Dementia competence and associated factors among care staff in long-term care institutions: a cross-sectional study

Background Dementia is a leading cause of disability and dependency among older adults, posing significant challenges for long-term care institutions. As frontline caregivers, the competence of care staff is a critical determinant of care quality and the well-being of older adults. Enhancing dementia competence of care staff not only improves care outcomes but also alleviates caregiving burden and contributes to workforce stability. Objectives To assess dementia care competence among care staff in long-term care institutions and examine its associations with dementia-related knowledge, caregiving attitudes, and sociodemographic and work-related factors. We also explored the indirect association between dementia-related knowledge and care competence through caregiving attitudes. Methods A cross-sectional study was conducted among 338 care staff from 21 residential long-term care institutions in Xi’an, China, between July 2024 and June 2025. Data were collected using the Chinese versions of the Dementia Knowledge Assessment Scale, Dementia Attitudes Scale, and Sense of Competence in Dementia Care Staff Scale. Descriptive analysis, Pearson correlation, and linear mixed-effects models were conducted using SPSS version 26.0. An exploratory cross-sectional indirect-association analysis based on Hayes’ Model 4 examined the indirect association through caregiving attitudes, using institution-clustered robust standard errors and 5,000 institution-level bootstrap resamples. Results The dementia care competence score of care staff was 47.9 ± 7.9. There were significant positive correlations among dementia-related knowledge, attitudes, and competence ( p < 0.05). Dementia-related knowledge showed a significant indirect association with SCIDS scores through caregiving attitudes (B = 0.112, 95% bootstrap CI [0.025, 0.177]), whereas the direct association was not statistically significant (B = 0.029, 95% CI [−0.125, 0.183]). After accounting for institution-level clustering, more positive caregiving attitudes and longer dementia care experience were associated with higher care competence, and care staff with senior middle school education or above had higher SCIDS scores than those with primary school education. Conclusion More positive caregiving attitudes and longer dementia care experience were associated with higher self-assessed dementia care competence, and differences were observed across educational groups. These findings may inform the development of dementia care training for care staff in LTC institutions.