African-American caregivers' perspectives on aggressive behaviors in dementia.

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.