Search for tag: "caregivers"

Interviewer: It's a conversation we're not used to having or starting. I'm talking about planning for end-of-life care, and if you are planning for end-of-life care because of a diagnosis with Alzheimer's or other sort of dementia, it becomes even more complicated whether it's for yourself, or whether it's a loved one that has that diagnosis.

So to help out with that process, we're talking to Kara Dassel. She's in the Gerontology Interdisciplinary Program in the University of Utah Health College of Nursing. And her research team has developed this thing called "The LEAD Guide," which stands for Life-Planning in Early Alzheimer's and Dementia. So everybody should have an end-of-life care plan. But from what I understand, if you have Alzheimer's or some sort of dementia, that end-of-life care plan is going to look a little different. Explain why that is.

Kara: There's more of a time crunch in a broader context within Alzheimer's disease or other types of dementia where there is a limited window where you're able to engage in your family member with dementia and learn about their preferences and wishes before they get too cognitively impaired where they're no longer able to have those conversations.

Interviewer: Wow. So after the diagnosis comes in and you find out that maybe a loved one or even yourself has dementia, how soon should that conversation start?

Kara: The earlier the better. It shows that you have better care outcomes as far as having your medical decisions match your preferences if you have those discussions and document it. You're less likely to be hospitalized if you don't want to be. You're less likely to be shuttled in between nursing homes and hospitals and rehab facilities. And it's a better outcome for the people making the decisions for you because they don't have the burden of trying to guess what mom would want.

Interviewer: When it comes to advanced care planning, I thought this was interesting. I tend to always think of just medical preferences, like this is what I want medically done or not done. But it goes beyond that. And "The LEAD Guide" is based on what you call value-based decisions. Explain what that means.

Kara: Yeah. So sometimes just checking a box of whether you want a ventilator or not doesn't give you the full context of end-of-life values and preferences. And in dementia, in particular, someone may be physically very healthy but lack decision-making abilities. And so you need to make decisions about if they need long-term care, is that going to happen in the home? Is it going to happen in assisted living, a nursing home? You needed to decide where their location of death is going to be, because with dementia people live on average 8 years after diagnosis, but they can live up to 20 years. And so there's a lot of care decisions and medical decisions that need to take place within that long death trajectory.

Interviewer: So this can be a tough discussion to have. So I guess I'm thinking from the perspective of maybe a family member wanting to bring it up after that diagnosis. Are there other reasons why it's just really important to have that discussion? Again, it's not a discussion we're used to having.

Kara: Right. Not a discussion you're used to having, and I think just knowing that your window is limited puts the time pressure on having these discussions within a context of progressive dementia. And I like to frame it with families as it is beneficial for the person with dementia and the family members to have this discussion for two reasons.

One, the person with dementia has the comfort and peace knowing that they were able to communicate what they want currently and then also what they want when they have advanced dementia. That might differ. They may want something different today versus five years from now when they're in a nursing home. And so being able to communicate that can bring a lot of peace and comfort to the individual.

And then also, family members can approach it as, "Do me a favor. I want to carry out your values and preferences, but I need to have this conversation with you in order to do that." And that would relieve a lot of burden or guilt or disagreements among family members. So it's really a service to the family to have this conversation.

Interviewer: I was surprised to see in the research that you and your team did to make this guide that, for some people, the emotional burden can last months or even years, the caregiver emotional burden.

Kara: Right. If you're in a situation where you really don't know what your husband or partner wants, or mom or dad and you have to, it's an acute situation in the hospital and you have to make a decision, you may question whether you made the right decision for years. There might be a lot of lingering guilt and stress of not knowing.

Interviewer: Yeah. So I'm looking through the guide here. What I really like about it is it seems pretty simple. And this is a point where I want to say this does not replace, if I understand correctly, an advanced directive. This is not an advanced directive. This works with.

Kara: Right. This is a supplemental guide that's not legally binding, but it provides additional information about a patient's values and preferences and some of those questions that are unique to dementia, like location of long-term care and preference for location of death.

Interviewer: It starts out with a little checklist of the end-of-life documentation that you should have, which is great because that can get confusing. So I like that. And then when you start getting into some of these end-of-life value questions, I found this fascinating because I think we put ourselves in the situation by not having these conversations. Like the very first question, I'm concerned about being a financial burden to my family or close friends. For my mom, like I would spend the money to continue to make her live if that's what she wanted. But then how often is there a disconnect that that's not actually what the person wants?

Kara: Right. And so a lot of these questions here about values, they help inform decisions. So if you know that your mom is really concerned about being a financial burden, then that will help you make decisions about her care in the future. And the same with being an emotional burden or a physical burden. You know, if your mom's really concerned about burdening you physically with day-to-day care tasks, then maybe that makes you feel a little more comfortable about placing her in a 24-hour skilled-care facility when that time comes, knowing that that's your mom's value.

Interviewer: Have you seen this actually in action?

Kara: Yes. So we have . . . A part of the process of developing this guide, we held multiple focus groups with healthy adults, caregivers of people with dementia, and people with early dementia themselves. And the feedback we got was very valuable about, "Wow, this is great. I hadn't thought about this." Or, "I never knew mom cared so much about not dying at home." So it really raised a lot of questions that they hadn't discussed before.

Interviewer: Yeah, that's fantastic. Is there anything else that we need to talk about this? I think this is such a fantastic tool, especially for somebody . . . You know, I know what we need to talk about. We need to talk about somebody with dementia, not only just the deterioration after the diagnosis, but end-of-life wishes tend to be different for patients that know that they're going to have dementia versus maybe somebody that knows that they're going to have cancer.

Kara: The dementia preferences were different from those other ones as far as not wanting medical treatment interventions in a situation of dementia versus cancer. And then, having a preference not necessarily to die at home, being more comfortable dying in a nursing home or at the hospital. And so a lot of the qualitative data that we got showed that the loss of sense of self, of independence, of memory really defines quality of life. And people didn't want to extend that type of life in general.

Interviewer: Understood. My last question is this is such a great tool. Is it something that anybody could use for planning end-of-life, even if it wasn't Alzheimer's or dementia? Because I know it was specifically designed for that, but could it be used for other cases as well?

Kara: Of course. So people may lose the ability to make decisions at the end of life for a variety of reasons, due to other medical conditions, head trauma. So you can use this guide to help with any sort of advanced care planning. It's just meant to facilitate the conversation.

updated: April 29, 2022
originally published: May 13, 2020

Dr. Gellner: When are school age kids able to stay home by themselves? I'll talk about preteens at home on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Back to school time doesn't just mean parents going out and buying new backpacks and pencils, but also time to think about where kids will be before and after school hours. The American Academy of Pediatrics released a statement in August recommending that elementary and middle aged school children still require adult supervision during those times.

As a parent, I get it, that's hard to do sometimes, especially as kids get older and the options for after school get less. For many kids, once they get to be double digits, especially if they start middle school around 11, parents think that they can stay home by themselves. And in some cases, that's okay depending on that child's maturity level, how safe the neighborhood is, are there adults around that the child could reach out to in case of an emergency, is there a way for a child to touch base with the parent to let them know they're home?

Some parents have the luxury of having another family member or a friend take care of their child. In these cases, parents need to stress that these caregivers need to follow the parent's rules about schedules, discipline, and homework. Kids are sneaky and they will try to get away with breaking those rules if they're being watched by somebody other than mom and dad.

If your child goes to an after-school program, make sure that the program has a good number of staff to take care of the children in the program and also make sure that they have a place your child can do their homework. Staff also need to meet state certification regulations for dealing with health issues, emergencies, and the facility itself needs to be inspected and approved as safe.

When it comes to homework, be sure that your child knows homework always comes first. Stress good study habits and make sure they have enough time available to do it, especially if they are involved in extracurricular activities. They should have a quiet place to do their homework as well, free of distractions like the TV and other electronic devices.

The bottom line is everyone needs to be on the same page, your child who needs to understand the importance of getting school work done and playtime comes later if they are home by themselves, after-school providers who need to be supportive of what each child needs and honor the request of the parents, and you as the parent, who needs to be able to set down these firm guidelines and make sure they are followed to ensure that your growing preteen or teen and those who are in charge of them, when you can't be, understand those expectations.

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Interviewer: Five tips for family caregivers of advanced cancer patients. That's next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: You find yourself in a situation where you have to provide care for a family member who has advanced cancer. It can be a very, very difficult time. And today we've got Dr. Lee Ellington. She's a clinical psychologist. She has five tips to help maybe make that process better not only for yourself but, more importantly, for the cancer patient as well. What is your first piece of advice for somebody that has found themselves in the situation?

Dr. Ellington: Number one is to communicate openly with the patient or other family members about the remaining days. It may be uncomfortable, but it's an important conversation to have.

Interviewer: And why is that conversation important? What does that do? What does that accomplish?

Dr. Ellington: It helps people prioritize what's important in their life, things that may have gone unsaid that they might have regrets about later. It helps open up some understanding and I think, in general, just talking about how we want to live in our final days needs to be an open conversation.

Interviewer: How about number two?

Dr. Ellington: If you have a patient with advanced cancer, then I think it would be important to learn about hospice before you need it. So explore hospice and what hospice offers and how not only will it help the patient that they're caring for but they may have many resources for the family. So hospice is a team approach. There's a chaplain, a social worker, a physician, nurse, hospice aids and other resources, and the unit of care is for the family.

Interviewer: So it's not so much necessarily always for the patient, but it's also for those that are caring for the patient in the family?

Dr. Ellington: They will encourage about the caregiver to take care of themselves, but sometimes the caregiver will say, "No, no, no. I can't do that now." But to be at their best, to really take care of the patient and themselves, they need to do both.

Interviewer: All right. So it's a good idea to have an idea what hospice can do, what kind of resources will offer you. What's number three?

Dr. Ellington: Consider yourself a hospice team member. So hospice is a team care approach and the family caregiver and the patient are part of that team. Caregivers have valuable information about the family, about the home life. They know a lot about the cancer and the disease and values and preferences and they should empower themselves to voice that and see themselves as a team member.

The fourth thing is to take care of themselves, self-care. So maintain their health the best that they can. Be sure they get the rest that they need and the resources to provide rested if that's necessary. So kind of pace themselves.

Interviewer: So don't abandon all the other things in your life. You still need to keep maybe exercise routines or give yourself some breaks away from caring for that patient. Again, I would imagine a lot of people are like, "No, I can't do that. That's selfish of me."

Dr. Ellington: Absolutely. That's the most common statement, I think. The other would be to seek support, whether from the hospice team, from families, from friends. People don't know what to do. They want to provide support to you, to both the patient and to the family and to take people up on that and ask for it, meals, a friend to talk to, a break. So seeking that support.

Interviewer: Yeah. And so often in that situation, you'll find people will say, "You know, if there's anything I can do," and then how often does that conversation just end right there? You're recommending that that family member should say, "You know what? It would really help if you could cook a potluck dinner for us tomorrow night or whatever."

Dr. Ellington: Absolutely.

Interviewer: Is there a big bottom-line takeaway when it comes to you're the caregiver, how can you care for yourself for the benefit of not only yourself and your loved one as well?

Dr. Ellington: Death does not just one person's experience. It's everyone's experience. There's loss, there are goodbyes. And so I think the takeaway is that to come together and decide how the family or the support ties want this to occur, want it to happen and be clear about that. So that means maybe taking a break so that they can be present for important conversations or can be present to provide the care they need. Or it may be taking a break to reflect on, "What just happened here?"

Interviewer: Do you find that that uncertainty of the person that is giving care not exactly knowing what the person that they're caring for wants can cause a lot of undue stress and that's why these conversations are important?

Dr. Ellington: Yes. People are afraid to talk about it and, certainly, the patient drives the course of the conversation. If they're not comfortable about talking about the final days and you've gently tried to make that occur, then you need to talk about with someone the final days and what you want and how you can make that happen for yourself and for the patient, but definitely, these conversations are difficult in our current culture.

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Dr. Jones: Caregiving, it's been called compassion in action. Sixty million Americans function as full or part-time caregivers for family members or people in their community. November is National Caregiver Month, and we honor those who, through love, loyalty, duty, or a combination of all three, give their heart, mind, and body to care for others. But how do caregivers care for themselves? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care. And today we're talking about the health of caregivers on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Jones: The economic value of informal and family caregiving in the U.S. is more than $300 billion a year, but there is also a cost to the caregivers. They've been called the invisible patient, in that their present in the doctor's office with the person for whom they care, but their responsibilities have a physical and mental cost. The risk factors associated with health problems and caregivers include, being a woman, the number hours of care provided, financial stress, cognitive impairment of the patient, a caregiver who lives with the patient, and a lack of choice in assuming the caregiver role. Today in the studio we're talking to a caregiver who is balancing her role as primary caregiver with her own health successfully, I might add. And I would like to welcome Kathleen to The Scope radio to talk about caregivers taking care of themselves. Welcome, Kathleen.

Kathleen: Thank you. I'm delighted to be here.

Dr. Jones: So help us understand a little bit about how long you've been the primary caregiver for a loved one in your home.

Kathleen: My husband was diagnosed with Alzheimer's about year after he retired. It's been nine years now that we've been dealing with this.

Dr. Jones: Did you plan for the long haul? Did you take it day-to-day, or a little bit of both? Did you think it was going to be this long?

Kathleen: No, I didn't think it was going to be this long. The prognosis, when you get it, is 3 to 20 years, and I looked in stunned shock at the doctor when he said that and he said, "But it won't be that long." I think probably because my husband was still considered early onset, because of his age. He was 63 at the time, but, no, I had figured really that he would probably be gone by now.

Dr. Jones: Some way, you've managed to stay alive cognitively intact, physically healthy. I mean, these are the things I'm assuming, but what have you learned over these years about taking care of yourself?

Kathleen: It's very, very important. There have been times when I thought I was doing fine and then suddenly realized that I really wasn't. What I do for myself is go hiking when I get a chance to. I belong to the book club, and I read voraciously. I read myself to sleep at night, partly because if I don't read before I go to bed my brain just starts thinking about all sorts of things. In this way, I can put myself in another world before I go to sleep. I indulge in chocolate as often as possible. I do volunteer work, and I'm lucky because I can still leave my husband home alone and I can take off and do volunteer work. I go to lunch with friends. At this point I can no longer take him to the theater or movies, so I go by myself.

Dr. Jones: In terms of his physical activities, can he dress and feed himself or is this something that you need to do for him?

Kathleen: He can still dress himself. If I don't put his clothes out for him, he will just put the same things on over and over again.

Dr. Jones: That sounds like me. That sounds like a great fashion idea.

Kathleen: But, yes, he can still dress himself, wash himself. Sometimes he needs a little encouragement, and he still eats by himself.

Dr. Jones: So you've been writing about your experiences. Is that helpful?

Kathleen: It has been extremely helpful. There's something about putting your thoughts in print that's very different from talking with someone casually, and you sort through your feelings and your emotions much more if you put it in print than you do when you're just speaking to someone. It's been extremely helpful for that. My goals with the blog were two-fold. Number one, to help me vent, but, number two, to help other people realize that we're all going through the same set of emotions at various times, and it's been very helpful.

Dr. Jones: I've certainly heard about writing as an exercise for people with PTSD and depression, but this is the first time I have actually thought of writing as a therapeutic choice for people who are locked in or choose to lock themselves into a caregiver role.

Kathleen: It's been extremely helpful. I noticed a change within the first few months in my feelings just because I had put them down and posted the blog. It was a very different feeling, so it's been extremely helpful.

Dr. Jones: Well, you mentioned talking to others. Can you expand on that little bit?

Kathleen: Yes. As I let friends know that my husband had Alzheimer's, I found other people out there who did. I mean, almost everybody knows someone, either in their direct family or a close friend, who has this disease or has some form of dementia. In my volunteer work I found several people who do, and we would start talking to each other. As we spoke together, we realized that we're going through some of the same things, different times maybe. This is a weird disease because everybody's a little bit different, but emotional horror is the same for all of us, and it helps.

Dr. Jones: You used the words "emotional horror." That's a strong word. I can see the use for writing. That's not something that you can just tell your children or tell someone casually, but that's a powerful sense that you might actually be able to write down or you can say in a small group of other caregivers.

Kathleen: Yes, and I do belong to a support group also for dementia.

Dr. Jones: What about respite care? Right now you can go for a walk and so keeping yourself physically fit and being able to go outside is really important. Sunshine on your face is critical, but what about respite care, if you need to go away longer than just a couple of hours?

Kathleen: There are facilities in the community where you can take whoever you're caring for, whether it's a spouse, a parent, whatever. You can leave them for a few hours or all day. Some people have insurance that will cover total expenses for that. The general cost, I think, is about $50 a day for those who don't have insurance that covers it. Its $50, that's a lot of money, but it beats a psychiatrist or the hospital bills if you succumb to caregiver-itis.

Dr. Jones: Right. What kind of ideas would you share? What do you think would help others?

Kathleen: The first thing is that I absolutely cannot dwell on this disease all the time. I would go completely bonkers if I did. You're in limbo for between 3 and 20 years, so you just cannot focus on the disease itself. So I locked that into a back corner of my mind and shut the door and go on with doing things I enjoy doing, which we've already discussed, chocolate being one of the most wonderful ones, chocolate, hiking, and getting together with friends.
The second, is guilt. So many people in my support group have said, "Well, I don't feel like I should take off by myself and go do something that's just for me because then I'm leaving my husband there by himself and I feel guilty about that." I lost the guilt bug a long, long time ago. You absolutely have to get out there and do things that are just for you that make you feel good, that you enjoy or you're not going to survive to take care of him. That's what you should feel guilty about.
I left my husband in respite care for a week recently and started to feel a little bit guilty as I was driving away, in spite of what I've just said. I turned on NPR and Diane Rehm was on, and she had someone from the Alzheimer's Association on who, as I turned it on, was saying Alzheimer's caregivers are six times more likely than the general public to develop Alzheimer's themselves because of the stress. I thought, "Okay, Kathleen, pat yourself on the back. You need this. You have to get out and go," and I did.

Dr. Jones: Well, you've really wrapped it up very nicely in a sense that, exercise, keeping yourself cognitively active, volunteering in another non-caregiving way, and chocolate. Great. So we are all caregivers to some degree or another, and, as I've been told, you cannot pull water from an empty well, so caregivers need to care for themselves. You mentioned that at this point you can leave your husband at home.

Kathleen: Yes.

Dr. Jones: The time may come when you can't do that.

Kathleen: Right.

Dr. Jones: Do you have plans for that, or are you just going to wait till that happens?

Kathleen: I'm peripherally aware of what's out there to use. The first thing that I will do when that happens is to take him to one of the places where you can leave them for a day for a few hours or all day so that I can escape and just do whatever I want to for that day. The second thing, which I'm already pursuing somewhat, I mentioned leaving him in respite care for a week, that, I think, is going to be a very good alternative to full-time care because it will allow me to escape completely for a week without the horrendous expense of full-time care. That would be my number two option. My two criteria for leaving him in full-time care would be if he gets violent or if he gets to the point where he needs physical help that I'm unable to give, if I have to lift him or something like that, that would be impossible. So those two things are my criteria.

Dr. Jones: Well, when I mentioned that Americans provide over $300 billion of care, if they had to have that care in a facility or have someone else hired to provide that care, that's what it would end up having cost. Full-time nursing home care for people who are at the end of their cognitive life is enormously expensive.

Kathleen: It is. At this point, it's the best-paying job I've ever had, and I don't see the cash but at least it's not going out.

Dr. Jones: That's a great way to put it.

Kathleen: Full-time care is anywhere from $6,000 to $8,000 a month. Medications would be extra.

Dr. Jones: Right, so it is very expensive.

Kathleen: It's very, very expensive.

Dr. Jones: Right. I tell people, from my own experience, once you add medications and doctor's visits it ends up being almost $100,000 a year.

Kathleen: Oh, yes.

Dr. Jones: $8,000 a month times 12 is 96.

Kathleen: Yeah.

Dr. Jones: So that's something that most people don't have insurance for.

Kathleen: Right.

Dr. Jones: Did you and your husband ever talk about long-term care insurance?

Kathleen: Long-term care insurance hadn't been around very long before he was diagnosed, and once he's diagnosed you can't get it.

Dr. Jones: Right.

Kathleen: So we talked about it briefly and then decided no. We had been in good health. Our parents had been in good health. We never anticipated this.

Dr. Jones: Well, that's a conversation that most of us don't want to have, but the realities are, with people living as long as we do, which is a blessing in so many ways, the fact that we may live beyond our cognitive capacities means that one out of three of us are going to spend time in some kind of health care facility.

Kathleen: Yes.

Dr. Jones: This is for younger people who can get long-term health insurance when it's still affordable.

Kathleen: Right.

Dr. Jones: But we never think it's going to be us.

Kathleen: Oh, you don't. Before you retire you never consider something like that.

Dr. Jones: Right. Well, as an aging nation, this is something we're going to have to pay attention to. As a member of the agers, I'm a Boomer, I want to live a long and productive life and I don't want to be a burden, but it's something that we as a nation are going to have to think about how we take care of our caretakers.

Kathleen: Yes.

Dr. Jones: What do you think is the most challenging thing in your role as a caregiver?

Kathleen: At this point in his development with the disease he's in stage six, out of the seven stages. I think the biggest challenge for me is that I get so terribly lonely. He has lost the ability to converse. He says three or four phrases over and over again, and I have to try to interpret those in context and sometimes that's impossible. He understands virtually nothing that I say, so I have no one to talk to and share with when we're at home together.

Dr. Jones: That's heartbreaking.

Kathleen: It is. It's very difficult. We've been married for 49 years, and I've lost the companion that I anticipated having. Now, that being said, I'm not going to do the pity party. I have friends and I have children that I talk to regularly and visit with regularly.

Dr. Jones: But the nights are long.

Kathleen: It's really hard.

Dr. Jones: Is it a challenge to care for someone for whom you now have to take care of?

Kathleen: Sometimes it really is. I know people who have said they just delighted in taking care of their spouse and were glad to do everything they could for them. I haven't been able to find the enjoyment in it. It gets very difficult. You're in limbo. You have no idea how long you're going to be doing this, and there are times when I just get frustrated and I resent being in this position.

Dr. Jones: And the person you are caring for is not the person that you fell in love with, that you raised your children with, that you had a career with, that you retired with.

Kathleen: No. My husband vanished many years ago, so I am taking care of a large two-year-old.

Dr. Jones: The National Family Caregiver support program, which is part of the National Administration on Aging, has a website that can direct you to ideas and local support. However, for all listeners, this Thanksgiving is the time to especially thank those who are providing compassion in action as caregivers. Thank you for joining us.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.

Dr. Cindy Gellner: Cell phones have become increasingly important and often a demanding part of life today. How do they get in the way of parent-child interactions though? That's today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to the Scope.

Dr. Cindy Gellner: So you're probably guilty of this. You'll sit at fast food restaurants or just having meal time out with your family or even at home, and you've got your cellphone there. And it goes, "You have a new message." Or whatever your notification beep is, and you feel the urge. I have to check it; I have to check it. Stop.
There's a new study out that came out just literally last week, and it talks about how parents' use of cellphones at meal times is actually hurting children. So how is this, you might ask?
Well, the researchers who did this in Boston and who published the study in the Journal of Pediatrics visited fast food restaurants, observed the caregivers, and how they were with, at least, one child and saw how much time they'd go on their mobile phone. And what were they doing on their mobile phone, and how did they interact with the children?
Probably about 80% of these adults used their mobile phones during the meal. Now the biggest influence on the interactions between the caregiver and the child appeared to be how absorbed in the cellphone that the caregiver appear to be.
Are they answering a call real quick from work or from a spouse that says, "Hey, I'm running late." Are they just checking an important email and making a quick response and putting the phone back down? Or are they playing a game, or are they on Facebook? What exactly are they doing?
And the other thing was how frequently they picked up the phone. Did they pick it up? Put it down? Pick it up? Put it down? Or they pick it up? Put it down? Or leave it down because sometimes things are emergencies, and you need to use your cell phone for something. But think about it. We all survived before cellphones even existed, and we can do it again.
So what about the kids while the parents are on the phone? How do the kids respond when the parents are on the phone? Also how did the parents respond when the child was trying to get their attention? Again, it all depended on how absorbed the adults were on their phone as to how they responded to the children. Quite often the parents who were on their cellphones a lot, from what the researchers saw, they weren't exactly on their best behavior.
And the highly absorbed adults, when they were on the phone so much and their children were misbehaving, they often responded harshly. Not in nice voices, but like "Get over here," things like that. It's really important that you put the phone down so that you can pay attention to your child's behavior. So one, your child knows how to behave in a public restaurant and two, when they do misbehave, you can get them reined in a lot faster and a lot nicer.
The one thing that researchers noticed too is the people weren't only talking on the phone, the most absorbed users were actually swiping or typing on their phone with their eyes never on the children, just on the phone. The study didn't draw any conclusions about the effects of this use, but it was very important to note how the children and the adults interacted.
This is important because absorbed parents not paying attention to their children, it actually has a really big effect on how the kids behaved. And not only that, it also has a big effect on how kids perceive their worth is to the parents. If the parents are so absorbed in their cellphones, the kids feel like, "Why am I even here? Why should I even try to be good? Mom and dad don't care, they're on their phones."
Kids who are not paid attention to a lot tend to have a lot of problems. The kids who do get the attention from their parents, the kids who do eat meals with their parents at home or out and don't have a phone involved, they do better in school. They're less like to drink, smoke, do drugs, having family meals together often led to less depression because the kids have great self-worth. They felt positive about their family interactions, and the families were closer.
So keep all of this in mind next time you're sitting at the table and that little notification goes off. Best thing to do, put it away. Turn it on vibrate if you have to so that you don't hear it, and it can wait. Interact with your kids because they really need you there to let them know that you care about them, and it will be a great benefit to them in the future if you do.

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