Backrests for Sitting Up in Bed: Types and Positioning

Why sitting up matters, and the risks

An upright position helps:

• Eating and drinking. Sitting upright reduces the risk of food or fluid going down the wrong way, in people with swallowing problems. See swallowing problems and dysphagia.
• Breathing. People with heart failure, COPD, pneumonia or breathlessness often breathe more easily sitting up.
• Digestion and reflux. Raising the upper body can reduce reflux and heartburn; see acidity and reflux in older adults.
• Alertness and mood. Being upright helps people see and take part in what is happening.
• Reading, writing and hobbies.
• Care tasks. Washing the face, oral care and feeding are easier.

But sitting up for long periods also brings risks:

• Sliding and shear. As the body slides down, the skin over the tailbone and buttocks is dragged against the sheet, and pressure builds up. This is a major cause of pressure sores; see preventing bedsores at home.
• Pressure on the tailbone, heels and buttocks, which carry more weight when seated.
• Poor posture, with a bent neck and rounded back, causing pain and breathing problems.
• Fatigue, if the person is not well supported.
• Skin sweating and heat against thick supports.

Types of backrest

Pillows. The simplest option, but soft pillows compress and slip. A person on a pile of pillows is rarely stable. Use firm pillows only as extras to fill gaps, not as a main support.

Bed wedge. A large foam wedge, with the high end behind the back and shoulders. It gives a consistent angle and is cheap and easy to use. The slope is fixed, so choose the height with care. It can slide on the mattress, so a non-slip cover helps. See wedge pillow guide.

Folding backrest with frame. A frame, usually of metal tubing with a padded back panel, that sits on the bed and adjusts to several angles with a ratchet or a strap. The person leans against it. It is lightweight and portable and widely used at home. Check stability, especially at steeper angles, and that the base cannot slide.

Backrest with arms. A backrest with side arms like a chair, giving more side support. Useful for people with poor trunk control, but heavier.

Bed backrest with a rest for the head. A higher backrest that has a headrest, for people who cannot hold their head up.

Adjustable backrest on a hospital bed. Powered or manual raising of the head section, which is the best option for people who sit up for long periods. It gives a smooth, continuous change of angle and a knee break to stop sliding; see hospital bed buying guide.

Inflatable or air backrests. Lightweight and portable; may feel unstable and can leak.

Lumbar cushions or rolls. A small cushion at the lower back adds support to the natural curve; see lumbar cushion guide.

Armchair or recliner as an alternative. For part of the day, a supportive chair may be better than a bed. See choosing a chair for an older person and sitting for long hours.

Choosing a backrest

Think about the person first.

1. Why do they need to sit up? Eating and breathing may need a steeper angle than reading. 2. How well can they support their own trunk? A person with strong trunk control may be happy with a simple folding frame. Someone who leans or slumps needs side supports or a hospital bed. 3. How long will they sit up? For short periods, a wedge or frame is fine. For many hours, an adjustable bed and pressure-relieving mattress are better. 4. Skin condition and sore risk. A fragile or at-risk person needs a surface that limits sliding, and professional advice. 5. Weight and size. Check weight limits and the width of the backrest. 6. Cleaning and covers. Removable, washable covers. Plastic covers trap heat and sweat; choose breathable cloth over waterproof covers. 7. Portability. A folding backrest travels and stores; a wedge is bulky. 8. Stability on the bed. Choose one with a non-slip base and straps, if needed. 9. Compatibility with the mattress and bed. A thick air mattress may change the angle and the stability of a frame. 10. Budget. Basic wedges and frames cost far less than an adjustable bed, but if you need to sit up many hours a day, the right equipment is an investment in comfort and skin.

Setting the angle

There is no single correct angle. Common practice:

• For eating and drinking: as upright as comfortable, often 60 to 90 degrees, for the meal and for at least 30 minutes afterwards, particularly with swallowing problems or reflux. A speech therapist may give specific advice.
• For breathing difficulties: as advised by the doctor, often 45 to 90 degrees. Some people with heart or lung disease prefer to sleep propped up.
• For rest and sleep: a lower angle, around 30 degrees or as comfortable, unless raised for breathing or reflux.
• For reading and activities: whatever is comfortable, with support for the neck and arms.

For people at risk of pressure sores, many guides suggest keeping the head of the bed at or below about 30 degrees when not eating or doing activities, to reduce sliding and pressure on the tailbone. When more upright is needed, raise the knees slightly first to stop sliding. Change position often and see positioning a bedridden parent.

Setting up for comfort and skin protection

1. Sit the person upright with hips well back against the bed head or backrest, so they sit on the buttocks and not on the tailbone. 2. Raise the knees slightly, using the knee break on a hospital bed or a pillow or small wedge under the knees, to stop sliding. The knees should be bent a little, not hyperextended. 3. Support the lower back with a small cushion if the person has a curve there. 4. Support the head and neck with a small pillow or a headrest, so the chin is not pushed on the chest. 5. Support the arms on pillows or the overbed table, so shoulders are not dragged down; see overbed table guide. 6. Heels: place a pillow under the calves to float the heels off the mattress. 7. Smooth the sheets under the person, removing wrinkles and crumbs. 8. Lift, not drag, when pulling the person up the bed. Use a slide sheet or two people. See turning a bedridden patient and how to lift and transfer safely. 9. Check the skin over the tailbone, buttocks, heels and shoulder blades after periods of sitting up. 10. Return to a flat or lower position for rest breaks.

Problems and fixes

• Keeps sliding down. Raise the knees, use a non-slip sheet under the buttocks (a thin non-slip mat that the nurse advises), check the angle, and ensure the backrest is firm.
• Neck pain or head drops forward. Adjust the head support and angle; see neck pillow guide. Report new weakness.
• Back pain. Add lumbar support, or adjust the angle; ask a doctor about persistent pain; see mattress firmness for back pain.
• Breathlessness gets worse lying back. Raise the angle, and tell the doctor.
• Sweating and heat. Use breathable covers, light cotton, a fan not pointing directly at the person; see keeping a bedridden parent cool in Indian summers.
• Red skin on the tailbone. Reduce time at steep angles, relieve pressure and call a nurse.
• Backrest falls over. Choose one with a stable base, and place against the headboard or wall.
• Person slumps to one side. Add side pillows or bolsters, or a backrest with arms, and ask a therapist for advice.
• Coughing at meals. Sit more upright, stop, and ask a speech therapist.

When to ask a professional

Ask a doctor, speech and language therapist or nurse for the right angle if your parent has swallowing, breathing, reflux or skin problems. An occupational therapist or physiotherapist can assess sitting balance and recommend supports. A nurse can check skin and advise on a mattress. Call urgently if the person has sudden breathlessness, chest pain, choking or colour change.