About

Karen A. Roberto is a University Distinguished Professor at Virginia Tech, serving as the Executive Director of the Institute for Society, Culture and Environment, and a Senior Fellow at the Virginia Tech Center for Gerontology. She is a faculty member in the Department of Human Development and Family Science. Her research focuses on adult development and aging, with particular expertise in gerontology. Roberto has been involved in various media mentions and articles related to elder care, aging social policies, resilience in aging, and community resources for older adults. She is actively engaged in research projects and is accepting new graduate students and research team members interested in her areas of expertise.

Research topics

• Medicine
• Psychology
• Medical emergency
• Gerontology
• Biology
• Surgery
• Internal medicine
• Physical therapy
• Business
• Clinical psychology
• Physical medicine and rehabilitation
• Engineering
• Developmental psychology
• Psychiatry

Selected publications

• Whole Health, Whole Communities — Dialogues to Reduce Rural Health Disparities

  NEJM Catalyst · 2026-04-30

  article
  PublisherDOI

• Support for Care Partners and Caregivers: 2023 Summit Session 5

  Alzheimer s & Dementia · 2025-06-01 · 2 citations

  articleOpen access

  INTRODUCTION: We report on Session 5 of the 2023 NIA National Research Summit on care, services, and supports for persons living with dementia and their care partners/caregivers, "Support for Care Partners and Caregivers." METHODS: The session included scholarly presentations, comments by national caregiver advocates, and a conversation among panelists, discussants, and online attendees. Panelists later worked with the National Institute on Aging to identify gaps and opportunities to improve support for care partners and caregivers. RESULTS: Presentations emphasized the need to construe caregiving within an intersectional framework; include meaningful stakeholder engagement in research; and recognize the complex fabric of local, regional, and national policy affecting caregiving services and supports. Discussants emphasized the need to recognize caregiver needs and enable caregiver agency in research, policy, or practice. DISCUSSION: The conversation underscored the importance of including caregivers in efforts to improve care/caregiving and by taking as broad a construction of caregiving as possible. HIGHLIGHTS: Presentations and discussions centered on three key themes: The critical importance of integrally engaging family caregivers in all aspects of research, practice delivery and improvement, and policy development; Recognition that inclusivity should be a driving principle in identifying and understanding caregivers and the caregiving role; Appreciation for the intersection of the spheres of research, practice, and policy in affecting the well-being of family caregivers and those for whom they provide care.

  PublisherOA PDFDOI

• Family Ties and Opioid Lies: Pathways to Elder Abuse in Rural Appalachia

  Innovation in Aging · 2025-01-01 · 3 citations

  articleOpen access1st authorCorresponding

  Background and Objectives: The opioid crisis has run rampant throughout America, with communities in rural Appalachia especially hard hit. While the direct effects of opioid use disorder on individuals, families, and communities are well documented, an unforeseen consequence of this crisis is the abuse of older adults by family members or paid caregivers with opioid addiction. The purpose of this study was to characterize cases of opioid-involved elder abuse compared to cases where opioids were not involved. Research Design and Methods: Guided by lifecourse and ecological perspectives, we analyzed quantitative case data and narrative notes for 220 substantiated incidences of abuse of persons aged 60+ that occurred between 2015 and 2017 in eastern Kentucky. Multinomial logistic regression analysis with robust standard errors was used to compare cases on key variables including the older adults' age, gender, income, activities of daily livings/instrumental activities of daily livings, and cognitive capacity. Composite narratives developed from thematic analysis of the case notes were used to contextualize opioid-involved elder abuse cases. Results: We found 25 opioid-involved cases of elder abuse and 15 cases in which the perpetrator used alcohol/other drugs. Compared to cases not involving substance abuse, women were more frequently victims of perpetrators who use opioids and alcohol/other drugs. Victims of opioid-involved abuse were more likely to experience material exploitation (stealing medication) than when perpetrators misused alcohol/other drugs or used no substances. A primary pathway to elder abuse was older adults taking in a family member due to various life circumstances. A second pathway to opioid-involved abuse was when older adults relied on the perpetrator for support and assistance. Discussion and Implications: Opioid misuse by perpetrators heightened susceptibility to elder abuse. Older adults are often protective of their struggling families and may not recognize their own vulnerabilities. Interventions sensitive to cultural norms and close family relationships are needed to combat opioid-involved elder abuse.

  PublisherDOI

• Opioid-Involved Elder Abuse in the United States: Perspectives from Adult Protective Services

  OBM Geriatrics · 2025-01-09 · 2 citations

  articleOpen access1st authorCorresponding

  The purpose of this descriptive study was to understand the nature, extent, and challenges confronted by APS programs in the United States in providing services to older clients affected by opioids. The study design involved a two-step process: Phase I involved telephone interviews with state-level Adult Protective Services administrators from 11 states considered to be “hot-bed states” for the opioid epidemic. Findings from the administrator interviews informed questions for Phase II telephone interviews with individual and small groups of local APS workers from the same states. Key findings that emerged from the interviews indicated that when opioids were involved in cases of elder abuse, allegations most often concerned self-neglect, followed by caretaker neglect and facility drug diversion. Perpetrators of opioid-involved abuse were mostly family members followed by facility staff; and cases involving opioids were perceived as harder to substantiate due to the difficulty of proving if and how medication was missing and the denial of the older victim if the perpetrator was a family member. The inability of older adults to manage medications prescribed to them was the most common explanation of how they became victims of opioid abuse. Improvements to intervention for cases involving opioids include giving APS the ability to perform background checks, more frequent use of electronic medical boxes for appropriate and timely dispensing of medications, holding perpetrators accountable to timeframes, and policies to facilitate greater access and trust of APS. In addition, working with community partners was a critical component to maximally helping older adults involved with opioid misuse. APS field staff stressed that available resources were inadequate for the complexities involved in working cases involving opioids and older adults, highlighting needs for greater financial assistance, enhanced and targeted training, specialists in addiction, and resources for homeless people.

  PublisherOA PDFDOI

• Niece and nephew dementia caregivers: family relationships and care dynamics

  The Gerontologist · 2025-06-14

  article1st authorCorresponding

  BACKGROUND AND OBJECTIVES: The dementia caregiving literature has largely ignored extended family caregivers who play a vital role in sustaining community living for older adults living with dementia. Guided by a life course perspective and grounded in a stress-coping framework, we focus attention on the caregiving experiences of nieces/nephews who have assumed the role of primary caregiver for their aunts/uncles, a topic that has received limited attention in the research literature. RESEARCH DESIGN AND METHODS: Employing a mixed-methods design, we conducted interviews with 20 niece and 5 nephew primary caregivers (Mage = 55 years; R = 38-67). Interviews were analyzed following principles of the life history approach to understand how family history and dynamics shaped care responsibilities and practices; correlation analyses assessed associations with caregiver outcomes. RESULTS: Interactions in childhood provided the foundation for establishing relationships with aunts/uncles. Two-thirds of the nieces/nephews never expected to be their relative's caregiver, but rather either gradually "fell into it" or abruptly assumed the role because of "family circumstances." Caregivers relied primarily on their own family for help with care tasks; aunts'/uncles' family members and paid services provided targeted assistance. Nieces/nephews who relied on family support to assist with care experienced more caregiver burden and faced greater family strain. DISCUSSION AND IMPLICATIONS: The nieces/nephews embraced their caregiver roles and were committed to ensuring their aunts/uncles received the care they needed. Findings contribute new knowledge about the complexity of extended family relationships and realities of dementia care amidst the transformations occurring in family life today.

  PublisherDOI

• Gender differences in spousal caregiver strain and paid service use among dementia caregivers in rural Appalachia

  Frontiers in Public Health · 2025-08-13 · 5 citations

  articleOpen access

  Spousal caregivers of persons living with dementia (PLwD) often experience high overload and loneliness due to the intensive and ongoing nature of caregiving for their partner. Paid in-home services, such as assistance with daily household tasks, respite care, or personal care, might help ease caregivers' physical strain; however, it is unclear if these in-home services effectively address loneliness and overload and whether their benefits differ by gender. Guided by the Stress Process Model, we analyzed structured interview data from 61 spousal caregivers living in rural Appalachia. Although husbands reported significantly lower loneliness and overload than wives, the overall use of paid services was similar across husbands and wives. Among those experiencing high stress, however, a higher percentage of husbands used in-home paid services than wives. Logistic regression analyses revealed that greater emotional strain (overload and loneliness) and higher functional impairment of the PLwD were independently associated with increased likelihood of paid service use. Our findings underscore the need for programs and policies to acknowledge emotional strain as a legitimate criterion for eligibility for paid services.

  PublisherOA PDFDOI

• Cultural motivations, instrumental support, and depressive mood among dementia family caregivers in rural Appalachia

  Aging & Mental Health · 2025-07-26

  articleSenior author

  OBJECTIVES: Although many dementia family caregivers receive instrumental help from relatives and friends for caregiving tasks, prior research on its impact on caregivers' mood has been inconsistent. Guided by the sociocultural stress and coping model, we used daily diary data to examine whether receiving instrumental support is associated with lower depressive mood among dementia family caregivers, and whether this association varies by caregivers' cultural motivations for caregiving (e.g. sense of duty). METHOD: = 65 ± 12.2 years; 88% White) who completed baseline interviews and a 7-day daily diary. Multilevel models assessed daily variations in instrumental support, depressive mood, and the moderating role of caregivers' cultural motivations. RESULTS: Greater instrumental support was not directly associated with lower daily depressive mood. However, cultural motivations significantly moderated this association. Specifically, caregivers with weaker cultural motivations experienced lower depressive mood on days they received more support, whereas those with stronger cultural motivations reported higher depressive mood. CONCLUSION: The psychological benefits of receiving instrumental support may be diminished for caregivers with strong cultural motivations. This underscores the need for culturally-tailored strategies that promote healthier coping and well-being among dementia family caregivers.

  PublisherDOI

• Dementia Care in Rural Appalachia: Multilevel Analysis of Individual- and County-Level Factors

  The Gerontologist · 2024-04-25 · 8 citations

  articleOpen accessSenior author

  BACKGROUND AND OBJECTIVES: Home- and community-based services (HCBS) are underutilized, despite offering significant health benefits to both care recipients and caregivers. Drawing upon Andersen's extended behavioral model of health services use, we examined individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia. RESEARCH DESIGN AND METHODS: We analyzed data from telephone interviews with 123 dementia family caregivers in rural Appalachian counties (Mage = 64.7, SDage = 12.2). Multilevel analyses were conducted to examine the effects of individual-level and county-level factors on the use of home-based services (home healthcare and personal care services) as well as community-based services (adult day care and transportation services). RESULTS: Results indicated that caregivers' receipt of informal support from family or friends was associated with more use of home-based services (B = 0.42, p = .003). Conversely, longer travel times to service providers were linked to use of fewer community-based services (B = -0.21, p < .001). Residing in counties with more home health agencies was associated with higher utilization of home-based services (B = 0.41, p = .046). However, higher county tax expenditures for HCBS were not linked to home-based or community-based service use. DISCUSSION AND IMPLICATIONS: Findings suggest that informal support in caring for the person living with dementia enables HCBS use in rural Appalachia. In contrast, limited geographic accessibility and service availability can impede HCBS use in rural regions. Policymakers are urged to allocate direct public funding to service providers to expand service availability in underresourced rural regions.

  PublisherOA PDFDOI

• Family Caregivers’ Management of Behavioral Expressions of Dementia

  The Gerontologist · 2024-02-24 · 11 citations

  articleOpen access1st authorCorresponding

  BACKGROUND AND OBJECTIVES: Behavioral expressions of dementia are often stressful for family caregivers to manage as they strive to ensure their relative's needs are met. Guided by Lazarus and Folkman's Transactional Model of Stress and Coping, we identified specific behaviors that disrupt daily routines and challenge the achievement of caregiving goals, and the approaches and strategies caregivers employ to address them. RESEARCH DESIGN AND METHODS: We conducted semistructured interviews with 30 family caregivers in rural Appalachia caring for a relative living with dementia. Analysis involved use of open and focused coding processes to identify the ways caregivers managed behaviors and bar graphs to examine management approaches relative to categories of behaviors and caregiver demographic and emotional well-being variables. RESULTS: Analyses revealed 10 types of behavioral expressions of dementia associated with confusion, irritability, and resistance to engaging in necessary activities of daily living. Caregiver approaches to managing behaviors included gentle persuasion, being harsh by yelling or threatening, being persistent in expecting the person with dementia to complete the tasks at hand, disengaging by postponing the activity, and employing a combination of strategies. Approaches differed across types of behavior and caregiver demographics and had varying effects on caregiver well-being. DISCUSSION AND IMPLICATIONS: Uncovering specific behaviors family caregivers of persons living with dementia found bothersome, caregivers' adaptive strategies for managing behaviors, and the impact of those approaches provides new information to inform training on effective dementia caregiving practices and development of targeted intervention programs for dementia care.

  PublisherOA PDFDOI

• Cancer and Social Support

  The SAGE Encyclopedia of LGBTQ Studies · 2024-01-01 · 1 citations

  reference-entrySenior author
  PublisherDOI

Recent grants

• Families in Appalachia Caring for Elders with Alzheimer's Disease (FACES-AD)

  NIH · $418k · 2017–2020

• NIH Grant R03HD059478

  NIH · $95k · 2010

Frequent coauthors

• Rosemary Blieszner

  Virginia Tech

  76 shared

• Jyoti Savla

  Virginia Tech

  71 shared

• Pamela B. Teaster

  Virginia Tech

  38 shared

• Nancy Brossoie

  Virginia Tech

  33 shared

• Brandy Renee McCann

  Virginia Tech

  26 shared

• Aubrey L. Knight

  Virginia Tech

  22 shared

• Katherine R. Allen

  Virginia Tech

  18 shared

• Raven H. Weaver

  Washington State University

  18 shared

Labs

• Department of Human Development and Family SciencePI