As the population increases and lifespan is extended, the aging population becomes large and diseases in older adults have brought great attention worldwide [1]. Diabetes is one of the fastest-growing diseases worldwide, projected to affect 693 million adults by 2045 [2]. The past 50 years have seen a growing aging population with an increasing prevalence of diabetes mellitus (DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥ 65 years) [3]. Older adults with diabetes are at greater risk than other older adults for several common geriatric syndromes, such as polypharmacy, cognitive impairment, depression, urinary incontinence, injurious falls, persistent pain, and frailty [4]. Furthermore, the presence of comorbidities, the increased predisposition to hypoglycemic events, and individual care needs add to the complexity of disease management in older adults [5].
Health promotion behavior is the "best good medicine" to effectively delay the development of diabetes, which can effectively block its vicious circle and promote the body, biochemical and other indicators to return to normal levels [6]. There has been substantial research undertaken on the role of health promotion behavior on physical and mental health outcomes [7]. Health promotion behavior is vital for diabetes in older adults.
Psychological factors are proven to influence the behavior of patients with DM [8]. Loneliness is the feeling of isolation regardless of objective social network size [9].In industrialized countries around a third of people are affected by this condition, with one person in 12 affected severely, and these proportions are increasing [10]. Higher loneliness is, however, associated consistently with worse health outcomes among older adults [11]. Previous research has reported that the Prevalence of Loneliness in older adults with diabetes during the COVID-19 pandemic increased from 12.3–22.1% [12]. A longitudinal cohort study showed loneliness had negative effects on health promotion behaviors [13].
Another negative psychological characteristic emphasized in patients with DM is diabetes distress [14]. Diabetes distress refers to the worries, concerns, fears, and threats that are associated with struggling with a demanding chronic disease like diabetes over time, including its management, threats of complications, potential loss of functioning, and concerns about access to care [15]. Many studies have investigated that diabetes stress is associated with health promotion behavior in older patients with DM [16, 17]. In a word, loneliness and diabetes are negative characteristics that seem to be associated with health promotion behavior in older patients with DM.
Considering all this evidence, it seems that loneliness and diabetes stress were considered as individual factors associated with health promotion behavior in older patients with DM. However, such studies remain narrow in focus dealing only with unidirectional relevance. Up to now, no previous study has investigated the moderating role of diabetes distress on loneliness to health promotion behavior in older patients with DM.
Hence, this study was designed to investigate the mediating association of diabetes distress on loneliness to health promotion behavior in older patients with DM.