About

Liza Behrens is an assistant professor at Penn State Ross and Carol Nese College of Nursing, specializing in nursing, health professions, and community engagement. Her research focuses on person-centered care, dementia, and nursing home residents and staff, with over 35 peer-reviewed publications on delivering person-centered dementia care in nursing homes. She is dedicated to implementing preference-based, person-centered care to enhance the well-being of residents with dementia and has extensive experience providing nursing care for older adults across various settings, including hospitals, clinics, nursing homes, and home-based care. Behrens has held leadership roles in nursing and clinical research and is involved in projects like the DIGNITY project, which aims to improve decision-making for aging individuals with dementia. Her teaching approach is grounded in her 25 years of experience as an adult learner, emphasizing student engagement and positive relationships to foster an inclusive learning environment and support the growth of nursing professionals and leaders.

Research topics

• Medicine
• Psychology
• Nursing
• Gerontology
• Clinical psychology

Selected publications

• Community-engaged intervention mapping for developing the DIGNITY program: Supporting decision-making in aging and dementia for autonomy in rural nursing homes

  Journal of Clinical and Translational Science · 2026-01-01

  articleOpen access1st authorCorresponding

  Background: Person-centered care that honors individual preferences can improve the well-being of nursing home (NH) residents with Alzheimer's disease and related dementias (ADRD). However, preferences such as going outside independently are often restricted due to perceived safety risks. There is a critical need for strategies that help NH staff balance safety concerns with residents' autonomy. Materials and methods: We developed the Decision-making In aGing and demeNtIa for autonomy (DIGNITY) intervention using the Community-Engaged Intervention Mapping (CEIM) Model. This multilevel, theory informed program was codesigned with NH stakeholders to support shared decision-making and promote preference-congruent dementia care. Results: A total of 53 stakeholders participated in focus groups and engagement sessions. Feedback informed six key refinements to the DIGNITY program: manual formatting, communication strategies, staff role delineation, addressing resident decision-making capacity, and identifying implementation barriers and facilitators. The final intervention includes a structured manual, decision-making tools, and a training and coaching program to support NH staff in honoring resident preferences while managing perceived risks. Conclusion: DIGNITY is a novel, stakeholder-informed intervention designed to support preference-based dementia care in rural NHs. Future research should assess its feasibility, acceptability, and impact on staff attitudes and resident outcomes.

  PublisherOA PDFDOI

• Balancing Infection Risks and Residents Social Activity Preferences: Nursing Home Staff Risk Perceptions

  The Gerontologist · 2025-04-22 · 1 citations

  articleOpen accessSenior author

  BACKGROUND AND OBJECTIVES: Social activities are recognized as vital for older adults' quality of life. The COVID-19 pandemic presented challenges for nursing home (NH) staff as they attempted to balance infection risks with residents' preferences for social activities. The purpose of this study was to gain an understanding of NH staff's experiences and actions accommodating resident preferences for social activities during pandemic restrictions. RESEARCH DESIGN AND METHODS: This study used a convergent mixed methods approach to provide an in-depth description of NH staff's (N = 24) risk propensity and decision-making. Quantitative data included self-reported demographics and risk perceptions using the Risk Propensity Scale. Qualitative data included semistructured individual interviews. Data were integrated to explain the link between individual risk perceptions and infection control practices related to social activities. RESULTS: Participants were purposively sampled to reflect a range of direct care NH staff roles including certified nursing assistants (29%), activities staff (25%), social workers (25%), and licensed nurses (21%). Participants were on average 39 years of age, mostly White (79%), and female (88%). Most identified as risk-avoiders (58%). Guided content analysis of interviews revealed two main themes that describe staff's behaviors while balancing infection control and residents' social activity preferences: factors of decision-making (family influence, organizational, staff and resident characteristics) and staff influencing preference-based care (cognitive skills and technical skills). DISCUSSION AND IMPLICATIONS: Risk perceptions and resultant decision-making vary among direct care NH staff. Mixed interpretation offers insight on staff's attempt to balance infection risks with residents' preferences to engage in social activities.

  PublisherOA PDFDOI

• Care Partner and Care-Receiver Kinship Influences Desire to Seek Long-Term Care After Hospitalization

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Dementia affects 57 million people worldwide, and over 7 million Americans live with Alzheimer’s disease. Care partners play vital roles in providing care, but they also express several stressors, including behavioral symptoms, relationship stressors, and preparedness. There is evidence that the kinship (type of relationship) and quality of the care partner/care-receiver relationship are related to long-term care placement and quality of life. However, limited research has examined how kinship influences the desire to seek long-term care, post-acute hospitalization. This secondary analysis of a cluster randomized clinical trial (Family-centered Function-focused Care) examined the association between kinship and desire to seek long-term care for person with dementia at discharge, 2 months, and 6 months post-acute-hospitalization by care partners of hospitalized patients with dementia (N = 158). Care partner kinship type was classified as spouse/partner (n = 47), adult child (n = 86), or other relatives/friends (n = 25). Findings showed significant main effects of kinship type with a desire to seek long-term care [discharge covariates: F(2,158)=4.80, p=.010, partial-η²=.061; 2-month: F(2,145)=4.54, p=.012, partial-η²=.059; 6-month: F(2,145)=4.21, p=.017, partial-η²=.055] . Spouse/partner care partners showed lower desire to seek long-term care compared to adult children across timepoints (discharge: M = 0.96 vs. 1.34, p=.019; 2-month: M = 0.91 vs. 1.57, p=.013; 6-month: M = 0.66 vs. 1.55, p=.013) and others at 6-months (p=.002). Significantly older care partner age across all timepoints (p=.012, p=.004, p=.009), higher neuropsychiatric symptoms (p=.024), and lower care partner preparedness (p=.030) were associated with desire to seek long-term care. Our findings support interventions targeted at the care partner-recipient kinship type, aiming at preparedness and behavioral symptom management.

  PublisherOA PDFDOI

• Demonstrating Feasibility of the DIGNITY Intervention for Delivery in Rural Nursing Home Communities

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract The DIGNITY intervention is a newly co-developed risk management strategy aimed at reducing barriers and enhancing staff engagement in risk mitigation to support residents’ care and activity preferences. This comprehensive staff-focused behavioral intervention remains untested. Therefore, a pilot test was conducted to evaluate its acceptability, appropriateness, feasibility, and preliminary efficacy among direct-care nursing home (NH) staff members. A 12-week, two-arm cluster randomized controlled trial was conducted in four rural Pennsylvania NHs. Staff (N = 54) and residents (N = 57) were recruited. All staff participated in a 60-minute introductory session and received a training manual. They were asked to refer to the manual during routine care planning for enrolled residents and while participating in six bi-weekly web-based coaching sessions. Staff rated their intention to honor residents’ risky preferences, as well as the acceptability, feasibility, and appropriateness of the intervention through surveys with closed and open-ended questions. Structured interviews collected residents’ satisfaction with preference fulfillment. Staff had an 83% retention rate and an 80% survey response rate. In the DIGNITY group, average scores for acceptability (4.19), appropriateness (4.24), and feasibility (3.99) exceeded benchmarks with supporting qualitative remarks, indicating high feasibility, acceptability, and appropriateness. Positive trends were seen in staff intent to honor residents’ preferences. A t-test revealed a statistically significant difference in resident satisfaction between study arms (p = .04). The DIGNITY intervention is feasible and shows promise in supporting NH staff engagement in risk mitigation for person-centered dementia care. Future research should assess DIGNITY’s efficacy across a larger sample of NHs.

  PublisherOA PDFDOI

• A Confidence and Preparedness Survey: Cognitive Interviews for Tool Assessment and Nursing Student Perspectives

  Global Qualitative Nursing Research · 2025-07-14

  articleOpen access

  Safe medication administration is a critical responsibility of registered nurses and is an essential skill developed during nursing education. Student confidence and preparation regarding medication administration are essential aspects of professional skill building. The Confidence and Preparation Survey (CPS) was used previously among homogeneous nursing student samples. The existing dominant discourse, shaped by ideologies and systems, can unfortunately lead to limited perspectives; therefore, the purpose of this study was to evaluate and refine the CPS for feasibility, clarity, and validity among nursing students primarily from groups that have been historically marginalized. A secondary purpose considered the conditions that affect perceived confidence and preparedness. Cognitive interviews were undertaken with baccalaureate nursing students ( n = 11) attending an urban college of nursing in the Northeastern region of the United States. Data were analyzed using rapid qualitative techniques and the framework matrix method. The CPS was readily understood and interpreted by this sample. Student perspectives of conditions that influence their understanding and interpretation of the CPS are described under three themes: (1) prior outside of school healthcare experiences influence understanding, (2) school experiences support survey comprehension, and (3) concerns over insufficient training within school. Findings also include a revised CPS instrument ready for further testing.

  PublisherDOI

• Anticholinergic Exposure During Rehabilitation: Cognitive and Physical Function Outcomes in Patients with Delirium Superimposed on Dementia

  Figshare · 2025-07-31

  article

  OBJECTIVES: We examined the association between anticholinergic medication exposure and subsequent cognitive and physical function in patients with delirium superimposed on dementia during rehabilitation. We also examined length of stay and discharge disposition by anticholinergic medication exposure. DESIGN: In this secondary analysis we used control group data from an ongoing randomized clinical trial. SETTING/PARTICIPANTS: Participants with delirium and dementia were enrolled at admission to post-acute care. These 99 participants had a mean age of 86.11 (±6.83) years; 67.6% were women; 98% were Caucasian; and 33% were positive for at least one APOE e4 allele. MEASURES: We obtained daily measures of cognitive and physical function using: Digit Span; memory, orientation and attention items from the Montreal Cognitive Assessment; CLOX; the Confusion Assessment Method; and the Barthel Index. Anticholinergic medication exposure was measured weekly using the Anticholinergic Cognitive Burden Scale. RESULTS: Using multilevel models for time we found that greater use of clinically relevant anticholinergic medications in the previous week reduced cognitive and physical function, as measured by Digit Span Backwards and the Barthel index, in the current week. There was no effect of anticholinergic medication use on delirium severity, and APOE status did not moderate any outcomes. Greater use of clinically relevant anticholinergic medications was related to longer length of stay but not discharge disposition. CONCLUSIONS: For vulnerable older adults, anticholinergic exposure represents a potentially modifiable risk factor for poor attention, working memory, physical function, and greater length of stay during rehabilitation.

• Initial Development of the DIGNITY Program: Balancing Autonomy and Safety in Dementia Care

  Innovation in Aging · 2025-12-01

  articleOpen access1st authorCorresponding

  Abstract In the name of safety, nursing Home (NH) residents living with dementia often have their preferences for care and daily activities disregarded by NH staff. This impinges on residents’ rights to exercise autonomy in clinical decision-making and leads to dissatisfaction with care comprising quality of life and well-being. No comprehensive evidence-based risk management strategies exist to assist NH staff to identify and support care choices of residents while attempting to balance autonomy with safety. Thus, the purpose of this project was to use community engagement intervention mapping techniques to develop a multilevel intervention designed to support shared decision-making with NH residents living with dementia thus promoting resident health and autonomy. This presentation will describe the early planning phase of intervention mapping including the construction of a logic model of the problem, a review of literature identifying behavioral, normative, and control beliefs associated with NH staff intentions to honor residents’ preferences, and a set of training goals and objectives. This project resulted in a multi-component intervention that guides shared decision-making in NHs to support person-centered dementia care called DIGNITY (Decision-making in aging and dementia for autonomy). It includes an adapted care planning protocol and staff training to help direct-care NH staff negotiate intrinsic and cultural factors in preference situations that carry a risk to residents’ health and safety. Initial development of this intervention sets the stage for initial program manual and tool development necessary for pilot testing the intervention in the future.

  PublisherOA PDFDOI

• Building Capacity for Community-Engaged Research: Frameworks and Methods for Successful Aging Science

  Innovation in Aging · 2025-12-01

  articleOpen access1st authorCorresponding

  Abstract Capacity building is integral to the success of community engaged research (CEnR). This is especially important for collaborating with new community and research partners. With the rapidly changing healthcare environment, researchers are often challenged to build capacity for successful research with older adults and their communities. This symposium will explore innovative frameworks and methodologies for capacity building in CEnR, focused on dementia care and healthy aging outcomes. The session will feature four presentations that highlight different approaches to fostering capacity development and community engagement in diverse settings. The first paper will present a framework for capacity development in Villages, a community-centered model for healthy aging. This research identifies key thematic categories for capacity growth, including understanding and motivation for research, cultivating partnerships, theorizing interventions, and procuring data systems. The second paper integrates CEnR and Two-Eyed Seeing, combining biomedical and indigenous knowledge frameworks to create a comprehensive dementia evaluation toolkit for Indigenous populations. The third paper shares insights on how capacity building using CEnR frameworks can drive sustainable changes in a significant public health challenge. The fourth paper highlights the barriers and challenges encountered while implementing CEnR frameworks and offers valuable lessons on what not to do in similar initiatives. The session will conclude with a moderated discussion that will engage presenters and participants in exploring strategies to advocate for community engagement in aging science, reports to funders, and plan for future capacity building work with community partners.

  PublisherOA PDFDOI

• DIGNITY: Initial Manual and Tool Development With Community Advisory Board

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Successful translation of scientific discoveries into health improvements requires community involvement in all research stages. Recruiting nursing home (NH) stakeholders has been challenging due to systemic issues highlighted during the COVID-19 pandemic. This project leverages existing NH community stakeholders to co-develop the DIGNITY program for future testing. A community advisory board (CAB) of NH stakeholders was established using purposive sampling. Semi-structured sequential focus groups collected stakeholder opinions on the development, refinement, implementation, and evaluation of the DIGNITY program for rural NH environments. Stakeholders completed a demographic survey and reviewed the drafted DIGNITY program intervention manual. Fourteen NH stakeholders, including academic and clinical experts (n = 5), NH administrators/leaders (n = 3), direct care workers (n = 2), regulators (n = 1), and ombudsman (n = 3), participated in four focus group sessions between October and December 2022. Qualitative content analysis of transcript data indicated that stakeholders found the DIGNITY program relevant and feasible for assisting rural NH staff in honoring residents’ risky preferences for care and activities. Stakeholders identified programmatic areas for modification within six themes: (1) DIGNITY manual formatting, (2) communication, (3) expanding staff roles, (4) addressing residents’ decision-making capacity, (5) potential barriers to implementation, and (6) potential facilitators to implementation. Discussions with stakeholders indicated a need to involve other key stakeholders in rural areas, including residents, family members, direct-care staff, and regulators, in the initial development of DIGNITY. Presented by a participating physician clinician, the discussion will provide a pragmatic participatory lens for improvements made to the DIGNITY program.

  PublisherOA PDFDOI

• Evaluation and Dissemination Strategies for Community-Engaged Research

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Community-engaged research and evaluation strategies have not been widely discussed or documented, especially those focused on older adults and the communities in which they live. To address the needs of the gerontological research community, this symposium describes evaluation, measurement, and dissemination strategies commonly used in community-engaged research and evaluation through real world examples. Three presentations highlight diverse strategies to perform community-engaged research, conduct evaluations with community partner input, employ meaningful measurement practices, and share findings back with community partners involved in the work. The first presentation showcases multi-level evaluation of a unique community-based and intergeneration nutrition program in New York City. This program emphasizes the intersection of multisector partnerships, multiple methodologies, and a combination of participatory engagement, process evaluation, and outcomes assessments. The second presentation showcases a Patient Centered Outcomes Research Institute (PCORI) project to develop a comprehensive tool to measure engagement activities in community-engaged research and evaluation and how these activities impact research outcomes. The third presentation focuses on dissemination activities in community-engaged work, primarily working with a community-based advisory board to develop a communication and dissemination plan at the outset of a dementia care needs and assets assessment among African immigrant community members in Minnesota. Finally, the session concludes with a moderated discussion to provide a forum for participants and presenters to co-construct practice-based strategies to apply to their own community-engaged research and evaluation projects centering older adults and the communities in which they live. Participants are encouraged to engage in discussion to generate applications for future dissemination. Community-Engaged Research Interest Group Sponsored Symposium

  PublisherOA PDFDOI

Frequent coauthors

• Ann Kolanowski

  42 shared

• Marie Boltz

  Pennsylvania State University

  37 shared

• Kimberly Van Haitsma

  Pennsylvania State University

  33 shared

• Elizabeth Galik

  24 shared

• Karen Eshraghi

  22 shared

• Jeanette Ellis

  University of Maryland, Baltimore

  22 shared

• Katherine Abbott

  Miami University

  19 shared

• Barbara Resnick

  University of Maryland, Baltimore

  18 shared

Awards & honors

• Early Career Scholar, Penn State Clinical and Translational…
• Associate Fellow, Leonard Davis Institute of Health Economic…
• Post-Doctoral Research Fellow, NewCourtland Center for Trans…