When elderly people with diabetes develop fragility, this can lead to falls, disability, hospitalizations, reduced quality of life and mortality. The aim of this study was to determine the frailty level in elderly patients with diabetes and to demonstrate the relationship between frailty and quality of life.
The elderly individuals with diabetes who were illiterate had higher levels of frailty in our study (p < 0.05). In studies conducted in our country and in other countries, the elderly with low levels of education were found to experience more frailty [17, 18, 19, 20, 21, 22]. The findings are directly in line with previous findings.
In present study, those who fell three times or more in the last year also experienced more frailty (p < 0.05). Several studies examining the factors related to frailty have reported more frailty in people with a history of falling in the last year and emphasized that there was a relationship between frailty and falls [17, 18, 22, 23]. For example, among 298 elderly people with and without type 2 diabetes with a mean age of 70.68 ± 5.45 years, those with diabetes experienced more falls and were frailer [4]. Falling is a major problem in elderly patients and is associated with frailty, as in this study. It is an expected result that the elderly people with a more prominent history of falling experienced more frailty. These findings are consistent with those of the previous studies.
In the study demonstrated that elderly people with diabetes using oral antidiabetics were frailer (p < 0.05). According to previous studies, frailty was more common in elderly people on continuous medication than those who were not [24]. Elderly patients may be more exposed to the adverse effects of oral drugs due to decreased [25, 26, 27]. We believe that higher rates of frailty in elderly patients in this study is due to exposure to adverse effects of drugs. The results support literature information.
The elderly people with diabetes complications had more frailty in our study (p < 0.05). Likewise, a relationship has been described between frailty and nephropathy in Chinese elderly people with type 2 diabetes [28]. In another study conducted with 7164 elderly people in Mexico, diabetes and hypertension or any occurring complications were associated with frailty [29]. A study conducted in our country concluded that the majority of elderly individuals with Type 2 diabetes who had coronary artery disease or neuropathy as a diabetic complication were frail [9]. Studies show that diabetes complications increase frailty. Old age and diabetes are two important factors that reduce muscle mass and strength [30, 31]. We believe diabetes complications added to these may have caused more frailty.
The mean frailty score of elderly individuals with diabetes in our study was 7.36 ± 4.35. O’Donovan et al. (2021) found that frailty was common in 662 elderly people aged 60 and over with diabetes [8]. Duzgun et al (2018) found the Edmonton Frail Scale mean score of 6.84 ± 3.83, i.e. apparently frail in the elderly over 65 years of age [20]. In another study using a similar scale, the majority of 366 patients with a mean age of 81.5 years experienced apparent frailty [24]. A score of 7–8 on the Edmonton Frail Scale is considered mildly frail. There are many risk factors that cause frailty in older people with diabetes. We believe that the majority of elderly people with diabetes had milder frailty because they did not use a walking aid and did not have a history of falling in the last year.
In the study, the quality of life decreased as frailty increased (p < 0.05). O’Donovan et al. (2021), in their cross-sectional analysis of the health, aging and retirement study in Europe, reported that participants with both diabetes and frailty rated their health status as poor, displayed more depression symptoms, and had a low quality of life [8]. In a study conducted in 662 elderly people aged 60 and over in Brazil, increased frailty was associated with reduced quality of life [10].
In addition, the quality of life was reported to be low in elderly patients with type 2 diabetes and frailty syndrome [2]. A relationship has been shown in our country between frailty and decreased quality of life in patients with type 2 diabetes over the age of 65 [9]. According to Karsli et al. (2022), quality of life is an important factor to be considered in the occurrence of frailty [4]. The importance of the relationship between frailty and low quality of life was also expressed in other meta-analyses and systematic reviews [32, 33]. Our study supports the conclusion demonstrated in other studies that quality of life decreases as frailty increases.