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

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.

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 (odds ratio OR 1.2, P=0.004). They were also more likely to have other problems: deep-vein thrombosis (odds ratio OR 1.59), pneumonia (odds ratio OR 1.39), and unplanned readmission (odds ratio 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 (hazard ratio 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 (relative risk RR 0.42, 95% CI 0.29 to 0.63, moderate certainty). A powered hybrid air support surface was relative risk 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 (relative risk 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 (relative risk 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) (relative risk RR 4.55, 95% CI 2.31 to 8.98). The first two studies only found worse subsequent outcomes in people with pressure ulcers; they do not establish that preventing ulcers lowers mortality.

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, 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；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, 等 (2026). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 6, CD009958. https://doi.org/10.1002/14651858.CD009958.pub4

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 the comparisons were between hospital support surfaces, so applying the findings to home mattresses is an extrapolation, 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.