If someone at home is bedbound long term, treat pressure ulcers as the first enemy: an electric air mattress, turning on a schedule, and a daily look at the places where bone sticks out

For elders who already had a pressure ulcer before hip-fracture surgery, the chance of dying within 30 days was about 20% higher. Switching to an electric air mattress cut new pressure ulcers by about 60%. In an intensive care unit (ICU), using a sensor reminder so that turning on time actually happened cut them by about 70%, while laying the person face down produced far more pressure ulcers. Look once a day at the sacrum, heels, hips, and the shoulders and back. If you find red that does not fade when pressed, find a nurse or a doctor that same day.

Cost

A home electric alternating-pressure air mattress starts at a few hundred yuan. A turn takes only a few minutes. The hard part is turning every 2 to 3 hours, including at night. One caregiver cannot keep that up alone.

Benefit

19520 patients who had hip-fracture surgery (U.S. NSQIP, National Surgical Quality Improvement Program, 2016 to 2019). People who already had a pressure ulcer before surgery had a higher share of deaths within 30 days. After other factors were taken into account, the link still held (OR 1.2, a 21% increase in the odds, P=0.004). They were also more likely to have other problems: deep-vein thrombosis (OR 1.59), pneumonia (OR 1.39), and unplanned readmission (OR 1.43). The average hospital stay was also 0.4 days longer. 324 hospitalized elders (mean age 86) were followed for a median of 18 months. A pressure ulcer on its own predicted long-term death (HR 1.500, 95% CI 1.059 to 2.126, P=0.020). "On its own" means that after other factors are set aside, it still predicts. 65 randomized trials were pooled (a network meta-analysis). They compared a powered active air support surface with a standard hospital mattress (a standard hospital support surface). A powered active air support surface is the electric air-mattress type. People using one had a lower rate of pressure ulcers (RR 0.42, 95% CI 0.29 to 0.63, moderate certainty). A powered hybrid air support surface was RR 0.22 (0.07 to 0.66). A Cochrane review of 11 trials and 4462 people, updated in 2026, compared turning every 2 hours with turning every 4 hours. The difference was unclear (RR 1.05, 95% CI 0.79 to 1.39, very low certainty). Comparisons among other turning intervals were equally uncertain. In a trial of 1226 intensive-care patients, wearable sensors that reminded staff in real time and gave a visual alert made turning every 2 hours actually happen. The pressure-ulcer rate was lower than usual care (RR 0.28, 95% CI 0.10 to 0.75, moderate certainty). In a trial of 116 people, the prone group (lying face down) had a higher pressure-ulcer rate than the supine group (lying flat) (RR 4.55, 95% CI 2.31 to 8.98).

Notes

The grade is B for three reasons. First, the two studies of mortality only saw that people who already had pressure ulcers later did worse. That is not the same as showing that preventing pressure ulcers brings mortality down. Second, the randomized trials on turning intervals are very uncertain. Third, the air-mattress evidence is firmer, but the studies compared mattresses on hospital beds, and applying that to a mattress at home is an extrapolation. Looking every day at the sacrum, heels, hips, and the shoulders and back, for red that does not fade when pressed, is ordinary nursing practice. There is no separate study of it. Care that long-term care insurance can pay for is in item 7. If a leg suddenly swells, treat it as deep-vein thrombosis: section 13, item 11. The stretch of long bed rest after a fall or a serious injury is in section 1, item 34.

Sources · 4

1. Porter SB, Pla R, Chow JH, et al. (2022). Preoperative Pressure Ulcers, Mortality, and Complications in Older Hip Fracture Surgery Patients. JAAOS Global Research & Reviews, 6(11). doi.org/10.5435/JAAOSGlobal-D-22-00117
2. Ottaviani S, Rondanina E, Longo E, 等 (2026). Impact of pressure ulcers and frailty on long-term mortality: a prospective cohort study of hospitalized older adults. European Geriatric Medicine, 17(2), 665-672. doi.org/10.1007/s41999-025-01331-8
3. Shi C, Dumville JC, Cullum N (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS ONE, 13(2), e0192707. doi.org/10.1371/journal.pone.0192707
4. Latimer SL, Chaboyer WP, Probst S, 等 (2026). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 6, CD009958. doi.org/10.1002/14651858.CD009958.pub4