We spend more than a third of our lives asleep, but when it comes to the elderly in residential care that time can be significantly higher. Pain, illness and poor mobility can sometimes mean that much of their day is spent in bed, so comfort is absolutely crucial.
Like me, you probably know that there’s nothing like snuggling on a comfortable mattress. But like the princess and the pea, any fold lumps and bumps can become torture after time.
As a physio, when I advise someone to buy a new mattress I’d recommend looking for something supportive, yet soft enough to fit to the body. A mattress that will help maintain the spine in a neutral position and protect against pain. Innerspring or memory foam can both offer essential spinal support and prevent problems developing. So, when I look at the thin and often flimsy basic foam mattresses that many people in residential care sleep on, I fear that we may be contributing to the epidemic of low back pain.
And backache is a big issue, particularly in the elderly. The risk of disabling back pain rises in older age, especially in those using health and social services, like those in residential care. Those with arthritis, scoliosis or kyphosis can end up in pain on these thin and often inadequate mattresses. We know that in studies, people with dementia report less pain and are given less analgesia, despite the evidence suggesting that 80% of patients in residential care facilities are in acute or chronic pain; so many may be suffering untreated. Prevention is better than cure, so we should be working to protect against, instead of responding to back pain.
Research has shown that using medium-firm supportive mattresses can decrease back pain and improve quality of sleep, which could work to improve residents’ life and wellbeing.
In later years, elderly people can be frail and often require more postural support and cushioning to help offload typical pressure points. Current mattresses may predispose to the development of pressure injuries. A Cochrane Collaboration review abstract looked at the way in which mattresses and overlays could impact on ulceration and pressure sores. It showed that higher specification foam alternatives to the standard foam mattress can reduce the incidence of pressure ulcers in people at risk and that Australian standard medical sheepskins could prevent pressure ulcers compared to standard care.
Anyone who works in aged care knows that patient migration is. In residential facilities and hospitals, the head of the bed is often elevated. This fact, together with the slippery waterproof mattress casing mean that gravity can make patients slide down towards the foot of the bed. In fact, one study found that nurses manual transferring patients up in bed nearly 10 times per shift! That is seriously hard work for staff and residents.
But it’s not just uncomfortable and awkward. Sliding can lead to friction and skin damage. It also moves the patient away from the pivot of the head of the bed. This results in the lumbar spine being unsupported, causing kyphosis and increased discomfort, especially in patients with existing low back pain or disc herniation. A supportive bed, careful care and positioning and the use of auto-contour or a knee gatch can help prevent migration.
So, it’s clear that we need to think carefully about the right mattresses for elderly residents. The current basic choices do not provide the support and pressure protection required. Obviously, we need something that addresses incontinence and hygiene issues- but there must be another answer. By acting before there is skin or skeletal damage, we can avoid having to use expensive dynamic pressure devices. It’s about comfort, care and cost-effectiveness, which is surely what we’re all in the business of providing.
