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If someone at home is bedridden for a long time, treat pressure sores as the number one enemy: use a powered air mattress, turn them on a schedule, and check the bony spots every day

  • Moderate value
  • Evidence B
  • Buys life
  • Costs a little
  • Takes time daily
  • Long-term effort

In plain words

For an older person who already had a pressure sore before hip-fracture surgery, the chance of dying within 30 days is about 20% higher. Switching to a powered air mattress cuts new pressure sores by about 60%. Turning on schedule, when it is really done, cuts them by about 70%. Don't let the person lie face down for long. Every day, look at the tailbone, heels, hips, shoulders and back, and if you see a red area that doesn't fade when pressed, contact a nurse or doctor the same day.

Cost

A household powered alternating-pressure air mattress starts at a few hundred yuan. Turning someone takes only a few minutes. The hard part is that you have to turn them every two or three hours, including at night, and one person cannot keep that up.

What you get

19,520 hip-fracture surgery patients (U.S. NSQIP, 2016 to 2019). People who already had a pressure sore before surgery had a higher share dying within 30 days. After accounting for other factors, the link still held (OR 1.2, odds up 21%, P=0.004). These people were also more likely to have other problems: deep vein thrombosis (OR 1.59), pneumonia (OR 1.39), unplanned readmission (OR 1.43), and the average hospital stay was 0.4 days longer. 324 hospitalized older people (average age 86) were followed for a median of 18 months. A pressure sore alone predicted long-term death (HR 1.500, 95% CI 1.059 to 2.126, P=0.020). Predicting alone means that once other factors are set aside, it predicts on its own. 65 randomized trials were pooled (network meta-analysis). The comparison was powered active air-flow support surfaces versus standard hospital mattresses (standard hospital support surfaces). A powered active air-flow support surface is the kind of thing a powered air mattress is. People using it had a lower rate of pressure sores (RR 0.42, 95% CI 0.29 to 0.63, moderate certainty). A powered hybrid air-flow surface gave RR 0.22 (0.07 to 0.66). A Cochrane review of 11 trials and 4,462 people (updated 2026). Turning every 2 hours versus every 4 hours, the difference was unclear (RR 1.05, 95% CI 0.79 to 1.39, very low certainty). Comparisons between other turning intervals were likewise very uncertain. In a trial of 1,226 ICU patients, a wearable sensor gave real-time reminders with a visual warning, which made turning every 2 hours actually happen. The pressure sore rate was lower than with usual care (RR 0.28, 95% CI 0.10 to 0.75, moderate certainty). In a trial of 116 people, the prone (face down) group had a higher pressure sore rate than the supine (lying flat on the back) group (RR 4.55, 95% CI 2.31 to 8.98).

Notes

It is rated B for three reasons. First, the two death studies only saw that "people with pressure sores did worse afterward," which does not mean "preventing pressure sores will lower the death rate." Second, the conclusions of the randomized trials on turning intervals are shaky. Third, the evidence on air mattresses is firmer, but those studies compared hospital bed mattresses, and applying it to home mattresses is extrapolation. Checking the tailbone, heels, hips, shoulders and back each day for "red that does not fade when pressed" is routine nursing practice and has no separate literature. For the care services that long-term care insurance can cover, see §17.7. If one leg suddenly swells, handle it as deep vein thrombosis; see §13.11. For the stretch of being bedridden after a fall or serious injury, see §1.34.

Evidence grade
B : Supported by research but without a precise number, or based on small or single studies.
Sources
  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). https://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. https://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. https://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. https://doi.org/10.1002/14651858.CD009958.pub4

Mentioned in

Translated from the Chinese original. Original book, section 17, tip 8. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer