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Medina V, Watts A, Fracachán-Cabrera M, Hazlewood C, Ramirez-Mantilla M, Vidoni ED, Perales-Puchalt J. Analysis of the intensity of engagement with CuidaTEXT, a text message intervention for dementia caregiver support among Latinos/as. ETHNICITY & HEALTH 2024:1-22. [PMID: 39107055 DOI: 10.1080/13557858.2024.2387111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 07/27/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVES To examine the associations between participant intensity of engagement with a text message intervention, CuidaTEXT, and socio-demographic factors, acceptability measures, and clinical outcomes among Latino/a caregivers of individuals with dementia. METHODS CuidaTEXT is a six-month, bilingual, and bidirectional intervention. We enrolled 24 Latino/a caregivers in a one-arm feasibility trial. Participants received approximately one automatic daily text message and could engage with the intervention by texting specific keywords (e.g. STRESS to receive messages about stress-coping), and by chat-texting with a live coach. We used metrics and psychometric scales to quantify variables. RESULTS Participants sent a total of 1847 messages to CuidaTEXT. Higher intensity of engagement was associated with higher intervention satisfaction (r = 0.6, p = 0.007), as were several other acceptability outcomes. We found no associations between intensity of engagement with CuidaTEXT and sociodemographic or clinical outcomes (p > 0.05). CONCLUSION Encouraging more intense engagement with CuidaTEXT might lead to higher levels of satisfaction with the intervention. However, it is possible that those who are highly satisfied, engage more intensely with CuidaTEXT. Future research should determine the directionality of these associations to optimize text message interventions. CLINICAL IMPLICATIONS Creating more opportunities to increase the intensity of text message engagement with caregiver support interventions may improve caregiver satisfaction with them.
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Affiliation(s)
- Valerie Medina
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Amber Watts
- Department of Psychology, University of Kansas, Lawrence, KS, USA
- Department of Neurology, University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
| | | | - Cameo Hazlewood
- Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Eric D Vidoni
- Department of Neurology, University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
| | - Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer's Disease Research Center, Fairway, KS, USA
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Engel L, Sokolova V, Bogatyreva E, Leuenberger A. Understanding the influence of different proxy perspectives in explaining the difference between self-rated and proxy-rated quality of life in people living with dementia: a systematic literature review and meta-analysis. Qual Life Res 2024; 33:2055-2066. [PMID: 38656407 PMCID: PMC11286712 DOI: 10.1007/s11136-024-03660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Proxy assessment can be elicited via the proxy-patient perspective (i.e., asking proxies to assess the patient's quality of life (QoL) as they think the patient would respond) or proxy-proxy perspective (i.e., asking proxies to provide their own perspective on the patient's QoL). This review aimed to identify the role of the proxy perspective in explaining the differences between self-rated and proxy-rated QoL in people living with dementia. METHODS A systematic literate review was conducted by sourcing articles from a previously published review, supplemented by an update of the review in four bibliographic databases. Peer-reviewed studies that reported both self-reported and proxy-reported mean QoL estimates using the same standardized QoL instrument, published in English, and focused on the QoL of people with dementia were included. A meta-analysis was conducted to synthesize the mean differences between self- and proxy-report across different proxy perspectives. RESULTS The review included 96 articles from which 635 observations were extracted. Most observations extracted used the proxy-proxy perspective (79%) compared with the proxy-patient perspective (10%); with 11% of the studies not stating the perspective. The QOL-AD was the most commonly used measure, followed by the EQ-5D and DEMQOL. The standardized mean difference (SMD) between the self- and proxy-report was lower for the proxy-patient perspective (SMD: 0.250; 95% CI 0.116; 0.384) compared to the proxy-proxy perspective (SMD: 0.532; 95% CI 0.456; 0.609). CONCLUSION Different proxy perspectives affect the ratings of QoL, whereby adopting a proxy-proxy QoL perspective has a higher inter-rater gap in comparison with the proxy-patient perspective.
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Affiliation(s)
- Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Valeriia Sokolova
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ekaterina Bogatyreva
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
| | - Anna Leuenberger
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
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Perales-Puchalt J, Acosta-Rullán M, Ramírez-Mantilla M, Espinoza-Kissell P, Vidoni E, Niedens M, Ellerbeck E, Hinton L, Loera L, Ramírez AS, Lara E, Watts A, Williams K, Resendez J, Burns J. A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study. JMIR Aging 2022; 5:e35625. [PMID: 35482366 PMCID: PMC9100381 DOI: 10.2196/35625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Latinx family caregivers of individuals with dementia face many barriers to caregiver support access. Interventions to alleviate these barriers are urgently needed. OBJECTIVE This study aimed to describe the development of CuidaTEXT, a tailored SMS text messaging intervention to support Latinx family caregivers of individuals with dementia. METHODS CuidaTEXT is informed by the stress process framework and social cognitive theory. We developed and refined CuidaTEXT using a mixed methods approach that included thematic analysis and descriptive statistics. We followed 6 user-centered design stages, namely, the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research and clinical advisory board guidance, sketching and prototyping, and usability testing of the prototype of CuidaTEXT among 5 Latinx caregivers. RESULTS CuidaTEXT is a bilingual 6-month-long SMS text messaging-based intervention tailored to caregiver needs that includes 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end of life, care of the person with dementia, behavioral symptoms, and problem-solving strategies; 783 keyword-driven text messages for further help with the aforementioned topics; live chat interaction with a coach for further help; and a 19-page reference booklet summarizing the purpose and functions of the intervention. The 5 Latinx caregivers who used the prototype of CuidaTEXT scored an average of 97 out of 100 on the System Usability Scale. CONCLUSIONS CuidaTEXT's prototype demonstrated high usability among Latinx caregivers. CuidaTEXT's feasibility is ready to be tested.
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Affiliation(s)
- Jaime Perales-Puchalt
- Alzheimer's Disease Research Center, School of Medicine, University of Kansas Medical Center, Fairway, KS, United States
| | - Mariola Acosta-Rullán
- Alzheimer's Disease Research Center, School of Medicine, University of Kansas Medical Center, Fairway, KS, United States
| | - Mariana Ramírez-Mantilla
- Department of Population Health, School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Paul Espinoza-Kissell
- Alzheimer's Disease Research Center, School of Medicine, University of Kansas Medical Center, Fairway, KS, United States
| | - Eric Vidoni
- Alzheimer's Disease Research Center, School of Medicine, University of Kansas Medical Center, Fairway, KS, United States
| | - Michelle Niedens
- Alzheimer's Disease Research Center, School of Medicine, University of Kansas Medical Center, Fairway, KS, United States
| | - Edward Ellerbeck
- Department of Population Health, School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ladson Hinton
- Alzheimer's Disease Research Center, University of California, Davis, Sacramento, CA, United States
| | - Linda Loera
- Alzheimer's Association, Southland Chapter, Los Angeles, CA, United States
| | - A Susana Ramírez
- Department of Public Health, University of California, Merced, Merced, CA, United States
| | - Esther Lara
- Alzheimer's Disease Research Center, University of California, Davis, Sacramento, CA, United States
| | - Amber Watts
- Alzheimer's Disease Research Center, Department of Psychology, University of Kansas, Lawrence, KS, United States
| | - Kristine Williams
- Alzheimer's Disease Research Center, School of Nursing, University of Kansas Medical Center, Fairway, KS, United States
| | | | - Jeffrey Burns
- Alzheimer's Disease Research Center, School of Medicine, University of Kansas Medical Center, Fairway, KS, United States
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Minyo MJ, Judge KS. Perceived Unmet Need and Need-Related Distress of People Living With Dementia. Gerontol Geriatr Med 2022; 8:23337214221092886. [PMID: 35651650 PMCID: PMC9149624 DOI: 10.1177/23337214221092886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
The unmet needs of people living with dementia have been shown to be multidimensional and impact well-being. However, there are a lack of studies examining variability of unmet needs and need-related distress from the person living with dementia's perspective. The current study (n = 12) examined the self-reported unmet needs and need-related distress of people with mild to moderate dementia. Seventy-five percent of participants (n = 9) identified at least one unmet need and 50% (n = 6) reported 10 or more unmet needs. "Finding and Arranging Services" and "Health Information" subscales had the highest reported average unmet needs. The most frequently reported unmet need-item was "getting information about your memory problems?" Participants reported variability in distress for both unmet and met needs. Continued research can provide beneficial information on the relationship between unmet needs, need-related distress, and outcomes of well-being for future interventions.
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Affiliation(s)
- Morgan J. Minyo
- Department of Psychology, Cleveland
State University, Cleveland, OH, USA
- Center for Research and Education,
Benjamin Rose Institute on Aging, Cleveland, OH, USA
| | - Katherine S. Judge
- Department of Psychology, Cleveland
State University, Cleveland, OH, USA
- Center for Research and Education,
Benjamin Rose Institute on Aging, Cleveland, OH, USA
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Bonds Johnson K, Epps FR, Song M, Lyons KS, Driessnack M. Using poetry as data to explore daily and formal care decision making within African American dementia dyads. Geriatr Nurs 2021; 42:919-925. [PMID: 34098446 PMCID: PMC8335738 DOI: 10.1016/j.gerinurse.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
There is limited research exploring how daily and formal care decision making occurs within African American dementia dyads as well as how these dyads navigate decision making across the dementia trajectory. Through semi-structured interviews, five African American dementia dyads shared their decision-making processes. We used a multimethod approach to the analysis of data, including qualitative and quantitative content analysis and the creation of I Poems. This novel use of I Poems provided a uniquely personal account of the lived experiences of the African American persons living with dementia, while other analyses revealed that within dyads, daily care decision making was led by African American persons living with dementia, whereas formal care decision making varied between dyads. There was intra-dyad congruence regarding who the final decision maker was in daily and formal care. Clinicians and researchers may be able to tailor interventions based on the dyad's involvement in these decision-making processes.
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Affiliation(s)
- Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322, United States.
| | - Fayron R Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322, United States
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Martha Driessnack
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
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Minyo MJ, Judge KS. Self-Reported Behavioral Symptoms of People with Dementia: A Pilot Study Examining Individual's Perceived Illness Experience. THE GERONTOLOGIST 2021; 62:e431-e441. [PMID: 34174068 DOI: 10.1093/geront/gnab091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons with dementia experience behavioral symptoms, such as agitation and repeating questions, which have been reported as one of the most burdensome and stressful aspects of providing care for dementia caregivers. However, no published studies have assessed the subjective experience of behavioral symptoms and distress from people with dementia. RESEARCH DESIGN AND METHODS The current pilot study examined the feasibility of people with dementia providing self-reported behaviors and behavioral-related distress. Data from a larger, on-going research study was used consisting of people with mild to moderate dementia (n = 12) residing in a long-term memory care facility. RESULTS Participants were able to provide reliable (∝=.91) self-reported data concerning their own behaviors and behavioral-related distress with variability among responses. The most frequently self-reported behaviors included agitation (66.7%) and complaining/criticizing things (58.3%) while the least reported behaviors were refusing to be left alone (8.3%) and yelling/swearing (8.3%). The highest behavioral distress reported was agitation (58.3%) while the least was wandering (8.3%). DISCUSSION AND IMPLICATIONS Understanding the subjective, perceived experience of people with dementia provides valuable information on the illness experience. Additional research is needed to examine the role and impact of self-reported behaviors and the resulting behavioral- related distress on outcomes of well-being. Subjective reports of behavioral-related distress could predict well-being, above and beyond that of traditional objective measures, creating the potential for novel non-pharmacological intervention development for people with dementia.
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Affiliation(s)
- Morgan J Minyo
- Department of Psychology, Cleveland State University, Cleveland, Ohio, USA
| | - Katherine S Judge
- Department of Psychology, Cleveland State University, Cleveland, Ohio, USA.,Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, Ohio, USA
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Bonds K, Whitlatch CJ, Song M, Lyons KS. Factors influencing quality of life in African-American dementia dyads. Aging Ment Health 2021; 25:703-710. [PMID: 31920090 PMCID: PMC7347433 DOI: 10.1080/13607863.2020.1711865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
Objective: Both caregivers and the older adults they care for can experience declines in quality of life (QOL) over the course of the dementia trajectory. Little research has examined QOL in African-American caregivers and even less in African-American persons with dementia (PWDs), making it difficult to identify associated factors.Method: Guided by the Negro Family as a Social System framework, a secondary data analysis was used to examine the influence of family structure, instrumental and expressive role functions on QOL in a sample of 62 African-American dementia dyads (i.e. African-American PWDs and their African-American caregivers). Dyadic data were analyzed using multilevel modeling to control for the interdependent nature of the data.Results: On average, African-American PWDs reported significantly worse QOL than African-American caregivers. Within African-American dementia dyads, QOL covaried. African-American PWDs experienced significantly worse QOL when their caregiver was a non-spouse and they themselves perceived less involvement in decision-making. In addition, African-American caregivers experienced significantly worse QOL when they reported greater dyadic strain with the African-American PWD and were non-spouses of African-American PWDs.Conclusion: Findings suggest understanding the interpersonal characteristics (e.g., dyadic relationship, family structure and role functions) of dyads may hold promise for improving their QOL.
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Affiliation(s)
- Kalisha Bonds
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Carol J Whitlatch
- Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, OH, USA
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
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Miller LM, Whitlatch CJ, Lee CS, Caserta MS. Care Values in Dementia: Patterns of Perception and Incongruence Among Family Care Dyads. THE GERONTOLOGIST 2020; 59:509-518. [PMID: 29546327 DOI: 10.1093/geront/gny008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons with dementia (PWDs) often place greater importance on their care values (i.e., maintaining autonomy and social relations, choosing caregivers, avoiding being a burden) than family caregivers (CGs) perceive, which can detract from dementia care planning (e.g., care arrangements or surrogate decisions). Notable variability has been found across family care dyads (PWD and CG) in their perceptions of care values, suggesting that there may be multiple patterns of perception. The purpose of this study was to characterize distinct patterns of perception of care values in family care dyads. DESIGN AND METHODS Using cross-sectional data from 228 community-dwelling family care dyads, we quantified dyads' average perceptions and incongruence in perceptions of the importance of everyday care values using multilevel modeling. These scores were then used in a latent class analysis to identify distinct patterns of perception, with the dyad as the unit of analysis. RESULTS Two distinct patterns of care value perception were identified. 25% of dyads were labeled as "CG underestimating" due to lower average estimations of the importance of PWDs' care values, and a significant amount of dyadic incongruence. Underestimating dyads were characterized by a confirmed diagnosis of dementia, lower cognitive function, and younger age in PWDs, and higher relationship strain in the dyad. IMPLICATIONS Care dyads that fall into an underestimating pattern may be at greater risk for inadequate dementia care planning. Interventions to improve care planning in this higher-risk group may include care values identification with the PWD, strategies for alleviating relationship strain, early-stage planning, and disease education.
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Affiliation(s)
| | - Carol J Whitlatch
- Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, Ohio
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Michael S Caserta
- College of Nursing and Center on Aging, The University of Utah, Salt Lake City
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Yamada T, Nakaaki S, Sato J, Sato H, Shikimoto R, Furukawa TA, Mimura M, Akechi T. Factor structure of the Japanese version of the Quality of Life in Alzheimer's Disease Scale (QOL-AD). Psychogeriatrics 2020; 20:79-86. [PMID: 31020753 DOI: 10.1111/psyg.12459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/16/2019] [Accepted: 04/01/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Quality of Life in Alzheimer's Disease Scale (QOL-AD) developed by Logsdon et al. in1999 is believed to be useful for evaluating responses from both patients and their caregivers. We previously confirmed both the reliability and the validity of the Japanese version of the QOL-AD. However, the factor structure of this scale should be confirmed because the QOL-AD covers multiple facets of dementia patients' lives. Thus, we performed a factor analysis of the Japanese QOL-AD. Then, we examined the correlations between each of the identified QOL factor scores and the results of other scales. METHODS The Japanese version of the QOL-AD was given to 132 AD patients and 132 caregivers. Four other tests were also performed at the same time: the Mini-Mental State Examination, the Neuropsychiatric Inventory (NPI), the Hyogo Activities of Daily Living Scale (HADL), and the Short Memory Questionnaire. A factor analysis using Varimax rotation was used to examine the dimensions underlying the QOL-AD. In addition, we examined the Pearson correlations between each of the identified QOL factor scores and the results of the other four tests. RESULTS Factor analyses of both versions of the Japanese QOL-AD (both the patients' and the caregivers' responses) revealed three factors that were named 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The 'psychological wellbeing' factor was significantly correlated with the Mood factor of the NPI. The 'human relationships' factor was significantly correlated with the Psychosis factor of the NPI. The 'physical and social environment' factor was significantly correlated with the HADL. CONCLUSIONS Both the patients' and the caregivers' responses to the Japanese version of the QOL-AD were composed of three factors: 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The present results support the multi-domain concept of QOL proposed by Lawton.
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Affiliation(s)
- Takahiro Yamada
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shutaro Nakaaki
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Junko Sato
- Department of Speech-Language-Hearing Therapy, School of Rehabilitation Science Seirei Christopher University, Japan
| | - Hirofumi Sato
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Shikimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior (Cognitive-Behavioral Medicine), Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Hansen BR, Hodgson NA, Gitlin LN. African-American caregivers' perspectives on aggressive behaviors in dementia. DEMENTIA 2018; 18:3036-3058. [PMID: 29578357 DOI: 10.1177/1471301218765946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose Although African-American dementia caregivers report less upset and more confidence managing aggressive behaviors when compared to whites, their contextual experience remains unclear and this study explores that context. Methods Semi-structured interviews with 13 African-American family caregivers were analyzed using content analysis. Results Two themes emerged, “It’s the disease…not the person” and “You got to pick your battles.” “It’s the disease…not the person,” reframing aggressive behavior, included three sub-themes. Sometimes the person with dementia seemed like a stranger but caregivers remembered “In there somewhere is that person.” Aggressive behavior made this perspective difficult as they reported, “Sometimes it’s hard not to take it personal.” Premorbid dyadic conflict made caregiving difficult but caregivers remembered they were “Not who they were then.” “You got to pick your battles,” reflecting cognitive and behavioral strategies, also included three sub-themes. Participants prioritized caregiving over other commitments by reminding themselves “I got to do what I gotta do.” Preventing aggressive behaviors was most successful when “We didn’t argue…we didn’t insist” and caregivers remembered “Don’t put her in a position to fail” when involving the person with dementia in activities. Implications African-American caregivers described substantial challenges when confronted by aggressive behaviors. Strategies employed by caregivers enabled them to maintain a caring perspective and the person with dementia to maintain calm. Interventions that help caregivers manage aggressive behaviors may benefit by considering the challenges, cultural values, and effective strategies used by African-Americans.
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Affiliation(s)
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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