Choosing an Anti-Bedsore Mattress: Bubble, Cell and Foam Compared

Start with risk, not product

Pressure sore risk is assessed by a nurse or doctor using a scoring tool and a skin check. Risk is influenced by:

• how much the person moves;
• whether they can feel pressure and discomfort;
• skin condition, moisture and previous sores;
• nutrition and body weight;
• circulation, diabetes and other illnesses;
• continence;
• how many hours are spent in bed or a chair.

In general:

• Lower risk: the person moves freely in bed, spends part of the day up and about. A good quality foam mattress and regular position changes may be enough.
• Medium risk: the person spends much of the day in bed or a chair, can move a little, or has fragile skin. A higher-specification foam mattress or a good overlay is usual.
• High risk: the person cannot move, has sores or has had them before, or has reduced feeling. An alternating pressure air mattress or a similar high-specification system, with a care plan, is usual.
• Very high risk or existing deep sores: specialist surfaces, under medical supervision.

If you do not know your parent's level, ask a doctor or nurse to assess it before you buy. See preventing bedsores at home.

The main types

Standard foam mattress. A regular mattress, firm or soft, is not pressure-relieving. It may be fine for a person who is active, but for those who stay in bed it can cause pressure points. Mattresses that are old, sagging or lumpy are a risk.

High-specification foam mattress. Made of layers of high-density foam, often contoured, convoluted or cut into sections, designed to spread weight. It needs no power and is durable. It can be used for low to medium risk, with regular repositioning. Check the foam density, thickness and certification, and look for a covering that is waterproof and breathable. Cheaper foam compresses with time.

Egg-crate foam overlay. A thin sheet of foam with an egg-box pattern. It is inexpensive and is widely sold as anti-bedsore. In practice it gives limited pressure relief, compresses quickly and may trap heat. It is generally not enough for people at medium or high risk. It may be of mild comfort for those at low risk.

Memory (viscoelastic) foam. Moulds to the body and spreads pressure, but it can be warm and may make it hard for a frail person to turn or get out of bed. Quality varies. In India's heat it can be uncomfortable. Choose only if a clinician advises.

Gel or gel-foam overlays. Contain a layer of gel that spreads load and conducts heat. More robust than egg-crate, but heavy. Good for seats and mattress overlays in some cases.

Bubble (cell) overlay with a small pump. A thin mattress with small air cells (bubbles) inflated alternately by a small pump. It is cheap and widespread. It can give mild pressure variation but is thin, and usually fails to protect a person at high risk, particularly if they weigh more than the rated limit or lie for long hours. The cells can puncture, and the pump may be noisy. Some families buy these because of their price and then find sores develop.

Alternating pressure air mattress (overlay or replacement). Larger tubes inflated in cycles by a stronger pump, relieving pressure from different areas in turn. This is the standard choice for high-risk patients at home. Replacement mattresses are thicker, and overlays are placed on top of an existing mattress. See air mattresses for pressure sores.

Low air loss mattress. Air cells with tiny holes that allow air to flow beneath the skin, reducing moisture and heat. Often used with alternating or static settings, and suitable for people with wet or macerated skin.

Constant low pressure (static air) mattress. Air cells interconnected so that the body sinks into a bed of air. No cycling, so quieter, but pressure may not vary.

Hybrid mattresses. A foam core with air cells on top or inside. If power fails, the foam still protects.

Sheepskin and medical-grade fleece. Can reduce friction and moisture; useful as an extra layer, not as a main pressure-relief surface. Check that they are washable, medical-grade and not synthetic.

Specialist surfaces. Such as air-fluidised beds, used in hospitals for severe wounds.

Comparing the options: a practical view

• Pressure relief: Highest with alternating air and low air loss systems for high risk; moderate with high-spec foam and hybrid; limited with bubble and egg-crate.
• Power need: Foam needs none. Air systems need electricity and a backup plan; see hospital beds and power cuts.
• Heat and moisture: Foam and memory foam can be hot. Low air loss helps. Cotton covers and light bedding matter.
• Noise: Pumps hum; foam is silent.
• Maintenance: Foam is simple but degrades. Air needs checking, cleaning and servicing.
• Stability for transfers: Air mattresses can be soft at the edge; foam is more stable. Consider the ability to sit and stand from the bed.
• Cost: Usually foam is cheaper than air. Cost drivers include pump quality, mattress thickness, materials and certification. We do not quote prices, but you can compare cost against how long you will use it.
• Availability and servicing: Check that the supplier has spare parts and after-sales service; see equipment returns, warranty and servicing.

What to check on any product

1. Weight rating. The patient's weight must be within the range, with margin. 2. Size. The mattress should fit the bed frame; a hospital bed often needs a specific length and width. 3. Thickness and foam density, for foam products. Ask for the specification. A thin foam pad on an old mattress does little. 4. Cover. Waterproof, breathable and wipeable, preferably a stretch cover that does not pull tight and cause "hammocking". 5. Pump quality, for air systems: alarms for low pressure and power failure, a weight setting, a quiet mode and a service history. 6. Fire safety and materials. Ask whether the materials meet safety standards. 7. Certification and documentation. A reputable supplier provides a manual, a model number and a warranty; see medical device licences and safe buying and spotting fake or poor quality care products. 8. Return policy. Can you return it if it does not suit? 9. Cleaning. Can the cover be wiped and disinfected? Is there a removable, washable cover? 10. Climate suitability. Does it handle heat and humidity?

Using a mattress well

A good mattress is only as good as its use.

• Keep turning the patient as advised, and check the skin at every turn.
• Use one layer of breathable linen, tight but not taut; avoid wrinkles. See bed linen and fabrics for sensitive older skin.
• Avoid plastic sheets directly under the patient. Use breathable incontinence pads such as washable underpads.
• Do not drag the person across the sheet; use a slide sheet or lift.
• Keep skin clean and dry, and use barrier cream if advised; see barrier cream and skin care.
• Protect the heels, using pillows under the calves so heels float, as the nurse advises; see positioning a bedridden parent.
• Pay attention to nutrition and fluids; see malnutrition in older adults.
• Check the mattress setting after any change in weight or position.

Common mistakes

• Buying a bubble mattress for a very high-risk patient and assuming that the job is done.
• Putting an air overlay on a saggy, old mattress.
• Using a ring cushion or donut, which can increase pressure at the edge; see ring cushion guide.
• Placing foam over a plastic cover that traps heat.
• Letting an air mattress deflate.
• Ignoring early signs, such as red patches that do not fade.
• Believing that the mattress means no turning.

When to ask a professional

Ask a nurse or doctor to assess risk and recommend a surface before you spend money. A tissue viability nurse or wound care specialist can advise on mattresses for existing sores. A physiotherapist and occupational therapist can advise on positioning, transfers and the bed. Seek urgent medical help for broken skin, blisters, black or purple areas, smell, drainage or fever. See pressure ulcers: stages and care.