Evaluation of the effect of frailty on foot care behaviors and self-efficacy in elderly and middle-aged individuals with Type 2 diabetes

Frailty increases the risk of adverse outcomes, leading to impaired muscle and nerve function and dependency as a result of vulnerability to stressors. The frailty-enhancing effect of diabetes leads to more rapid functional decline, complications and hospitalization than in individuals without frailty. Early detection of frailty can enable the implementation of targeted interventions to reduce functional decline. In this study conducted with individuals with type 2 diabetes, it was aimed to determine the effect of frailty on foot care behavior and self-efficacy in elderly and middle-aged adults. The study is descriptive and cross-sectional. Data were collected between August and December 2023 in the Internal Medicine and Endocrinology and Metabolic Diseases outpatient clinics and wards of Gaziantep Dr. Ersin Arslan Training and Research Hospital. A total of 150 individuals with Type 2 diabetes, 75 elderly and 75 middle-aged adults, who met the inclusion criteria were included in the study. Ethics committee approval, institutional permission and patient consent were obtained. Diabetic Individual Descriptive Information Form, Foot Care Behavior Scale (FCBS), Diabetic Foot Care Self-Efficacy Scale (DFCSES) and FRAIL Frailty Scale were used for data collection. Shapiro Wilk test, Mann-Whitney U test/Kruskall Wallis, Dunns' multiple comparison test, Spearman correlation analysis and simple linear regression analysis were used to analyze the data. The mean age of the individuals with diabetes who participated in the study was 62.81 ± 10.3 years, 48.7% were male and 51.3% were female. In this study conducted in a middle-aged and elderly population, it was found that as frailty increased, patients showed worse foot care behaviors and their self-efficacy decreased (p<0.001). According to the results of regression analysis, frailty was found to affect foot care behavior and self-efficacy in both elderly and middle-aged individuals (p<0.001), explaining 81.8% of the total variance of foot care behavior and 76.7% of the total variance of diabetic foot care self-efficacy. Those aged 65 years and over, those with a long duration of diabetes, those with a high number of medications used continuously, those with chronic disease in addition to diabetes, those with a short standing time during the day, those who develop complications due to diabetes, those who have difficulty balancing while standing, those who get stuck while walking, those who frequently hit their feet while walking, those who had foot-related problems, did not exercise, had a history of hospitalization in the last year, had previous or current diabetes-related wounds on their feet, and felt pain in the foot or leg while walking the level of frailty was found to be statistically significant (p<0.05). As a result, it was found that frailty significantly affected foot care and self-efficacy level. In line with these results, early identification of individuals with diabetes at risk of adverse events and assessment of the severity of frailty are recommended to prevent diabetes-related foot diseases.