Seat Cushions for Older Adults: Foam, Memory Foam and Gel

What a cushion can and cannot do

A seat cushion can:

• Spread weight across a larger area, lowering pressure under the sit bones and tailbone.
• Add height, making it easier to stand up from a low chair.
• Improve comfort for people with sore hips, a sore tailbone or thin padding from weight loss.
• Support posture when shaped to hold the pelvis in a good position.
• Reduce vibration in vehicles.
• Help protect skin, though only some types are designed for pressure sore prevention.

A seat cushion cannot:

• fix a chair that is too deep, too low or the wrong shape;
• replace regular movement, because even the best cushion does not allow someone to sit for eight hours without moving; or
• prevent pressure sores on its own in a person at high risk; see pressure care in a wheelchair.

The main types

### Standard foam

Polyurethane foam in a firm block, usually 5 to 10 cm thick. It is inexpensive and light and adds height. Quality varies a great deal: cheap foam flattens within months and loses support. Look for high-density foam, which stays resilient for longer. Suitable for short sitting and low pressure risk.

### Memory foam (viscoelastic foam)

A slow-recovery foam that moulds to the body and spreads pressure. It feels soft at first but stiffens in cool rooms and softens in heat; in hot Indian summers it can feel warm. It can make it harder to shift position or rise, because it holds the shape of the body. Good for comfort and moderate pressure relief; less good for people who need to move easily.

### Gel and gel-foam cushions

A gel layer, often in a pad or honeycomb, sits on a foam base. Gel conducts heat away, and distributes pressure and reduces shear. It is a popular choice for sitting for several hours. It is heavier than foam. See gel cushions for pressure relief.

### Air cushions

Cells or a bladder filled with air, which adjust to the body. Some are very effective in preventing pressure sores, but they must be inflated correctly, checked regularly and kept free from punctures. They are used for people at high risk, under a therapist's guidance.

### Wedge and slope cushions

Thicker at the back, sloping to the front, or the reverse, to tilt the pelvis. A wedge raised at the back helps with rising; a wedge raised at the front can help posture in some people. They are specialised and should be recommended by a therapist.

### Coccyx and cut-out cushions

Have a cut-out or groove at the back to relieve the tailbone. They suit people with tailbone pain or after certain injuries, but may not be suitable for general use. See cushions for piles and tailbone pain.

### Ring and donut cushions

A circular cushion with a hole. Often recommended, but usually not helpful, and sometimes harmful: they can concentrate pressure around the ring and restrict blood flow. See ring and donut cushions.

### Lumbar and back cushions

Support the lower back rather than the seat. See lumbar cushions for lower back pain while sitting.

Choosing by situation

For comfort in an armchair or sofa. A medium-firm foam or memory foam cushion, 5 to 8 cm thick, with a non-slip base, is usually enough. Make sure it does not make the seat too high or too soft.

For a chair that is too low. A firm, thicker foam cushion adds height, making it easier to rise. See helping an elderly parent stand from a chair. Do not raise a chair so high that the feet do not reach the floor.

For long sitting, such as in a wheelchair or recliner. A gel, gel-foam or air cushion with a fitted cover. Get advice from a therapist if your parent has skin at risk. See cushions for wheelchair users.

For car seats. A firm, non-slip foam cushion helps with height and comfort; avoid soft, thick ones that interfere with the seat belt or head restraint. See car seat cushions for older passengers.

For pain in the tailbone or after surgery. A cut-out or contoured cushion, on advice. See cushions after hip replacement, which has different needs.

For hot weather. A gel or breathable cushion with a mesh cover, and not a thick, dense memory foam.

For incontinence. A cushion with a waterproof, wipeable cover, or a protector over a washable cover.

Key features to check

Size. Fits the chair seat without hanging over the edge, and fits the person's hips. A common size is about 40 by 40 cm, but chairs vary. A cushion too big bunches; too small gives no support.

Thickness. Between 5 and 10 cm is typical. Thicker raises the seat and pushes the user higher. For wheelchairs, cushions of 5 to 10 cm are common.

Firmness. Press with your hand: the cushion should compress and spring back slowly, without bottoming out when you press hard. Firm enough to support but soft enough to be comfortable.

Cover. Breathable, washable, with a non-slip base. Zip covers should be removable. Check for a stretch cover that moves with the cushion.

Shape. Flat, contoured or wedge. Flat is the most versatile.

Weight. Heavy cushions are difficult for weak hands to move.

Safety. Fire-retardant or flame-resistant materials are often a feature of quality cushions. Check labels.

Warranty. Better cushions come with one.

How to use a cushion properly

• Put it the right way up and the right way round, following the label. Many cushions have a front, a back and a top.
• Make sure it is firmly in place, with a non-slip base, so it does not slide.
• Sit well back, with hips at the back of the seat, not on the edge.
• Check feet are on the floor or footrest, and knees are about level with hips.
• Check height. The elbow should reach the armrest or table comfortably.
• Shift position every 20 to 30 minutes, even with a good cushion.
• Look at the skin every day if sitting for long hours; see pressure ulcers: stages, wound care and prevention.

Mistakes to avoid

• Buying the thickest, softest cushion on the grounds that more is better. A very soft cushion makes standing harder and may not support.
• Using an old, flattened cushion. Replace it.
• Choosing a ring cushion for pressure sores.
• Stacking several cushions, which is unstable.
• Using a cushion that makes the chair too high or too low for the table.
• Forgetting the cover: a plastic cover causes sweating; choose a breathable one.
• Skipping advice for someone at high pressure risk.
• Not cleaning. See cushion covers, washing and hygiene.

Care and replacement

Wash the cover as directed, air the cushion in shade, and never leave foam in direct sun. Rotate or turn the cushion if the design allows. Replace foam when it flattens, crumbles or no longer springs back; this could be after six to twelve months for cheap foam and several years for good quality. Replace a gel or air cushion if it leaks, loses shape or feels hard. Keep a spare cover.

When to ask a professional

Ask an occupational therapist, physiotherapist or nurse for advice if your parent sits for long periods, has fragile skin, has had pressure sores, uses a wheelchair, has diabetes, is very thin or has pain that cushions do not relieve. See a doctor for skin that stays red or breaks down, persistent back or hip pain or numbness. Our care advisors can help choose a cushion.