A foam mattress overlay is the most appropriate intervention in this patient at risk for a pressure ulcer. Pressure ulcers are a common occurrence in hospitals and long-term care settings, affecting up to 3 million patients and costing nearly $11 billion per year in the United States. It is far less costly to prevent pressure ulcers than to treat them; therefore, physicians need to be proactive in assessing risk for pressure ulcers and instituting evidence-based preventive measures. Risk factors include advanced age, cognitive impairment, reduced mobility, sensory impairment, and comorbid conditions that affect skin integrity (such as low body weight, incontinence, edema, poor microcirculation, and hypoalbuminemia). Intervention is warranted in this patient with multiple risk factors, including older age, advanced dementia, bedbound status, and urinary and fecal incontinence. A clinical practice guideline issued by the American College of Physicians (ACP) recommends the use of advanced static mattresses (a mattress made of foam or gel that does not move when a person lies on it) or an advanced static overlay (a material such as sheepskin or a pad filled with air, water, gel, or foam that is secured to the top of a bed mattress) to prevent pressure ulcers in at-risk individuals. These interventions have been found to lower the risk of pressure ulcers relative to standard hospital mattresses. Advanced static mattresses and overlays work by redistributing pressure and reducing shear that may lead to development of ulcers.

Dynamic support surfaces, such as low–air-loss beds or alternating-air mattresses or overlays, have no demonstrated benefit in preventing pressure ulcers, and the ACP guideline recommends against their use in pressure ulcer prevention. Additionally, these dynamic systems are very costly and their use for this purpose represents a low value care intervention. The role of dynamic support surfaces is also unclear in treating patients with established pressure ulcers, as they have not definitively been shown to improve outcomes relative to advanced static support surfaces and frequent repositioning.

Although malnutrition is clearly a risk factor for pressure ulcers, there are minimal data supporting the effectiveness of enteral feeding as an intervention to prevent pressure ulcers. In some studies, the risk of ulcer development appeared higher in patients placed on enteral feedings than in those not receiving enteral nutrition. Additionally, enteral feeding is not without complications and may negatively influence quality of life. Although there is evidence that protein and amino acid supplementation are of benefit in patients with established pressure ulcers, the role of nutritional supplementation, and specifically enteral nutrition, for prevention of pressure ulcers has not been determined.

Frequent repositioning is often performed as a component of multimodal interventions to prevent pressure ulcers. Such multimodal interventions have been shown to be beneficial; however, there is a paucity of studies of repositioning alone and no good evidence to support repositioning alone as a pressure ulcer prevention tool. Nonetheless, repositioning should always be a part of a multimodal approach to pressure ulcer prevention.