Pressure-relieving care equipment is arranged through health services
The mattress or overlay used in pressure-sore care needs to be chosen through an assessment. I know buying something feels like a practical way to help, but getting the right care in place comes first. Whether equipment is provided, and which equipment, depends on the assessment and local services.
Pressure sores, also called pressure ulcers or bed sores, are areas of damage to the skin and the tissue underneath. The NHS says they are caused by something putting pressure on or rubbing the skin. They usually form over bony parts of the body, such as the heels, elbows, hips and tailbone.
The NHS lists symptoms including discoloured patches of skin that do not change colour when pressed, usually red on white skin, or purple or blue on black or brown skin; a patch of skin that feels warm, spongy or hard; and pain or itchiness. If you're helping someone else, listen when they describe a sore or itchy area as well as looking at their skin.
These sores can become a blister or open wound. The NHS says that, if untreated, they can reach deeper layers of skin, muscle and bone. Treatment can include antibiotics if a sore is infected, and surgery for severe ulcers. You don't need to wait for an open wound before getting help.
The NHS says you have a higher chance of developing pressure sores if any of the following apply:
- You have problems moving.
- You have had a pressure ulcer before.
- You have been seriously ill in intensive care or recently had surgery.
- You are underweight.
- You have swollen, sweaty or broken skin.
- You have poor circulation or fragile skin.
- You have problems feeling sensation or pain.
Tell the GP about any of these that apply.
What you might search for as a "pressure relief mattress" is care equipment. NICE's quality standard describes a mattress or overlay, a layer placed over a mattress, that spreads out pressure or takes pressure off different parts of the body in turn. These may also be called pressure reducing, pressure relieving or pressure redistributing devices. The standard says people at high risk are provided with this equipment through services in England and Wales.
NICE's clinical guidance recommends high-specification foam mattresses for adults admitted to hospital and adults assessed as high risk in primary and community care.3 For adults who already have a pressure ulcer, it recommends high-specification foam and says to consider a dynamic support surface if that is insufficient. It says not to use standard-specification foam mattresses for adults with a pressure ulcer. Leave that selection to the clinicians responsible for the person's care.
The 2021 Cochrane review by Shi and colleagues included 29 trials of clinical support surfaces, mainly in acute care and older patients.1 Foam surfaces may lead to more pressure ulcers than alternating-pressure air surfaces and reactive air surfaces. Evidence on comfort was not robust enough to say how foam affects it. Certainty was low or very low.
There is also a community nursing route. NICE's community nursing quality statement says people with a risk factor who are referred to community nursing services have a pressure ulcer risk assessment at their first face-to-face visit.5 Community nurses, often called district nurses, visit people at home. Specialist tissue viability nurses are reached through referral from a GP or community nurse, with routes varying locally.
For everyday comfort, choose a mattress you can turn on easily
A medium feel with latex or gel over pocket springs is the construction I favour for someone who moves easily and has none of the NHS risk factors. The surface spreads weight across your body while the springs and responsive comfort layer let you shift position without sinking deeply. The comfort advice applies to a mattress you buy yourself. Keep any mattress or overlay arranged by clinicians in place unless they change it.
Latex mattresses are well worth considering if you dislike feeling held in one position. Latex has a springy feel and responds quickly when you move. I also like gel comfort layers over pocket springs, provided the surface feels easy to turn on. Deep, slow memory foam is harder to turn over on, so avoid buying it for someone who already struggles with that movement.
Start with body weight when choosing the feel, then check how you lie and turn. Lighter people need a softer surface to sink in comfortably, while heavier people need firmer support. These are the comfort differences I look for when comparing mattresses:
| Your build or sleeping position | What to look for |
|---|
| Lighter build | A notch softer, so you can settle into the comfort layer without feeling perched on top. |
| Heavier build | A firmer feel that supports your weight without a deep dip beneath your hips. |
| Mostly sleeping on your side | Enough softness for your shoulder and hip to sink a little, while turning remains easy. |
| Changing position often | A responsive surface that lets you turn without waiting for the foam to recover. |
A firm edge matters when you sit on the side before standing. Choose a bed height that lets you sit with your feet flat on the floor, and check the combined height of the base and mattress. For an older person, I put those practical details ahead of choosing a firmer feel by default. Our guide to mattresses for older sleepers covers the wider comfort and access considerations.
A removable, washable cover makes everyday cleaning easier. I'm usually cautious about mattress protectors because they can hamper breathability, but where spills or sweat are likely, a breathable waterproof protector is a practical choice. Check the washing instructions before buying so you know whether you can clean and dry it at home.
If night sweats or incontinence are part of the picture, tell the GP or care team. On care equipment, get the responsible clinician's agreement before adding a protector, pad or topper. Extra layers need to fit the equipment's intended use.
A mattress topper can soften a sound mattress that feels too firm. It cannot fix a dip. Replace a mattress according to visible sagging and how you feel when you wake, with seven to ten years only a loose guide. If you're buying for someone else, ask how comfortable they feel in the morning as well as checking the surface yourself.
Raising the back section of an adjustable base can make sitting up and getting out of bed easier. I think that is a sound reason to consider one, although they are overpriced for most people. If the person is at risk or already has a sore, speak to the professionals managing their care before changing the base, and check that any proposed mattress is compatible.
Keep changing position and check skin every day, whatever the mattress
Keep up regular position changes and daily skin checks, even when the bed feels comfortable. The NHS says changing position and moving regularly is important to help relieve pressure on ulcers and help stop new ones forming. If you're caring for someone, make sure you understand their movement plan and how much help they need.
The NHS says that if you're being cared for at home, there are things you and your care team can do to lower your chances of getting a pressure ulcer: change position regularly, use specially designed mattresses and cushions, check your skin every day, try to stay active if possible, eat a healthy balanced diet, and do not smoke.
NICE's guidance for health and care professionals says adults assessed as at risk should change position frequently and at least every 6 hours, and adults assessed as at high risk at least every 4 hours. These minimums apply in any setting, including care at home. Follow the individual plan set by the care team, including any more frequent changes they advise.
During a daily skin check, look for the NHS symptoms: discoloured patches that do not change colour when pressed, usually red on white skin, or purple or blue on black or brown skin; a patch that feels warm, spongy or hard; and pain or itchiness. Check the areas the person rests on, including their heels and hips. If you notice symptoms, contact the GP.
Time spent sitting needs attention too. NICE says to consider a high-specification foam or equivalent pressure-redistributing cushion for adults who use a wheelchair or sit for long periods. An NHS community trust's pressure ulcer leaflet from Kent Community Health warns against ring or doughnut cushions because they can cause further pressure damage.6 Have the person's seating needs discussed as part of their care.
If someone finds it hard to change position without help, ask the nurse responsible for their care to explain how to help them move safely. You need guidance suited to their abilities and the space and equipment available at home.
Avoid these purchases and changes to care
- Buying a mattress instead of seeking care. A suspected sore needs a GP, and risk factors need assessment before you choose a mattress for everyday comfort.
- Moving less because the bed feels comfortable. Keep changing position regularly, whatever you sleep on, and follow any individual movement plan.
- Buying deep, slow memory foam for someone who struggles to turn. It is harder to shift position on. A mattress or overlay arranged by clinicians stays unless they change it.
- A soft pillow-top or euro-top that dips beneath the hips and shoulders. I avoid these when choosing a surface that needs to stay easy to move on, and a topper will not repair that sag.
- Ring or doughnut cushions. The NHS community trust warning is that they can cause further pressure damage.
- Adding extra layers to care equipment without agreement. Get approval from the responsible clinician before putting a protector, pad, topper or other layer over a care mattress or overlay.
When a pressure sore needs a GP, not a new mattress
NHS guidance on pressure ulcers says to see a GP if you think you or someone you care for have a pressure ulcer. If you're being cared for at home and think you're at risk of getting pressure ulcers, you can ask a GP for a risk assessment so your care team can make a plan to prevent them.
The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you or someone you care for have symptoms of a pressure ulcer and hot, swollen or red skin (it can look blue or purple on brown or black skin), pus coming out of the ulcer, a high temperature, or severe pain or pain that's getting worse. You can call 111 or get help from 111 online.
