The purpose of this study was to examine the African American (AA) dementia caregiving experience for community dwelling caregivers in the context of disruptive behaviors. A secondary analysis, utilizing the Aging and Demographics Study (N=742) was performed to examine background and proximal factors influencing disruptive behaviors among White and AA subjects. The Need Driven Dementia Compromised Behavior Model (NDB) was used as a framework. Logistic regression models examined associations among behavioral outcomes (hallucinations, delusions, agitation, and depression). Significant differences pertaining to background factors of the NDB model and variables associated with dementia/behavioral risk as well as behavioral outcomes were found between AA and White subjects for type of dementia, education, number of medications, number of conditions/procedures, MMSE scores, and the behavioral outcome of depression (p<0.05). Background factors demonstrated that disruptive behaviors were associated with increased odds of occurring if subjects with dementia had increased age (OR=1.02, 95%CI=1.00-1.05), cognitive impairment (OR=0.92, 95% CI=0.84-1.00), functional impairment (OR=1.16, 95%CI=1.10-1.22), were female (OR=2.81, 95% CI=1.41-5.61), were White (OR=0.37, 95%CI=0.20-0.67), and had increased number of medical diagnoses or conditions (OR=1.16, 95% CI=1.09-1.24). Significant differences pertaining to proximal factors of the NDB model for care recipients and variables associated with behavioral risk were found between AA and White subjects for sleep changes, type of relationship with caregiver, and frequency of contact with caregiver (p<0.05). Proximal analyses revealed disruptive behaviors were associated with increased odds of occurring if subjects were White (OR=0.14 95% CI=0.04-0.50), with increasing age (OR=1.04 (1.00-1.08)], with decreased frequency of contact [OR 3.92 (1.20-12.77)], increased hours/day of care [OR 1.05 (1.01-1.09)], and non-family caregiver provision [OR 7.33 (1.26-42.64)]. Decreased odds of disruptive behaviors occurring were associated with the absence of hunger changes [OR 0.31 (0.21-0.47)] and sleep changes [OR 0.67 (0.46-1.00)].
Recommendations for future research, practice, and policy include revisiting the literature, expanding research strategies, community based interventions, increased education of caregivers/care recipients, reimbursements for caregivers, and the initiation and continuation of local, state, and federal funding for research.