Papers by Francesca Falzarano
Innovation in Aging
The COVID-19 pandemic has disproportionately affected nursing home residents and staff, including... more The COVID-19 pandemic has disproportionately affected nursing home residents and staff, including the nursing assistants who provide critical supports for older adults and people with disabilities. The pandemic has added significant strain to an already vulnerable nursing home workforce, which has historically experienced high levels of turnover, chronic staffing shortages, and high burnout. At the same time, it has generated awareness of the value of the direct care workforce to provide care in places for those most at risk from the disease. Job satisfaction of nursing assistants is as major driver of turnover and intent to leave the job. Research has demonstrated organizational supports and job stresses that are associated with job satisfaction and turnover. However, limited research has investigated the factors associated with job satisfaction in nursing homes during the COVID-19 pandemic. Using data from an employee engagement and management system, we examined organizational su...
Innovation in Aging
The COVID-19 pandemic has accelerated the uptake and use of technology in hosting virtual and hyb... more The COVID-19 pandemic has accelerated the uptake and use of technology in hosting virtual and hybrid (combining virtual and in-person) meetings and events. In this presentation, Dr. Falzarano will describe the ways in which the 2021 Conference on Engaging Family and Other Unpaid Caregivers of Persons with Dementia in Healthcare Delivery leveraged videoconferencing systems (e.g., Zoom) and other web-based platforms (e.g., Qualtrics) to enact a hybrid event. Specifically, she will discuss the various components involved in the event’s planning and execution, including the appointment of a virtual liaison and audiovisual technicians to enable seamless integration and participation of both in-person and virtual attendees. She will also discuss how videoconferencing technology was used to facilitate the delivery of virtual panel presentations; strategies for immersing virtual attendees in both large group discussions and small group breakout sessions; and the process by which virtual att...
Innovation in Aging
The Cornell Institute for Translational Research on Aging (CITRA) Research-to-Practice Consensus ... more The Cornell Institute for Translational Research on Aging (CITRA) Research-to-Practice Consensus Workshop Model is an evidence-based method for generating practice- and policy-informed research agendas on aging-related topics. The model aims to bridge the gap between research-based knowledge and practice-based insight by involving multidisciplinary stakeholders in all aspects of the agenda-setting process. Using the CITRA model as a guiding framework, we convened an NIA-funded Conference on Engaging Family Caregivers of Persons with Dementia in Healthcare Delivery, with the goal of generating actionable research priorities that will lead to improvements in dementia caregiver identification, assessment, and support in health and long-term care settings. Conference attendees were multidisciplinary thought leaders representing five stakeholder groups: family caregivers of persons with dementia, healthcare providers, researchers, payers, and policy advocates. This symposium will describ...
Innovation in Aging
The negative effects of the COVID-19 pandemic on the well-being of direct care professionals (DCP... more The negative effects of the COVID-19 pandemic on the well-being of direct care professionals (DCPs; nursing assistants and aides) in nursing homes (NHs) has led to high rates of DCPs’ turnover and staff shortages - both issues that were already prevalent before the pandemic. More optimal staffing levels and less turnover are essential for optimal NH quality of care, but little is known about factors associated with turnover in DCPs in NHs during the pandemic. Hence, the purpose of this study was to examine the mediating roles of 1) quality of employer communication related to COVID-19; 2) DCPs’ perceived preparedness to care for residents with COVID-19; and 3) DCPs’ job satisfaction in the relationship between overall COVID-19-related work stress and intent to remain in one’s job (an indicator of turnover). Path analyses (N=809) demonstrate a significant, indirect effect between COVID-19-related stress and intent to remain in one’s position through the variables of communication, pr...
Health Equity
Introduction: Bereavement and grief are social phenomena influenced by a multitude of cultural fa... more Introduction: Bereavement and grief are social phenomena influenced by a multitude of cultural factors. Prior studies of bereavement adjustment have primarily focused on bereaved survivors who identify racially as white; knowledge of the experience of grief and bereavement among racial/ethnic and other minority groups, particularly among Latino/a groups, in the United States is limited. Objective: The purpose of this review is to synthesize the literature documenting the bereavement experiences of the Latino/a community, evaluate the strength of the current evidence, and provide recommendations to guide future research. Method: A narrative review of research on grief and bereavement in the Latino/a community published between 1990 and 2021. Two authors used a thematic, deductive approach to categorize emergent prevalent themes from the literature and used The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and The Oxford Center for Evidence-Based Medicine-Evidence Quality Rating Scale (OCEBM) approaches to evaluate the strength of the qualitative and quantitative reports reviewed. Results: Searches revealed 26 reports that were categorized into six themes: cultural values, mourning rituals, immigration, spirituality, disparities related to the COVID-19 pandemic, and the effects of COVID-19 on Latino/a communities. Our evaluation concludes that the evidence in this area is weak, with limited methodologically rigorous research examining the influence of culture on bereavement among Latino/a groups. Conclusion: Research is needed to identify Latino/a groups' mental health, cultural, social, and family needs and how fulfillment of mourning rituals and other cultural factors may promote or impede bereavement adjustment. Investigation into factors that may protect bereaved survivors against adverse mental health outcomes is also needed. A better understanding of Latino/a grief and bereavement is a step toward the development of culturally competent interventions designed to promote the mental health and psychosocial adjustment of Latino/a mourners.
Innovation in Aging, 2020
As cases of Alzheimer’s disease and related dementias (ADRD) continue to rise, informal caregiver... more As cases of Alzheimer’s disease and related dementias (ADRD) continue to rise, informal caregivers are critical resources in providing dementia care, yet caregiving is associated with high levels of burden, stress, anxiety and depression. Caregiving can be a prolonged and stressful experience, and impaired cognitive functioning in caregivers could impact their own health and quality of life and compromise the quality of care provided to their care-recipient. Thus, the purpose of the current study is to use the Stress Process Model as a guiding theoretical framework to identify whether primary stressors (e.g., care recipient functional status, cognitive problems) or secondary stressors (e.g., loss of self, economic conflict) predict performance across seven domains of cognition in 50 primary ADRD caregivers. Hierarchical regression analyses were used to examine which primary and secondary stressors emerge as predictors of cognitive performance. Results indicated that primary stressor...
Innovation in Aging, 2020
The emergence of COVID-19 and the measures implemented to curb its spread are anticipated to have... more The emergence of COVID-19 and the measures implemented to curb its spread are anticipated to have long-term implications for mental health. Older adults may be at increased risk for adverse mental health outcomes as opportunities to remain socially connected have diminished. Further research is needed to better understand the impact of pandemic-related stress on mental health. Utilizing the stress and coping framework, the purpose of this study is three-fold: 1) to examine the influences of COVID-19-related stress on depression, anxiety, and loneliness, 2) to assess the mediating role of coping style and social support, and 3) to investigate whether these relationships vary across age. Participants (N = 1,318) between the ages of 18-92 years completed an online survey, assessing pandemic-related stress, mental health, social support, coping, and their experiences with social distancing, during the initial implementation of social distancing measures in the United States. Stress, soc...
Cancers, 2021
Cancer patients and their family caregivers experience various losses when patients become termin... more Cancer patients and their family caregivers experience various losses when patients become terminally ill, yet little is known about the grief experienced by patients and caregivers and factors that influence grief as patients approach death. Additionally, few, if any, studies have explored associations between advance care planning (ACP) and grief resolution among cancer patients and caregivers. To fill this knowledge gap, the current study examined changes in grief over time in patients and their family caregivers and whether changes in patient grief are associated with changes in caregiver grief. We also sought to determine how grief changed following the completion of advance directives. The sample included advanced cancer patients and caregivers (n = 98 dyads) from Coping with Cancer III, a federally funded, multi-site prospective longitudinal study of end-stage cancer care. Participants were interviewed at baseline and at follow-up roughly 2 months later. Results suggest synch...
Innovation in Aging, 2021
Although long distance caregivers (LDCs) are starting to be recognized as a subgroup of care part... more Although long distance caregivers (LDCs) are starting to be recognized as a subgroup of care partners experiencing unique challenges and stresses, it is unknown 1) what types of supportive services LDCs use for themselves and 2) what factors are associated with supportive service use in this understudied caregiving population. In our sample of 304 LDCs (Mage=56.9), the most frequently utilized service was video phone/webcam systems to monitor the care recipient (CR). Guided by Andersen’s Model of Health Care Utilization and using multiple hierarchical regression analysis, younger age of the LDC (a predisposing factor) and need-related characteristics (greater caregiving burden and depressive symptoms, more time spent helping the CR, and worse CR functional status) were associated with greater use of supportive services. Enabling factors were not associated with service use. These study findings can help inform how to engage LDCs in supportive service utilization.
Innovation in Aging, 2020
In recent decades, assisted living facilities (ALFs) have grown dramatically as an alternative to... more In recent decades, assisted living facilities (ALFs) have grown dramatically as an alternative to nursing homes. Research in nursing homes has shed light on the nature of the relationships that exist between family members and staff. However, little is known about family-staff relations within ALFs. We present data from the first study to describe the prevalence of conflict and positive and negative family-staff interactions in ALFs and to examine whether positive and negative aspects of the relationship contribute to salient staff and family outcomes. We use data collected from 252 family members and 472 staff members across 20 ALFs from the Partners in Care in Assisted Living (PICAL) study. Participants completed measures including interpersonal conflict, depression, perception of treatment, and stress-related to caregiving. Results showed that conflict among family and staff members is relatively low in ALFs. For staff, interpersonal conflict and treatment by family members signi...
The New School psychology bulletin, 2019
Research has consistently shown that age is related to phenomenological memory characteristics (e... more Research has consistently shown that age is related to phenomenological memory characteristics (e.g., increased vividness is associated with increased age). However, little research has examined age-related qualitative differences in autobiographical memories. Thus, the purpose of the current study was to examine qualitative differences in the content of self-defining memories across age. Two hundred sixty-one individuals between the ages of 18 and 94 provided self-defining memory descriptions that were systematically categorized as part of a content analysis. No meaningful differences in content were identified across the three age groups. Word analysis was also conducted, and no differences in word choice were found across age. Results therefore suggest that the content of and the words used to describe self-defining memories are not significantly influenced by age. Keywords: aging, autobiographical memory, positivity effect, self-defining memory
The Journals of Gerontology: Series B, 2021
Objectives The increasing number of minority older adults, and the subsequent increase in family ... more Objectives The increasing number of minority older adults, and the subsequent increase in family members providing care to these individuals, highlights the need to understand how cultural values contribute to differential caregiving outcomes. Using the sociocultural stress and coping model as a guiding framework, the current study examined cross-cultural relationships among familism, social support, self-efficacy, and caregiving outcomes and examines how these relationships vary as a function of caregiver background characteristics. Methods Baseline data were collected from 243 participants in the Caring for the Caregiver Network randomized controlled intervention trial. Participants completed measures assessing familism, social support, self-efficacy, positive aspects of caregiving, depression, and burden. Results African American and Hispanic participants exhibited higher levels of familism compared to Whites. Compared to White participants, African Americans’ endorsement of fami...
Aging, Neuropsychology, and Cognition, 2020
Extensive literature exists documenting the relationship between stress and cognition. Caregiving... more Extensive literature exists documenting the relationship between stress and cognition. Caregiving for an individual with Alzheimer's disease can be aunique and chronic stress experience due to the increasing dependency of the care-recipient as the disease progresses. The current study examines the relationship between stress and cognitive performance in 47 dementia caregivers compared to 47 noncaregiver control participants matched on age, gender, and education. Participants completed measures assessing stress (measured via the Perceived Stress Scale) and seven domains of cognition including episodic memory, working memory, executive functioning, attention, visuospatial processing, processing speed, and implicit memory. Results showed that caregivers had poorer performance than non-caregivers on certain measures of episodic memory, working memory, and executive functioning; while no significant differences were observed on measures of attention, visuospatial processing, processing speed, or implicit memory. In addition, when controlling for general stress, caregiver performance on measures of processing speed and visuospatial processing was also poorer than non-caregivers. By controlling for levels of general stress that may not be related to caregiving, these results show that differences in cognitive performance are unlikely to be explained by general stress alone.
The Gerontologist, 2020
Background and Objectives The emergence of the Coronavirus Disease 2019 (COVID-19) and the measur... more Background and Objectives The emergence of the Coronavirus Disease 2019 (COVID-19) and the measures implemented to curb its spread may have deleterious effects on mental health. Older adults may be at increased risk for adverse psychosocial outcomes because opportunities to remain socially connected have diminished. Research is needed to better understand the impact of pandemic-related stress on mental health. The purpose of this study is 3-fold: (a) to examine the influences of COVID-19 pandemic-related stress on depression, anxiety, and loneliness; (b) to assess the mediating role of coping style and social support; and (c) to investigate whether these relationships vary across age. Research Design and Methods Participants (N = 1,318) aged 18–92 years completed an online survey assessing pandemic-related stress, mental health, social support, coping, and their experiences with social distancing, during the initial implementation of social distancing measures in the United States. ...
Innovation in Aging, 2020
Research examining the relationship between subjective cognitive complaints and objective cogniti... more Research examining the relationship between subjective cognitive complaints and objective cognitive performance has been mixed. Despite the lack of clear evidence demonstrating an association, subjective cognitive complaints are used as a criterion for the diagnosis of mild cognitive impairment and is considered a risk factor for Alzheimer’s disease. Cross-lagged panel analyses were used in the current study to examine the longitudinal relationships between subjective cognitive complaints (using the Memory Functioning Questionnaire) and objective cognition (e.g., reasoning, memory, spatial visualization, processing speed, and vocabulary) in healthy adults over 60 from the Virginia Cognitive Aging Project (N=441). Results indicated that objective and subjective cognition were only weakly related but that objective cognition is a stronger predictor of subjective cognitive complaints then vice versa. Although subjective cognitive complaints may be an early indicator of pathological agi...
The Gerontologist, 2020
Background and Objectives Assisted living facilities (ALFs) have quickly expanded as an alternati... more Background and Objectives Assisted living facilities (ALFs) have quickly expanded as an alternative to nursing homes. Research on nursing homes has revealed problems in relationships between family members and staff. However, little is known about these relationships within ALFs. The purpose of the current study was to examine the prevalence of conflict and positive and negative interactions from the perspective of both family members and staff and to examine the effects of positive and negative aspects of the relationship on salient staff and family outcomes in ALFs. Research Design and Methods Data were collected from 252 family members and 472 staff members across 20 ALFs who participated in the Partners in Care in Assisted Living study. Participants completed measures including interpersonal conflict, depressive symptoms, perception of treatment, and stress related to caregiving. Results Conflict among family and staff members was found to be relatively low. For staff, interpers...
Clinical Gerontologist, 2020
Objectives: Extensive literature has documented the experiences of informal caregivers and their ... more Objectives: Extensive literature has documented the experiences of informal caregivers and their interactions with formal care providers, yet this research is almost entirely limited to caregivers who live near their care-recipients. This study aims to describe long-distance caregivers' (LDC) experiences (e.g., satisfaction and challenges) with formal care providers. Subgroup differences were examined based on the care-recipient's (CR) dementia status and residential setting (community versus residential care). Methods: Data were collected from 296 LDCs (M age = 56.64, SD = 12.40) categorized into four subgroups based on CR dementia status and residential setting. Participants rated their overall satisfaction, satisfaction with communication and information, and described challenges faced in their interactions with formal care providers. Results: Challenges related to formal care providers were significantly greater and satisfaction significantly lower among LDCs of CRs in residential care, irrespective of dementia status, when compared to LDCs of CRs in the community. Conclusions: This study provides insights into the experiences of a growing segment of the caregiver population managing care from a distance, specifically in their interactions with formal care providers. Clinical Implications: The results of this study point to the possible necessity for the development of novel interventions to improve and enhance communication and collaboration between FCPs and informal caregivers.
Innovation in Aging, 2019
The purpose of this study (N=304) was to identify differences in LDCs’ experiences with their car... more The purpose of this study (N=304) was to identify differences in LDCs’ experiences with their care recipient’s (CR) formal care providers (FCPs) among four LDC groups based on CR dementia status and residential setting (community/nursing home [NH]). Results show that LDCs of CRs without dementia living in a NH are less likely to be satisfied with information/communication provided by FCPs compared to LDCs of CRs with dementia in the community. FCP-related challenges were significantly greater among LDCs of CRs in a NH, with or without dementia, compared to LDCs of CRs without dementia living in the community. A significantly greater proportion of LDCs of CRs living in a NH, with or without dementia, reported dealing with inadequate care as a challenge compared to LDCs of CRs with dementia living in the community. This highlights LDCs’ unique experiences related to FCPs based on differences in CR dementia status and residential setting.
Innovation in Aging, 2019
This study investigated the impact of LDC on mental health utilizing the Sociocultural Stress Pro... more This study investigated the impact of LDC on mental health utilizing the Sociocultural Stress Process Model as a conceptual framework. A path analytic model tested the impact of caregiving stressors (i.e. distance, frequencies of visits, hours spent helping, burden) and sociocultural values (i.e. familialism) on LDCs’ mental health outcomes (i.e. depression, anxiety), and resources (i.e. coping strategies, social support) which can mediate the association between stressors and mental health outcomes while controlling for socio-demographics. Results show that resources did not mediate the effects of stressors on the mental health outcomes. However, both higher depression and anxiety were associated with living closer to the care recipient (CR), less frequent visits, higher burden, being younger, being female, and less optimal income adequacy. In addition, higher depression was associated with lower use of coping strategies and higher education. Higher anxiety was also associated with...
Innovation in Aging, 2019
The purpose of this study (N=304) was to examine the characteristics of LDCs’ informal caregiver ... more The purpose of this study (N=304) was to examine the characteristics of LDCs’ informal caregiver (IC) network (Co-caregivers [Co-CG], other informal helpers) providing assistance to the care recipient (CR), and factors associated with more help received from ICs. The majority of LDCs in the sample reported working with at least one IC (81.9%) indicating the existence of a secondary care network. LDCs and Co-CGs were often siblings in comparison to other informal helpers that were more likely to be the CR’s friend. Results also show that CRs with children, living in the community, receiving no formal services, and lower levels of cognitive impairment receive more hours of help from ICs. In addition, more hours of help by ICs were associated with LDCs’ having higher scores of depression and anxiety, spending more hours per month helping the CR, and more frequent contact with CR. These seemingly discrepant findings are discussed.
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Papers by Francesca Falzarano