental wellbeing. Effective strategies included support and counselling, practical skills training, awareness and knowledge improvement, individual coping therapy, and computer-assisted care management protocol. Only one economic evaluation study was found. The psychological coping intervention for caregivers (START) was cost-effective. Conclusion: Enhancing the coping of informal caregivers with tailored interventions can promote their mental wellbeing and resilience. This review indicates that there is a notable scarcity of system-level interventions or comprehensive research on such interventions. While it is relatively straightforward to identify problems within the caregiving field, finding evidence-based solutions remains challenging. Trial registration: PROSPERO 2024, CRD42024551372.