For families with someone bedridden at home, pressure ulcers are a top concern: use an electric alternating-pressure air mattress, turn the patient regularly, and check bony areas daily

8. For families with someone bedridden at home, pressure ulcers are a top concern: use an electric alternating-pressure air mattress, turn the patient regularly, and check bony areas daily

Cost: Electric alternating-pressure air mattresses for home use start at a few hundred yuan. Turning a patient takes just a few minutes. The real challenge is doing it every two to three hours, even at night — no single caregiver can manage that alone.

In plain terms: Pressure ulcers are far more than just superficial skin injuries. Among older adults undergoing hip-fracture surgery, those already having pressure ulcers at admission face a roughly 20% higher chance of dying within 30 days. Three evidence‑based actions help: using an electric air mattress cuts new ulcer formation by about 60% compared with ordinary hospital mattresses; consistently turning the patient reduces risk by roughly 70% versus standard care; and keeping the person from lying prone for long periods also helps. Check the sacrum, heels, hips, and shoulders each day; if any area shows persistent redness that doesn’t fade when pressed, contact a nurse or doctor right away.

Benefit: Data come from 19,520 hip‑fracture patients in the U.S. NSQIP registry (2016‑2019). Those with pre‑existing pressure ulcers showed a higher 30‑day mortality rate; after adjusting for other factors, this link remained significant (OR 1.2, a 21% increase in risk, P = 0.004). They also faced higher rates of deep‑vein thrombosis (OR 1.59), pneumonia (OR 1.39), unplanned readmissions (OR 1.43), and an average hospital stay 0.4 days longer. In a follow‑up of 324 elderly inpatients (mean age 86) over 18 months, pressure ulcers independently predicted long‑term death (HR 1.500, 95% CI 1.059‑2.126, P = 0.020). A network meta‑analysis of 65 randomized trials compared electric alternating‑pressure air mattresses with standard hospital mattresses; the former lowered ulcer incidence (RR 0.42, 95% CI 0.29‑0.63, moderate certainty). Similar benefits were seen with hybrid systems (RR 0.22, 95% CI 0.07‑0.66). A 2026 Cochrane review of 11 trials involving 4,462 patients found little difference between turning schedules of 2 hours versus 4 hours (RR 1.05, 95% CI 0.79‑1.39, very low certainty). However, using wearable sensors to enforce 2‑hour turning intervals in an ICU setting cut ulcer rates compared with usual care (RR 0.28, 95% CI 0.10‑0.75, moderate certainty). Finally, patients kept in a prone position developed ulcers far more often than those lying supine (RR 4.55, 95% CI 2.31‑8.98).

Evidence grade: B

Sources: 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>; Ottaviani S, Rondanina E, Longo E, et al. (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>; 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>; Latimer SL, Chaboyer WP, Probst S, et al. (2026). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 6, CD009958. <https://doi.org/10.1002/14651858.CD009958.pub4>

Notes: This grade reflects three main points. First, the mortality studies showed only that patients with ulcers fared worse; they did not prove that preventing ulcers directly lowers death rates. Second, the evidence on optimal turning intervals from randomized trials is quite weak. Third, the data on air mattresses are relatively stronger, yet they compared hospital‑grade mattresses to ordinary home mattresses, so extrapolation to home use is somewhat uncertain. Daily inspection of bony areas is standard nursing practice and lacks dedicated research support. The mortality benefit is evaluated separately from cost calculations for other items in this section. Home‑based care services covered by long‑term care insurance are described in item 7. Sudden leg swelling should be treated as a possible deep‑vein thrombosis, as covered in section 13, item 11. Situations involving prolonged bed rest after falls or severe injury are discussed in section 1, item 34.