Nutrition and mobility: Innovative PI project to improve health and enjoy aging

NYC Health and Hospitals Corporation (HHC), municipal health care system, operates 4 nursing facilities w/3,000 beds, 99.9% occupancy, residents largely low income, multi-ethnic minorities. Nursing home admission means changes in environment, social situation, eating patterns. Research shows poor nutrition, circulation and skin integrity result from eating alone, immobility, taking multiple medications, tobacco use, poor dental health. Scientific evidence increasingly support good nutrition and continual mobility as essential for physical/mental health, quality life, active daily living. Using quality improvement techniques, feedback and satisfaction surveys, food service and physical independence were identified as improvement opportunities. They embarked on “home-like dining and social environment” project with objective to improve resident nutritional status and encourage physical/mental independence by improving meal service/dining décor, eliminating mundane tray deliveries and allowing socialization. Each multidisciplinary group including residents, implemented project to improve nutrition and mobility; positive social interaction, mental/physical stimulation, support system, opportunity for enjoyable and pleasant dining. Meals served were appealing considering special diets due to health/medical conditions, cultural preferences, religious beliefs. Project included refurbishing dining room w/garden-like décor; linen table cloths/napkins, chinaware, cutlery, center pieces w/ fresh flowers, cards w/resident's name and diet, background music, formal attire, socialization participation (e.g., group dancing w/instructors; exercise games using new technology- Wii game).

Responses very positive; e.g., felt like restaurant dining; soothing music lifted spirits; improved physical appearance/dressing; improved desire to dance/interact w/peers, improved appetite/food palatability. Project improved resident satisfaction with 85% better eating, gaining/maintaining weight, preventing skin breakdown and circulatory impairment, (e.g., pressure ulcers, deep vein thrombosis).