Associations of knowledge of Alzheimer’s disease and memory loss and employment status with burden in African American and Caucasian family caregivers

Abstract

Caring for an individual living with Alzheimer’s disease and other forms of dementia is especially challenging and impacts every aspect of the lives of the family caregivers. Family caregiving is defined as informal, unpaid care provided by family or friends to people with a chronic illness or disability. Caregiver burden, often experienced by a caregiver for a cognitively impaired family member, is multifaceted involving physical, psychological, social, and emotional problems. To date, little has been done to examine the relationship between the knowledge of Alzheimer’s disease and memory loss and caregiver burden. To fill this gap, a cross sectional, correlational design was employed to collect data from a convenience sample (N = 104) of African American and Caucasian dementia family caregivers. For this study, caregivers ranged from 25 to 89 years of age with African American caregivers possessing significantly lower levels of knowledge about Alzheimer’s disease and other dementias compared to Caucasian caregivers, p < .001. There were 44 caregivers who scored 41 or greater on the Caregiver Burden Inventory corresponding to moderate to severe and higher levels of burden. Results of hierarchical multiple regression models indicated that higher levels Alzheimer’s disease knowledge was significantly associated with lower caregiver burden for all caregivers, B = −0.294, p < .01. Additionally, employment status was significantly associated with caregiver burden. This study highlights the benefits of including disease specific knowledge within educational components of dementia related interventions and programs involving families.

Keywords

dementia family caregivers caregiver burden Alzheimer's disease knowledge caregiver employment status Alzheimer's disease

Introduction

Family caregivers are essential in the lives of persons living with dementia (Scott, 2013). Approximately 15.7 million individuals provide assistance with daily needs in comfortable and familiar environments to those diagnosed with Alzheimer’s disease or other forms of dementia (Alzheimer’s Association, 2017). On average, dementia family caregivers spend 24 hours per week providing care with activities of daily living and managing behavioral symptoms (National Alliance for Caregivers & AARP, 2015). Regardless of the rate of disease progression, family caregivers experience challenges that are both emotionally and physically detrimental (Alzheimer’s Association, 2017; McCabe, You, & Tatangelo, 2016). Literature suggests that the chronic stress associated with providing care to a loved one with Alzheimer’s disease can have a deleterious impact on physical and mental health (Schoenmakers, Buntinx, & Delepeleire, 2010).

In addition to the negative impact caregiving has on those caring for persons living with Alzheimer’s disease or other dementias, caring for individuals with Alzheimer’s disease will likely account for a significant amount in healthcare costs (Mausbach, Chattillion, Roepke, Patterson, & Grant, 2013). Family caregivers to those living with Alzheimer’s disease or other dementias constitute a valuable national health resource in that they provide approximately 70% of healthcare in the United States and offer millions of unpaid hours to care for their loved ones annually (Alzheimer’s Association, 2017). It is estimated that the economic value of dementia family caregiving was approximately $230.1 billion in 2016 (Alzheimer’s Association, 2017). Considering the burgeoning health care budget and the documented burden of dementia family caregivers, policymakers and practitioners are giving more attention to support the sustainability of family caregivers of persons living with Alzheimer’s disease or other dementias (National Academies of Sciences, Engineering, and Medicine, 2016). One way to support and sustain dementia family caregivers is through improving the caregivers’ knowledge of Alzheimer’s disease and other dementias, highlighted during the White House Conference on Aging (2015).

In other chronic conditions, individuals with increased disease-related knowledge had better health outcomes than those with limited knowledge (McCleary-Jones, 2011). Individuals with limited disease-related knowledge fared worse than their peers which resulted in increased hospitalization, emergency room visits, and infrequent use of preventive services, all which are associated with higher health care costs (Berkman et al., 2004; McCleary-Jones, 2011). While evidence establishes the benefit of disease-related knowledge in managing many chronic diseases (Berkman et al., 2004; McCleary-Jones, 2011), limited research has been done on the benefit of increased knowledge of Alzheimer’s disease and other dementias.

Caregiver burden

Caregiver burden is inclusive of physical, psychological, social, and financial demands (Kim, Chang, Rose, & Kim, 2012) as a result of caregiving. Worsening symptoms of Alzheimer’s disease and other dementias result in increased emotional stress and depression of dementia family caregivers, contributing to caregiver burden (Alzheimer’s Association, 2017). Pearlin, Mullan, Semple, and Skaff’s (1990) Stress Process framework provides a comprehensive understanding of caregiver burden. Determinants within this widely used model consist of contextual variables, stressors, and mediators, that contribute to caregiver outcomes (Sörensen & Conwell, 2011). Contextual variables include socio-demographic information for family caregiver and persons Alzheimer’s disease or other dementias. Stressors may be primary or secondary. Primary stressors include variables for family caregivers and persons living with Alzheimer’s disease and other dementias (e.g., cognitive status, problem behaviors, and functional dependencies). Secondary stressors are those that are related to roles and activities outside of the caregiving situation.

Employment is considered a secondary stressor. Employment is not directly related to the care needs of the person living with Alzheimer’s disease or other dementias; however, combining work and caregiving responsibilities that interfere with work is difficult and may be attributable to dementia family caregiver burden (Bauer & Sousa-Poza, 2015). Often, dementia family caregivers must reduce their work load or even quit their jobs to provide sufficient care (Bullock, Crawford, & Tennestedt, 2003; Laks, Goren, Dueñas, Novick, & Kahle-Wrobleski, 2016; National Alliance for Caregiving & AARP, 2015). For some, however, work is stress-buffering in that the time spent at work is a pleasant distraction from their caregiving responsibilities and offers social interaction not received by unemployed caregivers who spend the greater part of their day inundated in their caregiving responsibilities. This is especially true if the caregiver has established relationship quality among colleagues (Brody, 1990; Scharlach, 1994; Wang, Shyu, Tsai, Yang, & Yao, 2013).

Caregivers experience greater depressive symptoms including higher rates of fear, hostility, and sadness (Mausbach et al., 2013). While in their caregiving role, they often identify a loss of control in life, health problems, and diminishing social life as ways caregiving has directly impacted their lives (Springate & Tremont, 2014). Additionally, caregivers suffer from guilt related to feelings that they could do a better job and embarrassment from exhibiting irritation (Springate & Tremont, 2014). Caregivers also indicated significantly lower access to several psychological resources than non-caregivers, including social support, personal mastery, seeking social support, pleasant activities, self-efficacy for problem-focused coping, and self-efficacy for getting social support (Mausbach et al., 2013). Furthermore, because of the associated behavior and demanding load, dementia family caregiving is a more challenging caregiving role which leads to increased caregiver burden (Huang, Lee, Liao, Wang, & Lai, 2012).

Previous research findings substantiate the psychological impact of caregiver burden on dementia family caregivers. There are high rates of stress, distress, and psychological illness (e.g., depression) in family caregivers of persons living with Alzheimer’s disease or other dementias (Mahoney, Regan, Katona, & Livingstone, 2005). The effects of caregiver burden on dementia family caregivers place them at risk for negative outcomes and stretch across physical, psychological, and economic aspects of the caregiver's’ life (Losada, Marquez-Gonzalez, & Romero-Moreno, 2010; Tan, Jennings, Ramirez, Kofman, & Ercoli, 2017). Dementia family caregivers are often more depressed than the general population and caregivers for those with other chronic illnesses (Schoenmakers et al., 2010).

Comparisons of caregiver burden in minority populations have also been described, with encouraging, yet mixed findings (Bekhet, 2015; Belle et al., 2006; Cjaza, Loewenstein, Schulz, Sankaran, & Perdomo, 2013). For example, some studies suggest African Americans have lower baseline burden scores compared to other racial/ethnic groups (Bekhet, 2015; Belle et al., 2006; Cjaza et al., 2013; Elliot, Burgio, & DeCoster, 2010; Glueckauf et al., 2012). African American caregivers were found to be more resilient in response to the negative effects of caregiving and experience less burden than their Caucasian caregiving peers (Haley et al., 1996). Also, African American caregivers compared to their Caucasian caregiver peers report increased life satisfaction, fewer depressive symptoms, and were more satisfied with social supports (Clay, Roth, Wadley, & Haley, 2008).

Additional studies show that over time African American family caregivers demonstrate minimal or no further improvement in burden scores (Bekhet, 2015; Belle et al., 2006; Cjaza et al., 2013; Elliot et al., 2010) or limited improvement (i.e., spouses) (Belle et al., 2006). One suggested reason for these mixed findings posits that African Americans may not need or benefit from certain aspects of the interventions tested (Cjaza et al., 2013). In addition, measurement differences, low sample sizes which may skew findings, and aggregated data by intervention group of minorities without a focus on across racial differences could be attributed. Based on the literature, further attention is needed as African American family caregivers who may report lower burden overall, do not seem to improve, increasing their health risk.

Unaddressed caregiver burden can lead to physical frailty and poor health in dementia family caregivers. Dementia family caregivers are at greater risk for chronic illness such as heart disease or diabetes, even death (Alzheimer’s Association, 2015); all of which have negative implications for the caregiver dyad. Consequently, dementia family caregivers, often characterized as the “forgotten patient”, may experience the exacerbation of already diagnosed chronic conditions and other comorbidities (Laks et al., 2016; Levine, 2003). Mounting evidence substantiates the relationship between dementia family caregiving and its detriment on the physical condition of the caregiver (Alzheimer’s Association, 2015; Laks et al., 2016).

Caregiver knowledge of Alzheimer’s disease

Given the progressive process of Alzheimer’s disease or other dementias and the associated challenges, dementia family caregivers need education about the disease and care methods (Pahlavanzadeh, Heidari, Maghsudi, Ghazavi, & Samandari, 2010). Werner (2001) aimed to assess family caregivers’ level of knowledge about Alzheimer’s disease and its correlates when she surveyed 220 informal caregivers of individuals living with Alzheimer’s disease or other dementias. Werner (2001) found that caregivers had low levels of knowledge, particularly related to the prevalence, cause, and symptoms of Alzheimer’s disease or other dementias. Dieckmann, Zarit, Zarit, and Gatz (1988) extended research in this area to examine the benefit of Alzheimer’s disease knowledge and found that dementia family caregivers who lack understanding about Alzheimer’s disease and its progression may not function at an optimal level and be at risk for caregiver burden. Additionally, it is inferred that better public knowledge concerning Alzheimer’s disease and other dementias will result in earlier recognition of disease and improve the likelihood of proper treatment (Blay, Furtado, & Peluso, 2008). As a result, dementia family caregivers with increased knowledge of Alzheimer’s disease or other dementias are more likely to seek help and use more formal services (Ayalon & Areán, 2004).

In response to the unique challenges caregivers and persons living with Alzheimer’s disease or other dementias face, Kuhn and Fulton (2004) created an educational program for family caregivers to increase the Alzheimer’s disease knowledge and coping responses. The results indicated a positive impact for family caregivers participating in the program. Caregiver’s Alzheimer’s disease knowledge improved as did their self-efficacy and reactions to the care recipient’s impairment of their family member living with Alzheimer’s disease or other form of dementia (Kuhn & Fulton, 2004). Pahlavanzadeh et al. (2010) conducted a more recent study to assess the relationship between the Alzheimer’s disease knowledge and caregiver burden. Dementia family caregivers participated in a five-week education program and caregiver burden was assessed before, right after, and month one after participating in the program. Results indicated a decrease in caregiver burden, suggesting that better knowledge and understanding of dementia may decrease the burden caregivers often feel (Pahlavanzadeh et al., 2010).

Misconceptions and underutilization of services are often reported in studies with racial and ethnic minority populations (Ayalon & Areán, 2004; Jang, Kim, & Chiriboga, 2010). Ayalon and Areán (2004) surveyed four ethnic groups of older adult caregivers to assess knowledge of Alzheimer’s disease and found that certain ethnic groups, such as African American, Asian, and Latino adults, do not have sufficient information about Alzheimer’s disease, and this may explain the lack of services used by minorities (Ayalon & Areán, 2004). Roberts et al. (2003) explored the differences between African Americans and Caucasians regarding their beliefs and knowledge on Alzheimer’s disease and found both racial groups were generally similar in their beliefs about common symptoms, risk factors, and effectiveness of treatments. However, African Americans displayed less awareness of facts about Alzheimer’s disease, described fewer sources of information, and showed less perceived threat of the disease (Roberts et al., 2003).

As emphasized throughout literature, knowledge of Alzheimer’s disease and other dementias is important for both early detection and suitable treatment. Successful interventions and other methods of care can be facilitated by proper knowledge of Alzheimer’s disease and the utilization of appropriate services (Alzheimer’s Association, 2017; Jang et al., 2010). Current literature and research regarding the relationship between knowledge of Alzheimer’s disease and memory loss and caregiver burden is limited. To extend knowledge in this area, this study will examine the knowledge of Alzheimer’s disease and memory loss in African American and Caucasian family caregivers and the relationship between this knowledge and self-perceived caregiver burden. Specifically, this study will seek to answer the following research questions:

What is the relationship between knowledge of Alzheimer’s disease and memory loss with caregiver burden among African American and Caucasian dementia family caregivers?

What is the relationship of employment status with caregiver burden among African American and Caucasian dementia family caregivers?

Are there racial differences on study variables for African American and Caucasian dementia family caregivers?

Methods

Sample

A convenience sample of Alzheimer’s disease family caregivers was recruited from dementia family caregivers listed on the database of the local Alzheimer’s Association and a service agency for dementia families in a southern state. To be included in this study, the self-identified caregivers provided daily care for an individual who is diagnosed with Alzheimer’s disease or other dementias. The diagnosis may have come from a physician or psychological testing. Given the focus on dementia family caregivers, formal and paid caregivers were excluded from this study. For the current analysis, three caregivers who identified as a racial category other than African American or Caucasian and five caregivers who specified their relationship with the care recipient as something other than spouse or child were not included. This resulted in the analytic sample of 104 family caregivers.

Measures

Demographics

Each participant completed a biographical information sheet of basic demographics, such as age, gender, employment status, and race. Employment status was categorized as full-time, part-time, retired, or unemployed. Participants self-reported their relationship to the person living with dementia as a spouse, adult child, or other relationship type caregiver. Data regarding their length of time providing care and whether they co-resided with the care recipient was also collected.

Knowledge of memory loss and Alzheimer’s disease

Alzheimer’s caregiver knowledge was measured using the Knowledge about Memory Loss and Care (KAML-C) test (Kuhn, King, & Fulton, 2005). The KAML-C is a reliable 15-item measure that was developed to measure Alzheimer’s disease and memory loss knowledge in Alzheimer’s caregivers in the areas of medical information, caregiving, and legal and financial planning. One point is given for each correct response. Higher scores suggest greater knowledge of Alzheimer’s disease and memory loss.

Caregiver burden

Caregiver burden was measured using the Caregiver Burden Inventory (Novak & Guest, 1989). The CBI is a widely used 24-item global measure of burden capturing both the objective and subjective aspects of caregiver burden and has a potential scoring range of 0 to 96. Higher scores correspond to more caregiver burden. The CBI exhibited good internal consistency within this sample, α = .91.

Analyses

All analyses were conducted using SAS V9.1.3 (SAS Institute Inc., 2004). Means and frequencies were computed, and t-tests and chi-square analyses were used to compare sociodemographic data (e.g., age, years of caring, caregiver burden and employment) of African American and Caucasian caregivers. Hierarchical multiple regression models were conducted to examine the covariate-adjusted relationships between variables of interest and caregiver burden. An initial model examined the bivariate association between race and burden. Subsequently, additional models added blocks of demographics, employment status, and caregiver knowledge about memory loss. Of particular interest was whether each block increased the variance accounted for after taking into account the previous blocks. This was accomplished by utilizing the increment change in R-square test.

Results

Descriptive statistics for study participants are presented in Table 1 (N = 104). On average, the sample of caregivers was 63 years old and the majority (80%, n = 88) was female. Fifty-two (47%) caregivers were African American; 64 (62%) were children caring for a parent, and 60 (58%) lived with the person they were caring for. There were 44 caregivers (42%) who scored 41 or greater on the CBI corresponding to moderate to severe and higher levels of burden. Caregivers answered approximately 60% of the KAML-C questions correctly with African American caregivers possessing lower levels of knowledge of Alzheimer’s disease and memory loss compared to Caucasian caregivers (7.69 vs. 9.53; p < .05). African American caregivers had been providing care longer than Caucasian caregivers (5.20 vs. 4.06 years), and a higher percentage of African American caregivers resided with their family member living with dementia care recipient (75.00% vs. 42.86%), p values < .05. There were no other racial differences observed within the sample for demographic characteristics.

Table 1.

Racial comparisons on study variables (N = 104).

Variable	African American/Black (non-Hispanic)n = 48	White (non-Hispanic)n = 56	t (χ²)	p value
Age, mean (SD)	61.88 (11.52)	64.23 (10.81)	−1.08	.2848
Years providing care, mean (SD)	5.20 (3.41)	4.03 (2.45)	2.03	.0449
Gender, n (%)
Female	41 (85.42)	41 (73.21)	(2.31)	.1288
Male	7 (14.58)	15 (26.79)
Relationship, n (%)
Spouse	16 (33.33)	24 (42.86)	(0.99)	.3196
Child	32 (66.67)	32 (57.14)
Co-residence with AD patient, n (%)
Yes	36 (75.00)	24 (42.86)	(10.94)	.0009
No	12 (25.00)	32 (57.14)
Employment status, n (%)
Full-time	13 (27.08)	15 (26.79)	(3.54)	.3155
Part-time	2 (4.17)	7 (12.50)
Retired	15 (31.25)	20 (35.71)
Unemployed	18 (37.50)	14 (25.00)
Knowledge about memory loss and care, mean (SD)	7.75 (2.43)	9.63 (2.44)	−3.92	.0002
Caregiver burden, mean (SD)	40.13 (14.22)	39.05 (18.25)	0.33	.7422

Due to the age differences between spouse and child caregivers, relationship to the person living with dementia and not age was included in the multivariate analyses. Results of the hierarchical regressions predicting caregiver burden are presented in Table 2. Model 1 revealed that there was no bivariate relationship between race and caregiver burden and that race alone did not account for a significant amount of variability in caregiver burden. The addition of years providing care, gender, relationship to the care recipient, and co-residence accounted for a significant amount of variance above and beyond the variance accounted for by race, R² Δ = .116, p = .016. There was a significant relationship between years providing care and caregiver burden for this model. Overall, providing more years of care was associated with higher levels of caregiver burden. Subsequently, in Model 3, there was a trend for employment status accounting for more variance above and beyond the variance accounted for by race and demographic variables, R² Δ = .068, p = .053. Finally, the addition of caregiver knowledge about memory loss in Model 4 accounted for a significant amount of variance above and beyond the variance accounted for by race, demographic variables, and employment status, R² Δ = .066, p = .005. In the final model, employment status (unemployed vs. full-time employment, B = .330, p = .004) and knowledge about memory loss (B = −.294, p = .005) were significantly associated with caregiver burden. Caregivers who were unemployed reported more burden than those who were employed full-time, and having higher levels of knowledge about memory loss was associated with less caregiver burden. There was also a trend for African Americans reporting less caregiver burden than Caucasians in this final covariate-adjusted model (B = −.185, p = .075).

Table 2.

Hierarchical regression models for the associations between race, demographics, employment status, knowledge about memory loss, and caregiver burden (N = 104).

Measures	Model 1	Model 2	Model 3	Model 4
African American race	.024	−.092	−.110	−.185^
Years providing care		.207*	.160	.124
Female gender		.088	.073	.090
Spouse caregiver		.061	.080	.116
Co-residence		.210^	.210^	.120
Employment status
Part-time vs. Full-time			.042	.016
Retired vs. Full-time			.083	.119
Unemployed vs. Full-time			.306**	.330**
Knowledge about memory loss				−.294**

Note. Standardized betas are presented; ^p < .10, *p < .05, **p < .01, ; full-time employment status was used as the reference group.

Model 1: R² Δ = .001, p = .810; Model 2: R² Δ = .116, p = .016; Model 3: R² Δ = .068, p = .053; Model 4: R² Δ = .066, p = .005.

Discussion

The purpose of this study was to examine the relationship between the family caregiver’s knowledge of Alzheimer’s disease and other dementias to caregiver burden. This study sought to explore racial differences and examine relationships between Alzheimer’s disease and memory loss knowledge and caregiver burden for African American and Caucasian American family caregivers. Results of this study indicated that increased knowledge of Alzheimer’s disease and memory loss was beneficial for African American and Caucasian dementia family caregivers. Results also indicated a trend toward a statistically significant difference in the level of knowledge between African American and Caucasian family caregivers, with African Americans appearing to have lower levels of Alzheimer’s knowledge and memory loss than Caucasian family caregivers. This finding is consistent with previous research that examined knowledge of Alzheimer’s disease and other dementias in a diverse group of non-caregiving older adults and found that African American older adults had less Alzheimer’s disease knowledge than their Caucasian peers (Ayalon & Areán, 2004). It is important to note that level of education, economic, and cultural factors may be contributing factors in the knowledge difference observed between African American and Caucasian dementia family caregivers.

Dementia family caregivers in this study reported moderate to severe levels of caregiver burden. This finding is also consistent with previous research (D’Onofrio et al., 2015, Papastavrou, Kalokerinou, Papacostas, Tsangari, & Sourtzi, 2007). Interestingly, findings in this study indicated no significant difference in caregiver burden between African American and Caucasian family caregivers. This finding is inconsistent with previous research that suggests that African American caregivers are less burdened than their Caucasian caregiver peers (Bekhet, 2015). Bekhet (2015) suggest that resourcefulness, positive thinking, and well-being act as a buffer against caregiver burden. A plausible explanation for this finding is that both African American and Caucasian caregivers in this study had access to and receive services that likely yielded a greater sense of well-being and increased resourcefulness in both groups of family caregivers.

In addition to providing further evidence on the benefit of Alzheimer’s disease and memory loss knowledge for family caregivers, the results of this study provided further understanding on the relationship between caregiver burden and employment. Specifically, unemployed caregivers reported more caregiver burden than did those who were employed full time. The Role Enhancement perspective (Marks, 1977) provides a framework that helps to better understand why employed caregivers may experience less caregiver burden than unemployed caregivers. This perspective posits that having multiple roles offers positive outcomes such as role privileges, status security resources for enhancement, and personality gratification. Rozario, Morrow-Howell, and Hinterlong (2004) found this to be true in their examination of caregivers with multiple roles. Specific results of that study indicated that family caregivers with multiple roles reported significantly better self-rated health (Rozario et al., 2004). Also, employed caregivers may experience an energy-gains rather than energy-expenditures experience while operating in these competing roles (Marks, 1977). Wang et al. (2013) found that low work conflict and caregiver preparedness decreased the impact of care-giving demands on mental health. Given that 6 in 10 of dementia family caregivers are employed (Alzheimer’s Association, 2017), additional research is necessary to fully understand the relationship between employment and dementia family caregiver burden.

The findings in this study are compelling and have both policy and practice implications. As part of their assessment of dementia family caregivers, clinical practitioners should identify stressors in both caregiver and persons living with Alzheimer’s disease or other dementias that contribute to caregiver burden and incorporate them in dementia training, education, and interventions. Increased knowledge of Alzheimer’s disease and other dementias will likely yield caregivers with a greater understanding of the associated behavioral manifestations, and the social and physical limitations associated with dementias and who then will be better equipped to make caregiving decisions. Policy implications suggest the need for expanded health care policy that will provide funding for additional services and resources for caregiver education and support.

Limitations

While the cross-sectional study design was an efficient way to determine the association between Alzheimer’s disease and memory loss knowledge and caregiver burden, the internal validity of the study is limited, and there is no evidence that supports causality between the variables. Additional results from an examination of the association over time are needed to help explain the findings. Additionally, the use of a small convenience sample limits the ability to extend study findings to the general population of Alzheimer’s disease family caregivers; thus, the findings in this study have limited generalizability. Also, the small sample size reduces the statistical power for examining important associations in the covariate-adjusted models, such as the association between races and caregiver burden. The findings in this study are also limited by the use of self-report data. Consequently, self-report data can lead to response bias which would occur if research family caregivers responded according to what they deemed socially desirable rather than provide a response that reflects their caregiving experience. Finally, the lack of education level data of the family caregiver compounds the findings in a manner that makes it difficult to interpret if low levels of Alzheimer’s disease and memory knowledge are a result of low literacy or a lack of disease-related knowledge. Collecting education attainment level in future research would fill this gap.

Limitations notwithstanding, the findings of this study have research and practice implications. Future research in this area will benefit from a larger sample to increase the generalizability of findings to the general population of family caregivers. A measure of knowledge of Alzheimer’s disease, other dementias and memory loss that has been tested with minority groups will increase the validity of future research findings. In practice with family caregivers, the social service practitioner should use interventions in practice that offer knowledge and support, such as psychoeducational support groups. The medical provider should also be aware of the health literacy of individuals and family caregivers to ensure that knowledge provided is understood and effectively applied.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Cathy B Scott, PhD is an associate professor at the University of Tennessee, Chattanooga and Program Director of the Bachelors of Social Work Program. Dr Scott completed her doctoral studies at the University of Tennessee, Knoxville College of Social Work. She completed both the UAB Geriatric Faculty Scholars and the MUCAAR Aging Research Fellows program and her research focus is on the education and sustainability of dementia family caregivers with a particular interest in reducing caregiver burden in dementia family caregivers.

Olivio J Clay, PhD is currently an associate professor of Psychology at the University of Alabama at Birmingham (UAB). Dr Clay completed his doctoral degree in Lifespan Developmental Psychology at UAB. The overall focus of his research is to aid in developing theory-based, culturally relevant interventions targeted to help reduce health disparities within older adults. Other research interests include caregiving, multiple morbidity, and research methodology. Dr Clay serves as a Scientist within the UAB School of Medicine Alzheimer’s Disease Center and is a Fellow of the Gerontological Society of America.

Fayron Epps, PhD currently serves as an assistant professor at Georgia State University Byrdine F. Lewis College of Nursing and Health Professions and as an affiliate faculty with the Gerontology Institute and Partnership for Urban Health Research. She completed her postdoctoral fellowship with the National Hartford Center of Gerontological Nursing Excellence and is currently a Tideswell Emerging Leaders in Aging Scholar. Her program of research involves evidence-based practices for promoting quality of life for African Americans with dementia and their family caregivers. She is currently working with the faith community to support African American families living with dementia.

Fawn A Cothran, PhD RN GCNS-BC is an assistant professor in the Family Caregiving Institute at the Betty Irene Moore School of Nursing at UC Davis. She works to support health and well-being for persons with chronic and serious illnesses as well as their family and caregivers, with an emphasis on older adults. She is a 2013–2015 Claire M. Fagin Fellow with the National Hartford Centers of Gerontological Nursing Excellence and focuses her research on the physical and mental health of African-American dementia family caregivers.

Ishan C Williams, PhD, FGSA associate professor at the University of Virginia, School of Nursing. Her current research focuses on quality of life among older adults with dementia and their family caregivers, chronic disease management for older adults with type 2 diabetes, and culturally appropriate community-based interventions among African-American adults. Her research further concentrates on understanding the health care needs of older adults and their family caregivers within social, cultural, and geographical contexts.

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