C. Riffin

• PhD
• Cornell University

Using an innovative approach, we identified research priorities in palliative care to guide future research initiatives. We searched 7 databases (2005–2012) for review articles published on the topics of palliative and hospice–end-of-life care. The identified research recommendations (n = 648) fell into 2 distinct categories: (1) ways to improve me...

Background Poor sleep contributes to adult morbidity and mortality. Purpose The study examined the extent to which trait positive affect (PA) and PA reactivity, defined as the magnitude of change in daily PA in response to daily events, were linked to sleep outcomes. Methods Analyses are based on data from 100 respondents selected from the National...

Chronic pain is a debilitating and pervasive health problem, particularly among older adults. Researchers and clinicians acknowledge that pain conditions do not occur in isolation, but rather exact a toll on the individual sufferer and the family system at large. No research, however, has explicitly explored the impact of older parents' chronic pai...

Objectives: The emotional and physical health consequences of caring for a family member are well documented. However, although personality has been shown to affect dyadic interactions and been linked with individual outcomes for both care recipients (CRs) and caregivers (CGs), the influence of CR personality on CG health remains unexplored. Meth...

A growing body of literature supports a link between positive emotions and health in older adults. In this article, we review evidence of the effects of positive emotions on downstream biological processes and meaningful clinical endpoints, such as adult morbidity and mortality. We then present relevant predictions from lifespan theories that sugge...

Objectives People living with HIV experience an elevated risk of serious medical illnesses as they age, but access palliative care (PC) at lower rates than individuals without HIV. HIV psychiatrists provide longitudinal psychosocial care to individuals living with HIV. As such, HIV psychiatrists can play an important role in providing PC to people...

This pilot trial aimed to evaluate the feasibility, acceptability, and preliminary efficacy of Collaborative Healthcare Encounters with Caregivers (CHEC), a checklist-based intervention designed to enhance caregiver participation in older adults’ primary care visits. N = 52 older patient-caregiver dyads were randomized to CHEC ( n = 28) or usual ca...

Objectives: The purpose of this pilot study was to evaluate the implementation feasibility and to establish preliminary efficacy of LDCare - a remotely delivered, manualized, multi-component intervention developed to support long-distance family caregivers (LDCs) of older adults with dementia. Methods: The study design was a one-arm pre-post-int...

Arthritis, which affects tens of millions of middle-aged and older adults, is one of the most common causes of activity limitation, disability, and chronic pain. Despite evidence that total joint replacement (TJR) can improve quality of life and physical functioning in arthritis patients, many eligible TJR candidates hesitate to pursue surgical int...

Introduction: Family caregivers serve vital functions in older adults’ health care, but their own needs are not systematically assessed in routine care delivery. The present study employed a user-centered approach to develop and evaluate a pragmatic checklist to support proactive identification and discussion of caregivers’ concerns in primary care...

Background Self‐care for adults with hypertension includes adherence to lifestyle behaviors and medication. For unpaid caregivers with hypertension, the burden of family caregiving may adversely impact self‐care. We examined the association between caregiver strain and hypertension self‐care among caregivers with hypertension. Methods and Results...

Care partners are crucial to supporting the complex health needs of older adults with dementia, but they are not systematically identified in care delivery. As part of a real-world implementation project in geriatric primary care, we adapted a portal-based agenda setting intervention, OurNotes, by incorporating items to help care partners self-iden...

Importance Home health aides and attendants (HHAs) provide essential care to older adults and those with chronic conditions in the home. However, some HHAs struggle with poor mood and stress, which may have been exacerbated by the COVID-19 pandemic. Objective To elicit HHAs’ perspectives toward mental health and well-being, including how their job...

The Program of All-Inclusive Care for the Elderly (PACE) is a community-based care model in the United States that provides comprehensive health and social services to frail, nursing home-eligible adults aged 55 years and older. PACE organizations aim to support adequate pain control in their participants, yet few evidence-based pain interventions...

Background and Objectives Despite its prevalence and impact, pain is underdetected and undermanaged in persons with dementia. Family caregivers are well positioned to detect pain and facilitate its management in their care recipients, but they lack training in symptom recognition and communication. This study reports findings from a pilot trial eva...

Family caregivers play an essential role in supporting the health and well-being of older adults with dementia, a population projected to increase rapidly over the coming decades. Enrolling caregivers of people with dementia (PWD) in research studies is vital to generating the evidence necessary to support broader implementation of efficacious inte...

Despite the significant stress of family caregiving, caregivers’ needs and risks are often overlooked in healthcare settings. This study examined the factors associated with primary care physicians’ perceived responsibility to identify and address caregiver needs and risks. Using a national random sample of U.S. primary care physicians ( N = 106),...

Pain is under-detected and poorly managed in persons with dementia (PWD). Family caregivers are well situated to detect and facilitate management of pain in PWD, but they receive little guidance and training in these tasks. Our group developed the Pain Identification and Communication Toolkit (PICT), a manualized, multicomponent intervention to hel...

In 2021, loved ones of individuals with Alzheimer’s disease and related dementias (ADRD) provided an estimated $271 billion worth of unpaid care (Alzheimer’s Association, 2022). While there is mounting consensus for the need to support caregivers, interdisciplinary collaborations are necessary to facilitate the translation of evidence‐based program...

Despite the negative emotional and physical consequences of caregiving, caregivers’ needs and risks are often overlooked in health care settings. This study used survey data from a national random sample of primary care physicians (N=106) to examine the factors associated with physicians’ perceived responsibility to identify caregiver needs and ris...

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...

More than 6 million adults in the United States are affected by Alzheimer’s Disease and related dementias (ADRD), the majority of whom rely on assistance from an unpaid caregiver (family, friends). The goal of the 2021 Conference on Engaging Family and Other Unpaid Caregivers of Persons with Dementia in Healthcare Delivery, funded by the National I...

This presentation, by Consensus Conference Director, Dr. Riffin, will describe the major priorities identified by the 2021 Conference on Engaging Family Caregivers of Persons with Dementia in Healthcare Delivery. Recommendations centered on the need for multidisciplinary collaborations that attend to (1) Identification and assessment of dementia ca...

More than 6 million adults in the United States are affected by Alzheimer’s disease and related dementias (ADRD), the majority of whom rely on assistance from an unpaid care partner (family, friends; Alzheimer’s Association, 2022). ADRD care partners assist with disease management tasks (Riffin et al., 2017) and perform critical functions within th...

Objective: To examine and compare health care provider perceptions for integrating family caregivers into patient encounters and other processes of care by medical specialty. Data sources/setting: Data were from 19 interviews conducted in 2018, 10 with primary care or palliative care providers and nine with proceduralists or interventionists in...

Medicare Conditions of Participation require hospitals to provide training to family and unpaid caregivers when their support is necessary to enact the post-discharge care plan. However, caregivers often report feeling unprepared for this role. We perform a cross-sectional analysis of the 2017 National Health and Aging Trends Study and its linked N...

Family caregivers are a largely hidden but vital workforce within medical and long-term care settings. Family caregivers are actively involved throughout care delivery systems and provide crucial assistance to people with chronic conditions. Building on the person- and family-centered care approach and recent recommendations from national organizat...

Clinical trials for dementia caregivers have suffered from small sample sizes that lack adequate power to detect treatment benefits. Addressing these methodological shortcomings is contingent upon successful recruitment and enrollment of caregiver participants, but major barriers impede their participation in research. This presentation describes t...

Background Pain in older persons with dementia is both under-detected and under-managed. Family caregivers can play an important role in addressing these deficiencies by communicating their care recipient’s symptoms and behaviors to medical providers, but little is known about how caregivers and providers approach pain-related discussions in the co...

Importance Medicare conditions of participation require hospitals to provide training to family and unpaid caregivers when their support is necessary to enact the postdischarge care plan. However, caregivers often report feeling unprepared for this role. Objective To describe the characteristics of caregivers who assist with posthospitalization ca...

Importance: Caregiver strain has been shown to be associated with adverse effects on caregivers' health, particularly among those with cardiovascular disease. Less is known about the association of caregiver strain with health behaviors among caregivers with diabetes, a disease that requires a high degree of self-care. Objective: To examine the...

Pain in older persons with dementia (PWD) is severely under-detected and under-managed. Family caregivers can play an important role in addressing these disparities by acquiring the requisite skills to communicate PWD’s pain symptoms and behaviors to health care providers, but little is known about how caregivers of dementia patients and their prov...

Family caregivers play an important role in the healthcare of older adults, but their circumstances, needs, and risks are often unknown to medical professionals. Standardizing how caregivers’ needs are assessed in healthcare delivery can help clinicians design care plans that take caregivers’ capabilities into account and provide targeted recommend...

Objectives: To characterize current practices, barriers, and facilitators to assessing and addressing family caregivers' needs and risks in primary care. Design: Cross-sectional, national mail-based survey. Setting: American Medical Association Masterfile database. Participants: U.S. primary care physicians (N = 106), including general inter...

Objective Older adults are commonly accompanied to routine medical visits. This study identifies challenges and explores approaches to managing patient-family interactions in primary care. Methods Semi-structured interviews were conducted with primary care clinicians and staff (N = 30) as well as older adult patients and family caregivers (N = 40)...

Objectives: To understand current practices, challenges, and opportunities for a systematic assessment of family caregivers' needs and risks in primary care. Design: Qualitative study consisting of in-depth semi-structured interviews. Setting: Four primary care practices located in urban and rural settings. Participants: Primary care clinici...

The presence of family caregivers in clinical encounters is becoming more common with the aging of the US population and the continued shift of care responsibilities from health professionals in clinical settings to family caregivers at home. Patients accompanied to clinical encounters by caregivers are more likely to be older, sicker, and have low...

Despite broad appreciation of family caregivers’ relevance to older adults’ health care, few primary care-based interventions have incorporated mechanisms to facilitate systematic caregiver identification, screening, and support. Actionable knowledge regarding how such interventions may be incorporated into clinical practice is remarkably limited....

Best practice guidelines have emphasized the importance of routine pain assessment of older persons with dementia (PWD), yet pain remains severely underdetected and undermanaged in this population. Training family caregivers in observational pain assessment and subsequent communication of the assessment results to a healthcare provider has the pote...

Family caregiver engagement in clinical encounters can promote relationship-centered care and optimize outcomes for people with Alzheimer’s disease and related dementias (ADRD). Little is known, however, about effective ways for health care providers to engage family caregivers in clinical appointments to provide the highest quality care. We descri...

Nearly 18 million family and unpaid caregivers assist older American individuals with disabilities.¹,2 Caregivers are a crucial source of care for older adults with disabilities and complex care needs but often report feeling unprepared and poorly supported in their caregiving role.¹ Emerging evidence suggests that support of family caregivers, inc...

This letter comments on the letter by Buck et al.

OBJECTIVES To examine factors associated with caregiver burden from a multifactorial perspective by examining caregiver and care recipient characteristics and a full range of caregiving tasks. DESIGN Nationally representative surveys of community‐dwelling older adults and their family caregivers residing in the United States. SETTING 2011 Nationa...

Objectives To explore patient and caregiver experiences, preferences, and attitudes toward the provision and receipt of caregiving assistance with medical tasks. Design Qualitative study consisting of in‐depth interviews with 20 patient–caregiver dyads. Setting Community and academic‐affiliated primary care clinics. Participants Individuals aged...

Total joint arthroplasty (TJA) is an efficacious treatment for advanced osteoarthritis, but patient acceptance is below medical recommendations, especially among older adults. The present study explored potential explanations of age effects. Participants (n = 100, aged 40–93) had chronic knee or hip pain and were considering but had not previously...

Studies examining the relationship between informal caregiving and caregiver burden have largely focused on samples defined by disease or disability, and on the provision of disability-related assistance. This study characterizes a broad range of caregiving activities provided to a nationally-representative sample of community-dwelling older adults...

The empirical literature on caregiver burden has been dominated by a focus on dementia and disease-specific samples, and the risk associated with providing disability-related assistance. In this study, we analyzed data from 611 community-dwelling older adults without dementia or severe disability who participated in the 2011 National Health and Agi...

Objectives: To estimate the number of caregivers providing assistance to community-dwelling older persons with and without dementia and with or without substantial disability; to describe the characteristics of caregivers and care recipients in these groups; to characterize the health-related tasks that caregivers provide; and to estimate associat...

Objective. : Not only is persistent pain a debilitating health problem for older adults, it also may have negative effects on family relationships. Studies have documented the effects of pain on spouses and on parents of young children. However, research has not extended this line of inquiry to later life, and specifically to the impact of older p...

Objectives: Thinking about a loved one's suffering can be emotionally stressful and have negative effects on a person's psychological and physical health over time. This study examined the hypotheses that when thinking about a partner's suffering (1) recalling past support provision to the suffering partner can decrease distress and anger and incre...

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases t...

This article provides an overview of the literature describing the effects of geriatric patients’ pain on family members’ relationships, psychological well-being, and physical health. The theoretic mechanisms that underlie the association between patients’ pain and family members’ outcomes are outlined, and studies describing these mechanisms are s...

Concern over the need for effective and accessible healthcare for individuals with advanced chronic illness has drawn attention to the significant gaps in our knowledge of palliative medicine. To advance our understanding of this field, community-based participatory research (CBPR) is proposed as a tool for future research initiatives. This paper o...

Purpose: Elder mistreatment is now recognized internationally as a pervasive and growing problem, urgently requiring the attention of health care systems, social welfare agencies, policymakers, and the general public. In this article, we provide an overview of global issues in the field of elder abuse, with a focus on prevention. Design and metho...

Objectives: The present study investigates age differences in the types of decision support that total joint replacement (TJR) candidates desire and receive when making the decision to pursue surgery. We consider the social structural (relationship to the patient) and experiential factors (network members’ experience with TJR) that influence indivi...

This article explores whether understanding of the effects of children's problems on older parents' well-being can be advanced by exploring differences in parent-child relationships within families. Using data from a study in which mothers reported on all adult children, we addressed the question: Do patterns of maternal favoritism moderate the imp...

We employed the research-to-practice consensus workshop (RTP; workshops held in New York City and Tompkins County, New York, in 2013) model to merge researcher and practitioner views of translational research priorities in palliative care. In the RTP approach, a diverse group of frontline providers generates a research agenda for palliative care in...

Despite broad recognition that social networks play a key role in the management of chronic musculoskeletal pain (CMP), little is known about when and why older adults with CMP choose to involve others in treatment decisions. This study investigates the types (i.e., informational, emotional, and instrumental) and sources (i.e., formal and informal)...

Purpose: To investigate joint decision making perceptions and preferences among older adults with chronic musculoskeletal pain (MSP). Method: Purposive sampling was used to identify a group of Hispanic and non-Hispanic White older adults (>55 years) with MSP from one outpatient practice and one senior center in New York City. Semi-structured inte...

Background: Substantial agreement has been achieved on research priorities in palliative care over the past 15 years, as evidenced by consensus conferences and systematic reviews. Despite the presence of a widely endorsed research agenda, however, addressing the gaps in scientific knowledge has progressed slowly, suggesting that researchers face s...

The authors examined how ambivalence toward adult children within the same family differs between mothers and fathers and whether patterns of maternal and paternal ambivalence can be explained by the same set of predictors. Using data collected in the Within‐Family Differences Study, they compared older married mothers' and fathers' (N = 129) asses...

The goal of this paper is to demonstrate a process by which qualitative and quantitative approaches are combined to reveal patterns in the data that are unlikely to be detected and confirmed by either method alone. Specifically, we take a sequential approach to combining qualitative and quantitative data to explore race differences in how mothers d...

We propose a unifying hypothesis of schizophrenia to help reconcile findings from many different disciplines. This hypothesis proposes that schizophrenia often involves pre- or perinatal exposure to adverse factors that produce a latent immune vulnerability. When this vulnerability is manifested, beginning around puberty with changes in immune func...