Impact of frailty on foot care behaviors and self-efficacy in middle-aged and older adults with type 2 diabetes.

Abstract

Frailty is increasingly recognized as a condition that negatively affects self-management in individuals with type 2 diabetes. Limited evidence exists regarding its impact on diabetic foot self-care and self-efficacy, particularly in middle-aged populations. This study aimed to examine the effect of frailty on foot care behaviors and self-efficacy among middle-aged and older adults with type 2 diabetes. A descriptive, cross-sectional study was conducted with 75 middle-aged (40-64 years) and 75 older (≥65 years) adults diagnosed with type 2 diabetes. Data were collected using the FRAIL Scale, the Foot Care Behavior Scale, and the Diabetic Foot Care Self-Efficacy Scale. Group comparisons were performed using independent t-tests, and regression analyses were used to evaluate the predictive role of frailty. Frailty prevalence was 22.7 % in middle-aged adults and 42.7 % in older adults. Regression analyses showed that frailty was a strong predictor of both self-efficacy and foot care behaviors. Each one-point increase in frailty score was associated with a ∼12-point decrease in self-efficacy (β=-0.876; p < 0.001) and an ∼8-point decrease in foot care behaviors (β=-0.905; p < 0.001). The explanatory power of frailty was greater in middle-aged adults compared to older adults. Frailty significantly impairs foot care behaviors and self-efficacy in adults with type 2 diabetes. Routine frailty screening, even from middle age, may support the early identification of individuals at risk for diabetic foot complications and inform preventive wound care strategies.