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IntroductionIn the last decade, increasing research interest has been expressed in responsive behaviours of older adults living in long-term care (LTC) homes, including nursing homes and assisted living facilities. Responsive behaviours are not only a sign of underlying unmet needs, but when directed against (towards) paid staff can lead to decreased quality of work life, and may contribute to lower quality of care. In this systematic review, we aim to synthesise empirically based quantitative and qualitative evidence on factors and stakeholder (eg, staff and family members) experiences of factors associated with the responsive behaviours of people living in LTC directed towards staff.Methods and analysisThis study will be a systematic review of published and ‘grey’ literature. Twelve bibliographical databases will be searched, and for each database, we will use appropriate subject headings and keywords that cover two concepts: LTC and responsive behaviour. No publication date or language filter will be used. The title and abstract of each extracted record will be screened, followed by screening of full text of included papers. Then data extraction and quality assessments will be undertaken. Each stage will be completed independently by pairs of authors. For quantitative studies, meta-analysis will be conducted if pooling is possible; otherwise, a critical narrative analysis will be conducted. For qualitative studies, thematic analysis will be conducted. Factors will then be organised at the individual, interpersonal, institutional and larger societal levels. Sensitivity analysis will be conducted to explore the influence of risk of bias and publication bias on the results. Subgroup analysis will be conducted for people who live with dementia and those who do not.Ethics and disseminationEthics approval is not required for this systematic review. The results of this study will be disseminated via peer-reviewed publication and presentation at professional conferences.

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A report from the Center for Disease Control1 noted two outbreaks of idiopathic neonatal hyperbilirubinemia associated with the use of a phenolic disinfectant detergent, when used in higher than recommended concentrations. These outbreaks were examined in more detail by Wysowski et a12 at the Atlanta Center for Disease Control, confirming a temporal relationship between the excessive utilization of the phenol and neonatal hyperbilirubinemia. Daum et al,3 on the basis of these reports and their own in vitro experiment, concluded that the results thus far warranted removal of concentrated phenolic detergent solutions from newborn care areas, or the assurance of the proper dilutions. There are as yet, however, no reports examining the effects of this detergent on the neonate when used in recommended concentrations. Since a phenolic disinfectant detergent (Superphen, Rebco Chemicals, Burlington, Ontario) was already in use in all areas where newborns are housed at this hospital (in the manufacturer's recommended dilution of 1¼ oz/gal, applied daily to floors and once a month to walls), a prospective study was designed to compare the incidence of significant physiologic neonatal jaundice when either a phenolic (Superphen) or nonphenolic (Quaternary Ammonium, Quad "detergent sanitizer" formula no. 1492, G. H. Woods Company, Toronto, Ontario) disinfectant detergent was used in the nursery areas. MATERIAL AND METHODS Two nurseries in Women's College Hospital (designated nursery I and II) were included in the study. In nursery I, the use of Superphen was continued as usual for the first six months of 1976, and the Quad compound used for the second six months.