When to Replace an Overdue Pressure Relief Mattress

Why pressure relief mattresses do not last forever

Every pressure relief mattress is working every minute of the day. Foam compresses and slowly loses the memory that lets it spring back. Air cells stretch, seams weaken and pumps lose a little of their puff. Covers crack, wash up thin and stop being waterproof. None of this happens with a dramatic failure – it creeps up quietly, and by the time skin damage appears, the mattress has often been past its best for months.

Every product is different, so check the manufacturer's guidance, but these figures are a useful rule of thumb. Foam mattresses and overlays usually have a useful life of three to five years. Alternating and dynamic air mattresses typically last five to seven years, and their covers often less. Wheelchair cushions in daily use can be done in 18 months to three years. If the person using it is heavier, spends longer in bed, or has already had a pressure ulcer, treat those numbers as the outer limit rather than the target.

Signs it is time to look more closely

Pressure damage rarely announces itself. These are the everyday signals that should prompt you to inspect the mattress properly.

• Skin that is red, purple or darker than usual in the morning, in the same spot every day.
• Redness that does not fade within 30 minutes of the person moving off it.
• Any mark that feels warm, boggy, hard or broken.
• The person saying they feel as though they are "sitting on the bed frame".
• Needing to shift position more often than usual, or waking with discomfort.
• A pump that sounds different – clicking, buzzing, running constantly or cutting out.

One of these on its own is worth investigating. Two or more usually means the mattress is no longer doing its job.

Cover checks: the part everyone overlooks

The cover is the barrier between skin and the workings of the mattress. Once moisture can get inside, foam goes soggy and air cells become sticky and perish. Check the cover by hand, not by eye – a cover can look fine in daylight and still have given up.

• Hold it up to a window. If you can see light through it, fluid will pass through it too.
• Look at seams, zip and corners. Cracking, peeling or white stress lines at the folds are the usual failure points.
• Check underneath for dried stains, dampness or a musty smell.
• Confirm the cover is still the right one. A standard sheet stretched over an air mattress defeats the point of it.

Wipe covers with the cleaning product the manufacturer recommends, and never place the mattress directly on a bare slatted base without its cover.

The bottoming-out test you can do at home

"Bottoming out" means the mattress is no longer holding the person clear of the surface beneath. It is easy to test without any equipment.

• With the person lying in their usual position, slide a flat hand under the sheet beneath the base of the spine (the sacrum) and under the heels.
• You should be able to feel about 2.5 cm of soft support below your hand before you reach the mattress base or the bed frame.
• Run your hand along the length of the mattress. Feel for hard ridges, collapsed patches and areas where the cover is stretched tight over something solid.
• Do the same on the wheelchair cushion, sitting the person upright with their usual posture and feet properly supported.

If your fingers meet resistance straight away, stop using the mattress for sleeping and arrange a replacement or an interim overlay the same day.

Air mattresses: small checks that make a big difference

An alternating mattress needs its cells to inflate in turn, and it needs to be set for the person's weight. If the pressure is too low, the body rests on the base. If it is too high, the surface becomes rigid and the alternating cycle stops helping.

• Watch a full cycle. Every cell should visibly rise, then fall. Look for cells that stay flat or stay permanently firm.
• Listen for air escaping. A slow hiss near the pump or tubing means a leak.
• Check tubing for kinks, trapped edges or damage where it joins the mattress.
• Look at the weight setting on the pump – it should match the person using it, not the last person who used it.
• Switch off and unplug before checking anything electrical, and never open the pump housing yourself.

Keeping track, and asking for help early

Write the date on the label or on a small card kept with the pump, and note the model, cover type and when it was supplied. Take a photo of the mattress label – it is useful if you need to explain the situation over the phone.

A weekly check takes two minutes and fits into your usual routine. Record anything you find, with the date.

Ask for a fresh assessment if the person's weight, mobility, continence or general health has changed, if they are spending more time in bed, or if they are recovering from an ulcer. In the UK you can request this through your GP, district nurse or community therapy team, and wheelchair cushions through your wheelchair service. Do not wait for the annual review if something has changed.

Finally, remember that a mattress is one part of pressure care, not the whole of it. Regular repositioning, keeping skin clean and dry, protecting heels and checking skin morning and evening all matter just as much. If you spot a mark on the skin that does not fade, seek advice from a healthcare professional the same day.