African American Dementia Caregivers Research Articles

THE NIH STAGE MODEL AND STUDY EXAMPLES OF EARLY STAGES IN DEMENTIA CARE INTERVENTION DEVELOPMENT RESEARCH

Abstract The NIH’s Stage Model provides a common language to facilitate discussion of intervention development research. According to NIH Stage Model (2022), “an examination of the mechanisms of behavior change or the principles underlying an intervention is encouraged by the NIH Stage Model in every Stage of behavioral intervention development.” The five papers in this symposium focus on early-stage intervention development by refinement, adaptation and pilot testing (Stage 1) related to dementia and palliative care (PC) clinical trials. The first paper is a cluster trial of a PC education program for nurses (N=23) in 10 assisted living communities that tested the mechanism of staff self-efficacy in increases in advance care planning discussions with family members of residents living with dementia. The second paper is a clinical trial that tested the feasibility of Companion Robots in live-alone Korean-American older adults (N=30) to determine which features help improve health behaviors (e.g. medication adherence, daily exercises). The third paper is a single-site clinical trial pilot study developed with stakeholders which tested the feasibility of a palliative care community health worker support program for hospitalized minoritized persons living with dementia and their caregivers. The fourth paper adapts an evidence-based e-PainSupport intervention for use with dementia caregivers to report patient pain and administration of analgesics. The fifth paper is a protocol to test the feasibility and acceptability of a culturally sensitive caregiver peer support program (Pair2Care) in current (n=15) and trained former (n=15) African-American dementia caregivers. The discussant will highlight ways to improve clinical trial mechanisms.

Investigating how telephone‐based mindfulness training impacts family conflict and communication for rural African American dementia caregivers

AbstractBackgroundOlder African Americans (AA) are disproportionately affected by Alzheimer’s disease and related dementias (ADRD). In turn, AA ADRD caregivers are more likely to provide in‐home care while being less likely to use respite services as compared to White caregivers. Caregiving for people with ADRD is associated with considerable physical, financial, and emotional strain (Alzheimer’s Association, 2022). Mindfulness‐based interventions (MBI) can be effective at addressing these issues for ADRD caregivers and have been found to be culturally acceptable for AA caregivers (Woods‐Giscombé et al., 2014). However, few studies have tested targeted MBI on rural AA caregivers. As part of a broader study, we investigated the effects of a telephone‐delivered MBI on AA ADRD caregiver burden and relevant secondary outcomes for both caregiving team members. The purpose of this study is to explore how mindfulness training impacts family conflict within the informal caregiving team.MethodPrimary caregivers and care partners of people with dementia participated in an eight‐week MBSR training program consisting of eight telephone‐delivered, instructor‐led classes and one virtual retreat. Post‐participation interviews with study participants (n = 51) were analyzed using Atlas.ti to assign descriptive meaning to sections of the data. After all codes were finalized, a detailed codebook was created, which included each code, its definition, and an example quote, along with any comments.ResultOur analysis revealed four key themes illustrating how the mindfulness intervention served to positively impact family conflict and communication among participating caregivers. Mindfulness training: 1) is helpful in resolving present family conflict; 2) provides tools for future conflict resolution; 3) helps the caregiver feel more present/in control despite family conflict; and 4) enriches already positive family connections.ConclusionNearly all caregivers described the intervention as being helpful in resolving current family conflict, and those caregivers who did not endorse present family conflict stated that the mindfulness training provided tools for alleviating future conflict should it occur. Most caregivers reported that the intervention helped them to feel more present and better able to work through conflict when family miscommunication did occur. Similarly, caregivers confirmed that mindfulness training acted to reinforce already positive family connections.

Application of Topic Modeling on Artificial Intelligence Studies as a Foundation to Develop Ethical Guidelines in African American Dementia Caregiving.

We applied natural language processing and topic modeling to publicly available abstracts and titles of 263 papers in the scientific literature mentioning AI and demographics (corpus 1 before Covid-19, corpus 2 after Covid-19) extracted from the MEDLINE database. We found exponential growth of AI studies mentioning demographics since the pandemic (Before Covid-19: N= 40 vs. After Covid-19: N= 223) [forecast model equation: ln(Number of Records) = 250.543*ln(Year) + -1904.38, p = 0.0005229]. Topics related to diagnostic imaging, quality of life, Covid, psychology, and smartphone increased during the pandemic, while cancer-related topics decreased. The application of topic modeling to the scientific literature on AI and demographics provides a foundation for the next steps regarding developing guidelines for the ethical use of AI for African American dementia caregivers.

ENGAGING A COMMUNITY ADVISORY BOARD TO VALIDATE A CULTURALLY TAILORED INTERVENTION MODEL

Abstract National dementia research priorities call for interventional studies addressing the needs of vulnerable populations experiencing disparities and for greater inclusion of dementia care recipients and their family caregivers in research. While studies document disparities, high needs and experiences of African American dementia caregivers, there is limited translation of this knowledge into the development, implementation, and dissemination of dementia-specific culturally tailored interventions. Research methods that facilitate engagement capable of strengthening data collection and culturally congruent interpretation of caregiving perspectives are needed to inform intervention development. Drawing on a qualitative study utilizing Grounded Dimensional Analysis, we employed a longitudinal engagement method with a Community Advisory Board (CAB) to validate a culturally tailored crisis intervention model for African American dementia caregivers. We identified lessons learned through a review of transcripts, memos and research team discussions. CAB members identified language, family structure, cultural history, knowledge, and respect as important features for cultural tailoring.

AFRICAN-AMERICAN DEMENTIA CAREGIVER STRATEGIES INVENTORY (DCSI-A): INITIAL PSYCHOMETRIC EVALUATION

Abstract Recent studies have found promising evidence of the benefits of cognitive-behavioral interventions (CBIs) in improving depression and health status of African-American dementia caregivers (CGs). However, limited information exists about the specific CB strategies used in these investigations and which CB strategies were most effective in reducing caregiver distress and distress-related health problems. To address these shortcomings, Glueckauf and colleagues developed the African-American Dementia Caregiver Strategies Inventory (DCSI-A) using data from two CBI interventions (Nf129). The primary objectives of the current study were: (a) to identify the most frequently used categories of CBI strategies deployed by African-American CGs and (b) to conduct an initial evaluation of the psychometric properties of the DCSI-A. Descriptive statistics were calculated to assess strategy category frequency and percent of total responses. The two most frequently used strategies were: (1) CG Health-Related Intervention Strategies with 19 endorsements, 16.10% of total strategies and (2) Strategies for CG Social, Recreational, Personal Enhancement and Other Community Activities with 18 endorsements, 15.25% of total responses. These findings suggested that health-related and social, recreational, and personal enhancement strategies were the most commonly used by African-American CBI participants. Intercoder agreement was assessed across two one-month coding intervals, each of which contained 5 coding sessions. Mean percent of agreement and Kappa were .94 and .93, respectively. Both reliability measures fell within the highly acceptable range. Coder drift was minimal across the two time intervals. Future research will evaluate the psychometric properties of the DCSI-A with a larger sample of African-American CGs undergoing CBI.

African American Dementia Caregivers’ Perspectives on and Appraisal of Stress Associated with the Caregiving Role: A Qualitative Study

AbstractBackgroundAfrican Americans are disproportionately impacted by Alzheimer’s disease and related dementias (ADRD), with family members providing the majority of support and care. Dementia caregivers often face high levels of stress and burden which contribute to poor physical and psychological health outcomes. African American dementia caregivers often face greater risk for stress and burden with discrepant evidence on whether this leads to worse outcomes compared to counterparts. Yet African American dementia caregivers remain under‐included in research designed to understand and ameliorate the stress and burden of caregiving. Our study aimed to understand African American dementia caregivers’ perspectives and appraisal of stressors surrounding caregiving and stressful events, such as hospitalization of the person with ADRD.MethodsWe harnessed qualitative interview data from the Stakeholders Understanding of Prevention Protection and Opportunities to Reduce HospiTalizations (SUPPORT) Study, a multi‐site study designed to determine family caregiver perspectives surrounding hospitalizations for people with ADRD residing in highly disadvantaged neighborhoods. Data from 30 dementia caregivers who self‐identified as African American were analyzed using thematic analysis.ResultsAll participants described the presence of stressors and stressful events related to their life broadly and to dementia caregiving more specifically. However, there was great variation in the described degree of stressors in caregiver’s daily life. Caregivers experiencing a greater number, more recent, and more acute stressors described greater burden in their daily life. Long‐standing stressors, such as family conflict and financial hardship, sometimes ‘resurfaced’ with the proximity and role changes brought on by caregiving. Other individual and situational factors, such as one’s own health or status as a ‘sandwich caregiver,’ or the habits and preferences of the person with ADRD, could serve as contributors to overall stress. Few caregivers related stressors to long‐term outcomes, though some described strategies to seek formal mental health counseling.ConclusionsAfrican American dementia caregivers described a variety of acute and ongoing stressors that related not only to caregiving for the person with ADRD but also the caregiver’s personal health and their broader familial and neighborhood context, signaling the need for adaptive caregiver support interventions capable of addressing intervention targets across various stressors.

Exploring Coping Strategies and Barriers in Dementia Care: A Mixed-Methods Study of African American Family Caregivers in Kentucky.

This study explores coping strategies and barriers to dementia care experienced by African American dementia caregivers in Kentucky. Utilizing a convergent mixed-method design integrating focus group and survey data on African American dementia caregivers recruited through churches in Kentucky (N = 28), we elucidate three coping strategies: love-based coping, religion-based coping, and family support. Results from survey data supported these themes, with over 90% of participants reporting that they provide care to give back to family members and for religious reasons. However, over half of the caregivers' reported strain due to three barriers identified by focus group data: time constraints, low support, and the high cost of formal care. This exploratory study highlights the importance of intervention tactics for African American dementia caregivers that focus not only on individual and family support but also community-based outreach and support.

Using Artificial Intelligence to Develop a Lexicon-Based African American Tweet Detection Algorithm to Inform Culturally Sensitive Twitter-Based Social Support Interventions for African American Dementia Caregivers.

We extracted 3,291,101 Tweets using hashtags associated with African American-related discourse (#BlackTwitter, #BlackLivesMatter, #StayWoke) and 1,382,441 Tweets from a control set (general or no hashtags) from September 1, 2019 to December 31, 2019 using the Twitter API. We also extracted a literary historical corpus of 14,692 poems and prose writings by African American authors and 66,083 items authored by others as a control, including poems, plays, short stories, novels and essays, using a cloud-based machine learning platform (Amazon SageMaker) via ProQuest TDM Studio. Lastly, we combined statistics from log likelihood and Fisher's exact tests as well as feature analysis of a batch-trained Naive Bayes classifier to select lexicons of terms most strongly associated with the target or control texts. The resulting Tweet-derived African American lexicon contains 1,734 unigrams, while the control contains 2,266 unigrams. This initial version of a lexicon-based African American Tweet detection algorithm developed using Tweet texts will be useful to inform culturally sensitive Twitter-based social support interventions for African American dementia caregivers.

Aspects of Grit Among Dementia Family Caregivers

Dementia family caregivers often show deep devotion and a strong sense of purpose and duty toward their relatives needing care. The concept of grit, which includes aspects of commitment, purpose, perseverance, and resilience, is a novel theoretical approach to expanding understanding of dementia family caregiver strengths amidst the challenges they face. Multiple psychosocial and contextual factors are likely to interact with and influence grit among these caregivers. This symposium addresses commitment to the family dementia caregiver role, willingness to embrace the stressful work of caregiving, and perseverance in finding ways to sustain caregiving roles under typical and adverse circumstances. Blieszner focuses on associations between grit and stressors and strains that challenge caregiver well-being and jeopardize continued caregiving. Wilks considers the impact of spiritual support on sustaining resilience among Caucasian and African American dementia caregivers. McCann explores caregivers’ responses to changes in informal support and social interactions available to assist with home care tasks over the course of the COVID-19 pandemic. Albers examines the strengths and resources caregivers draw upon to manage the challenges of caring for and supporting a relative in long-term residential care during the pandemic. Collectively, these presentations provide new insights into the range of influences on aspects of grit and circumstances in which grit sustains caregiving. Discussant Margrett considers the value of the concept of grit for furthering understanding of caregivers’ abilities to manage typical and unique challenges in their caregiver roles and offers suggestions for future research and interventions to enhance grit among dementia family caregivers.

Experiences of African American Dementia Caregivers During the COVID-19 Pandemic

African American caregivers are often confronted with the complexities of caregiving through the lens of race and associated health disparities. The COVID-19 pandemic has both exacerbated the systemic disparities and deeply rooted inequities experienced by African Americans and laid bare their effects on the community of caregivers. The purpose of this project was to explore the experiences of African American dementia caregivers during the COVID-19 pandemic. Nineteen African American caregivers of persons living with dementia were recruited by primary investigators and community partners with purposeful sampling techniques to participate in semi-structured focus groups that were held April 2021. Four overarching themes were constructed during thematic analysis: social isolation, decreased well-being, the good and bad of telehealth, and challenges in fulfilling the caregiver role. Caregivers expressed that they became socially isolated from family and friends, which led to them becoming depressed and mentally strained. Several caregivers felt they could not carry out their caregiver duties due to the constraints surrounding the pandemic. The varying levels of interaction with and the comfort level of physicians utilizing telehealth led to caregivers having mixed reviews on the popularized service. The results of this study will be used to culturally adapt caregiving education courses and programs promoting mastery and competency during a pandemic. In preparations for future public health crises, healthcare professionals will be able to use the results of this study to address the specific needs and improve the experiences of African American dementia caregivers.

Feasibility of the ACTPlan Program for African American Dementia Caregivers: A Self-Directed Multimedia Delivery

African Americans (AA) are less likely than White Americans to complete advance care plans or end-of-life treatment documents. They face significantly greater risk of Alzheimer’s Disease, a silent epidemic for this population, and other dementias. The healthcare system’s lack of dementia support for AAs contributes to disparate care. A four-session caregiver group education program was conducted on advance care planning for AA dementia family providers. The program was based on Kolb’s Experiential Learning Model and initially found effective in an R01 study using in-person delivery by a professional. The present pilot assessed feasibility of delivering the program in a self-directed multimedia format without professional facilitation, using Session 1 on tube feeding decisions as the test session. Twenty-six AA dementia caregivers completed the session in groups of 5 to 8 at a church equipped with a large TV screen. On-screen prompts guided navigation through the program which included recorded lecture, slides, short videos on decision-making, and group discussions. Using quantitative and qualitative methods, pre-and post-survey instruments were administered and interviews conducted. Usability ratings averaged 84%. Knowledge and self-efficacy gains exceeded those of the R01, with a 35% increase in correct responses on knowledge items, versus 18% for the R01 subjects; and increase in perceived decisional self-efficacy of 31% versus 30% for the R01 subjects. Qualitative feedback was universally positive. These findings confirm the feasibility of the self-guided multimedia approach to delivery of the program. A large RCT is planned which, if successful, will support wide dissemination to AA caregivers in need.

Resilience and Service Needs Among African American Caregivers of People With Dementia: A Pilot Mixed-Methods Study

African American caregivers face unique challenges and strengths in addressing the needs of dementia care recipients. The purpose of the current study was to explore the roles of the familism and faith and service preferences and needs for African American dementia caregivers. Through collaborative partnerships among the research team, Alzheimer’s’ Association, Area Agency on Aging, and local churches, we obtained focus group and survey data (N=30) from African American dementia caregivers. Most caregivers were female (90%) and older than 51 years and had provided care more than 3 years. CGs showed strong cultural reasons (e.g., faith, duty, paying back) for providing care (range 0-40;M= 34.5; SD= 5.2). Focus groups data, which was audio taped, transcribed, and analyzed by three researchers using content analysis, revealed three major themes related to dementia care experiences and needs. First, caregivers explained positive aspects of caregiving for both the individual caregiver and family (growth in faith, sense of self -efficacy, feeling of gratefulness). Second, caregivers also described negative aspects that pose substantial challenges such as lack of services, lack of balance in life, family conflicts over care, and mistrust based on their previous experiences with existing health care systems. Third, caregivers described their knowledge of dementia and shared their self-care and coping strategies and a need for support group services. The findings show an urgent need to implement culturally responsive services, especially in undeserved areas and populations, for caregivers to maintain or improve their emotional well-being and quality of care as well as family relationships.

Abstract WP437: Where Are We Located Now With Artificial Neural Network? Application of Deep Learning for the Development of Culturally Sensitive Social Support Interventions for Dementia Caregivers

Introduction: Little is known about culturally sensitive interventions for Hispanic and African American family caregivers for persons living with vascular dementia. Applications of deep-learning neural networks have expanded rapidly in recent years, from the first uses in character recognition (1989) to the high-profile AlphaGo (2016) from Google DeepMind. The purpose of this study is to visualize topics from health literature that use deep learning, exploring the techniques’ ability to provide a foundation for developing culturally sensitive Twitter-based social support interventions for Hispanic and African American dementia caregivers. Methods: The corpus of deep learning literature was extracted from 506 studies mentioning deep learning from PubMed library. Text mining was conducted using AutoMap to identify topics and semantic relations from the corpus. Results were visualized as network clusters of frequently applied topics and isolated topics. Results: Literature applying deep learning are limited to 1) imaging and radiology, 2) genomics, 3) cancer (N=506 studies). Topics on dementia and drug discovery were identified as an emerging area for the adaptation of deep learning techniques (Figure 1). Only seven journals in the PubMed library were identified as having published more than 10 studies applying deep learning methods. Conclusion: Despite its popularity in art and science research, deep learning is at an early stage of adoption in health science, largely focused on limited topics, e.g., imaging and disease diagnosis. Applying deep learning methods may provide insights for developing culturally sensitive Twitter-based interventions for Hispanic and African American dementia caregivers. Implementing education on applying deep learning to imaging and vascular-dementia prediction may be a good start to adapt, deepen and broaden the scope of health analytics to improve vascular dementia patients’ health outcomes.

Community resource referral needs among African American dementia caregivers in an urban community: a qualitative study

BackgroundAfrican American caregivers of community-residing persons with dementia are mostly unpaid and have high rates of unmet basic and health needs. The National Alzheimer’s Project Act (NAPA) mandates improved coordination of care for persons with dementia and calls for special attention to racial populations at higher risk for Alzheimer’s Disease or related dementias (ADRD) to decrease health disparities. The purpose of this study is to describe the perceptions of African American caregivers of people with dementia about community resources needed to support caregiving as well as their own self-care.MethodsUsing a qualitative study design, in-depth, semi-structured qualitative interviews were conducted with caregivers (N = 13) at an urban geriatric clinic to elicit community resource needs, barriers to and facilitators of resource use and how to optimize clinical referrals to community resources. Caregivers were shown a community resource referral list (“HealtheRx”) developed for people with dementia and were queried to elicit relevance, gaps and insights to inform delivery of this information in the healthcare setting. Data were iteratively coded and analyzed using directed content analysis. Results represent key themes.ResultsMost caregivers were women (n = 10, 77%) and offspring (n = 8, 62%) of the person with dementia. Community resource needs of these caregivers included social, entertainment, personal self-care and hospice services. Main barriers to resource use were the inability to leave the person with dementia unsupervised and the care recipient’s disinterest in participating in their own self-care. Facilitators of resource use included shared caregiving responsibility and learning about resources from trusted sources. To optimize clinical referrals to resources, caregivers wanted specific eligibility criteria and an indicator of dementia care capability.ConclusionsAfrican American caregivers in this study identified ways in which community resource referrals by clinicians can be improved to meet their caregiving and self-care needs.

Telephone-delivered Mindfulness Intervention for African American Dementia Caregivers

Telephone-delivered Mindfulness Intervention for African American Dementia Caregivers

Effects of in-person and telephone-based cognitive behavioral therapies on health services use and expenditures among African-American dementia caregivers with depressive symptoms

ABSTRACT Objectives: To compare the effects of telephone-based and in-person cognitive behavioral therapy (CBT) on health services use and expenditures among African-American dementia caregivers (CGs) with depressive symptoms. Methods: We analyzed data collected from 109 caregivers in a randomized controlled trial comparing the effects of telephone-based and in-person CBT on health services use and costs. Study participants were assigned randomly to either telephone or in-person CBT. Data were collected one week before and one week after the 12-week intervention. The Health Service Composite (HSC) was used to collect information on health services (physical and mental health, emergency room, hospital) utilization and associated expenditures. Intervention cost data were collected using micro-costing analysis. We used generalized linear models to examine whether the two groups differed in total health care expenditures over the six-month study period. Results: CG characteristics and health services use were similar at pre-intervention. CGs’ monthly health expenditures averaged $924 and $844 in the in-person and telephone-based groups, respectively. However, intervention costs were lower for telephone-based than in-person CBT. Adjusting for CG characteristics and pre-intervention health status, there were no statistically significant differences in average monthly expenditures between the two intervention groups across time. Discussion: Findings suggest that while telephone-based CBT offers more participation flexibility, it has a similar cost profile as compared to the in-person CBT. Despite the lack of cost saving, telephone-based CBT may be an important option for providing skills building and support to older African-American family CGs with barriers to access resources for respite care and transportation.

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.

African American Dementia Caregiver Problem Inventory: Descriptive analysis and initial psychometric evaluation.

The primary objectives of the present study were: (a) to develop the African American Dementia Caregiver Problem Inventory (DCPI-A) that assesses the types and frequency of problems reported by African American dementia caregivers seeking cognitive-behavioral intervention, (b) to evaluate the intercoder reliability of the DCPI-A, and (c) to measure the perceived severity of common problems reported by this caregiver population. The development of the DCPI-A was divided into 3 major steps: (a) creating an initial sample pool of caregiver problems derived from 2 parent randomized clinical trials, (b) formulating a preliminary version of the DCPI-A, and (c) finalizing the development of the DCPI-A that includes 20 problem categories with explicit coding rules, definitions, and illustrative examples. The most commonly reported caregiver problems fell into 5 major categories: (a) communication problems with care recipients, family members, and/or significant others, (b) problems with socialization, recreation, and personal enhancement time; (c) problems with physical health and health maintenance, (d) problems in managing care recipients' activities of daily living; and (e) problems with care recipients' difficult behaviors. Intercoder reliability was moderately high for both percent agreement and Cronbach's kappa. A similar positive pattern of results was obtained for the analysis of coder drift. The descriptive analysis of the types and frequency of problems of African American dementia caregivers coupled with the outcomes of the psychometric evaluation bode well for the adoption of the DCPI-A in clinical settings. (PsycINFO Database Record

The Senior Companion Program Plus: A culturally tailored psychoeducational training program (innovative practice).

A purposive sample of African American Senior Companions (N = 23) participated in a 5-day, 20-hour psychoeducational training designed to address the unique cultural needs of African American dementia caregivers. Previous studies have not utilized lay caregiver volunteers such as Senior Companions in dementia research in the United States. Pre- and post-tests were administered to determine whether African American Senior Companions increased their knowledge of Alzheimer's disease after participating in the Senior Companion Program Plus. Results from both the quantitative and qualitative data suggest that participants improved their understanding of Alzheimer's disease. Findings from the Senior Companion Program Plus pilot warrant further study for its potential as cost effective, culturally tailored training for Senior Companions who serve persons with dementia and their family caregivers.

Factors Associated with Unmet Needs among African-American Dementia Care Providers.

Racial and ethnic minorities currently comprise 20% of the U.S. population; in 2050, this figure is expected to rise to 42%. As a result, Alzheimer’s disease (AD), the 5th leading cause of death for people aged 65 and older, is likely to increase in these groups. Most dementia caregiving for these populations comes from family and friends, especially among families with lower socioeconomic status. A convenience sample of 30 African-American dementia caregivers was interviewed to determine unmet needs. Participants expressed a limited desire for formal services, such as support groups, legal advice, case management, and homemaker services. Instead, commonly expressed needs were daytime respite care and especially a desire for family and social support. Many caregivers expressed a need for other family members to share responsibility in the process; therefore, methods for caregiver support that address multiple family members in care provision may be beneficial for this group.