Investigating the Relationship between Health Literacy and Self-Care with Vulnerability Syndrome in Elderly People with Diabetes Referring to Comprehensive Health Centers in Ardabil City

Hosseinpour, Fatemeh; Saboor, Malihe; Abolfathi Momtaz, Yadollah; Zandieh, Zhaleh; Haghi, Marjan

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Investigating the Relationship between Health Literacy and Self-Care with Vulnerability Syndrome in Elderly People with Diabetes Referring to Comprehensive Health Centers in Ardabil City

Fatemeh Hosseinpour

, Malihe Saboor

, Yadollah Abolfathi Momtaz ^*

, Zhaleh Zandieh

, Marjan Haghi

Department of Gerontology, Faculty of Social Health, University of Rehabilitation Sciences and Social Health, Tehran, Iran , ya.momtaz@uswr.ac.ir

Abstract: (237 Views)

Background: Frailty syndrome is associated with adverse health outcomes in older adults. Identifying factors related to frailty among older adults with diabetes can help improve their health. Therefore, this study aimed to investigate the relationship between health literacy, self-care, and frailty syndrome in elderly individuals with diabetes referred to comprehensive health centers in Ardabil in 2023.
Methods: The present study was a cross-sectional descriptive study conducted on 241 elderly people with diabetes referring to comprehensive health centers in Ardabil, who were selected using a multi-stage random sampling method. Data were collected using demographic questionnaires, health literacy, diabetes self-care, and the Tilberg Frailty Checklist. Data analysis was performed using descriptive and analytical statistics in SPSS-26 software.
Results: The mean age of the participants was 66.56±7.35 years; the majority were female (58.40%), married (78.60%), and illiterate (29.20%), living with their spouses and children. The mean and standard deviation of health literacy, self-care, and vulnerability scores were 54.16±25.62, 113.60±15.02, and 6.02±3.17, respectively. Regression analysis indicated that female gender (β=0.142, p=0.023), age (β=0.171, p=0.002), economic status (β=0.123, p=0.028), living alone (β=0.142, p=0.006), and history of hospitalization (β=0.152, p=0.003) were significantly associated with increased frailty, while self-care showed a significant association with reduced frailty.
Conclusion: The results demonstrated that female gender, age, economic status, living alone, and history of hospitalization were significantly associated with increased frailty, whereas self-care was significantly linked to reduced frailty. It is recommended that targeted educational programs be developed to enhance health literacy and self-care, alongside the design of multifaceted interventions focusing on socio-economic factors to alleviate the burden of frailty syndrome among older diabetic adults.

Keywords: Health Literacy, Self-care, Vulnerability Syndrome, Diabetes, Elderly

Full-Text [PDF 532 kb] (107 Downloads)

Type of Study: article | Subject: hygiene
Received: 2025/06/3 | Accepted: 2025/08/17

References

1. Alabadi B, Civera M, Dela Rosa A, Martinez-Hervas S, Gomez-Cabrera MC, Real JT. Frailty is associated with oxidative stress in older patients with type 2 diabetes. Nutrients. 2021;13(11):3983. [DOI:10.3390/nu13113983] [PMID] []

2. Khiyali Z, Javidi Z, Elham Banaei E, Afsaneh Ghasemi A, Dehghan A. Relationship between perception of aging and social support with treatment adherence in the aged with type 2 diabetes in Fasa, 2018. J Gerontol. 2021;5(4):54-65. [Full text in Persian]

3. Bahador F, Mahfoozpour S, Masoudiasl I, Vahdat S. A systematic review of the management of preventive health care for the elderly in the world. Iran J Ageing. 2022;16(4):592-607. [Full text in Persian] [DOI:10.32598/sija.2021.3180.2]

4. Noroozian M. The elderly population in Iran: an ever growing concern in the health system. Iran J Psychiatry Behav Sci. 2012;6(2):1. [Full text in Persian]

5. Emine E, Sevgi K, Ezgi Ü, Melike B. Care dependency and diabetes self-care activities in elderly individuals with diabetes. Elder Health J. 2020;6(1):131-139. [DOI:10.18502/ehj.v6i2.5021]

6. Abdelhafiz AH, Sinclair AJ. Diabetes in the elderly. J Diabetes Metab. 2022;50(11):737-740. [DOI:10.1016/j.mpmed.2022.08.008]

7. Griffin SA, Perera NKP, Murray A, Hartley C, Fawkner SG, Kemp SP, et al. The relationships between rugby :union: and health and well-being: a scoping review. Br J Sports Med. 2021;55(6):319-326. [DOI:10.1136/bjsports-2020-102085] [PMID]

8. Goli Roshan A, Navabeh Hosseinkhani S, Norouzadeh R. The relationship between health literacy of elderly diabetics and adherence to treatment, Babol, Iran, 2021. J Qom Univ Med Sci. 2021;14(12):70-80. [Full text in Persian] [DOI:10.52547/qums.14.12.70]

9. Yümin T, Bakar Y, Şimşek T. The effect of diabetes on quality of life in patients with type 2 diabetes. Turkey Clinics J Sports Sci. 2017;9(2):77-86. [DOI:10.5336/sportsci.2016-54283]

10. Strain W, Down S, Brown P, Puttanna A, Sinclair A. Diabetes and frailty: an expert consensus statement on the management of older adults with type 2 diabetes. Diabetes Ther. 2021;12(5):1227-1247. [DOI:10.1007/s13300-021-01035-9] [PMID] []

11. Sezgin D, O'Donovan M, Cornally N, Liew A, O'Caoimh R. Defining frailty for healthcare practice and research: A qualitative systematic review with thematic analysis. Age Ageing. 2019;92:16-26. [DOI:10.1016/j.ijnurstu.2018.12.014] [PMID]

12. Abd Ghafar MZA, O'Donovan M, Sezgin D, Moloney E, Rodríguez-Laso Á, Liew A, et al. Frailty and diabetes in older adults: Overview of current controversies and challenges in clinical practice. Front Clin Diabetes Healthc. 2022;3:895313. [DOI:10.3389/fcdhc.2022.895313] [PMID] []

13. Buckinx F, Reginster J-Y, Gillain S, Petermans J, Brunois T, Bruyère O. Prevalence of frailty in nursing home residents according to various diagnostic tools. J Frailty Aging. 2017;6(3):122-128.

14. Wang Q, Lai H, Wang Y, Qi J, Pan B, Wang J. Prevalence of frailty in China: Protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020;99(20):e20079. [DOI:10.1097/MD.0000000000020079] [PMID] []

15. Vaingankar JA, Chong SA, Abdin E, Picco L, Chua BY, Shafie S, et al. Prevalence of frailty and its association with sociodemographic and clinical characteristics and resource utilization in a population of Singaporean older adults. Geriatr Gerontol Int. 2017;17(10):1444-1454. [DOI:10.1111/ggi.12891] [PMID]

16. Sinclair AJ, Abdelhafiz AH. Multimorbidity, frailty and diabetes in older people-identifying interrelationships and outcomes. J Pers Med. 2022;12(11):1911. [DOI:10.3390/jpm12111911] [PMID] []

17. Yoshizawa Y, Tanaka T, Takahashi K, Fujisaki-Sueda-Sakai M, Son B-k, Iijima K. Impact of health literacy on the progression of frailty after 4 years among community-dwelling older adults. Int J Environ Res Public Health. 2021;19(1):394. [DOI:10.3390/ijerph19010394] [PMID] []

18. Huang CH, Lai Y-C, Lee YC, Teong XT, Kuzuya M, Kuo K-M. Impact of health literacy on frailty among community-dwelling seniors. J Clin Med. 2018;7(12):481. [DOI:10.3390/jcm7120481] [PMID] []

19. Hejazi S, Peyman N, Tajfard M, Esmaily H. The impact of education based on self-efficacy theory on health literacy, self-efficacy and self-care behaviors in patients with type 2 diabetes. Iran J Health Educ Health Promot. 2018;5(4):296-303. [Full text in Persian] [DOI:10.30699/acadpub.ijhehp.5.4.296]

20. Reisi M, Mostafavi F, Javadzade H, Mahaki B. Communicative and critical health literacy and self-care behaviors in patients with type 2 diabetes. Iran J Diabetes Metab. 2015;14(3):199-208. [Full text in Persian]

21. Liu Y, Meng H, Tu N, Liu D. The relationship between health literacy, social support, depression, and frailty among community-dwelling older patients with hypertension and diabetes in China. Front Public Health. 2020;8:280. [DOI:10.3389/fpubh.2020.00280] [PMID] []

22. D'Souza MS, Karkada SN, Parahoo K, Venkatesaperumal R, Achora S, Cayaban ARR. Self-efficacy and self-care behaviours among adults with type 2 diabetes. Appl Nurs Res. 2017;36:25-32. [DOI:10.1016/j.apnr.2017.05.004] [PMID]

23. Ong-Artborirak P, Seangpraw K, Boonyathee S, Auttama N, Winaiprasert P. Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities. BMC Geriatr. 2023;23(1):297. [DOI:10.1186/s12877-023-04010-0] [PMID] []

24. Gaffari-Fam S, Lotfi Y, Daemi A, Babazadeh T, Sarbazi E, Dargahi-Abbasabad G, et al. Impact of health literacy and self-care behaviors on health-related quality of life in Iranians with type 2 diabetes: a cross-sectional study. Health Qual Life Outcomes. 2020;18:1-9. [Full text in Persian] [DOI:10.1186/s12955-020-01613-8] [PMID] []

25. Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, et al. 2022 National standards for diabetes self-management education and support. Sci Diabetes Self-Management Care. 2022;48(1):44-59. [DOI:10.1177/26350106211072203] [PMID]

26. Mazoochi F, Gobbens RJ, Lotfi M-S, Fadayevatan R. Diagnostic accuracy of the Tilburg Frailty Indicator (TFI) for early frailty detection in elderly people in Iran. Arch Gerontol Geriatr. 2020;91:104187. [Full text in Persian] [DOI:10.1016/j.archger.2020.104187] [PMID]

27. Montazeri A, Tavousi M, Rakhshani F, Azin SA, Jahangiri K, Ebadi M, et al. Health Literacy for Iranian Adults (HELIA): development and psychometric properties. Payesh (Health Monitor). 2014;13(5):589-99. [Full text in Persian]

28. Rahaei Z, Mehrjoyan N, Barzegr F, Anbari-Nogyni Z. Is higher health literacy associated with better self-care in the elderly? J Health Literacy. 2020;5(3):26-35. [Full text in Persian]

29. Saeed H, Saleem Z, Naeem R, Shahzadi I, Islam M. Impact of health literacy on diabetes outcomes: a cross-sectional study from Lahore, Pakistan. Public Health. 2018;156:8-14. [DOI:10.1016/j.puhe.2017.12.005] [PMID]

30. Chahardah-Cherik S, Gheibizadeh M, Jahani S, Cheraghian B. The relationship between health literacy and health promoting behaviors in patients with type 2 diabetes. Int J Community Based Nurs Midwifery. 2018;6(1):65-75. [Full text in Persian]

31. Quartuccio M, Simonsick EM, Langan S, Harris T, Sudore RL, Thorpe R, et al. The relationship of health literacy to diabetes status differs by sex in older adults. J Diabetes Complications. 2018;32(4):368-72. [DOI:10.1016/j.jdiacomp.2017.10.012] [PMID] []

32. Ishak NH, Yusoff SSM, Rahman RA, Kadir AA. Diabetes self-care and its associated factors among elderly diabetes in primary care. J Taibah Univ Med Sci. 2017;12(6):504-11. [DOI:10.1016/j.jtumed.2017.03.008] [PMID] []

33. Vosoghl K, Abootalebi Daryasari G. The study of self-care agency in patients with diabetes (Ardabil). Q J Berjand. 2009;8(4):197-204. [Full text in Persian]

34. Modarresi M, Gholami S, Habibi P, Ghadiri-Anari. Relationship between self-care management with glycemic control in type 2 diabetic patients. Int J Prev Med. 2020;11:127. [Full text in Persian] [DOI:10.4103/ijpvm.IJPVM_207_19] [PMID] []

35. AbbasZadeh Bazzi M, Karimiaval M. Relationship between health literacy and self-care behaviors in diabetic patients type II referred to the center of diabetes control and prevention in Zabol. J Health Literacy. 2018;3(1):10-19. [Full text in Persian]

36. Tang Z, Shen C, Tong W, Xiang X, Feng Z, Han B. Frailty in community-dwelling adults aged 40 years and over with type 2 diabetes: association with self-management behaviors. J Environ Res Public Health. 2022;19(15):9092. [DOI:10.3390/ijerph19159092] [PMID] []

37. Abdallah SMA, Ayoub AI, Makhlouf MME, Ashour A. Diabetes knowledge, health literacy and diabetes self-care among older adults living with diabetes in Alexandria, Egypt. BMC Public Health. 2024;24(1):2848. [DOI:10.1186/s12889-024-20238-w] [PMID] []

38. Vicente MC, Silva CRRd, Pimenta CJL, Bezerra TA, Lucena HKVd, Valdevino SC, et al. Functional capacity and self-care in older adults with diabetes mellitus. Aquichan. 2020;20(3). [DOI:10.5294/aqui.2020.20.3.2]

39. Rashıdı M, Yıldırım G, Karaman F, Çakmak S, Durusoy E, Akgöz HF, et al. Determination of the relationship between frailty level and quality of life in elderly individuals with type 2 diabetes. Sci Rep. 2024;14(1):32028. [DOI:10.1038/s41598-024-83766-w] [PMID] []

40. Kong L, Zhao H, Fan J, Wang Q, Li J, Bai J, et al. Predictors of frailty among Chinese community-dwelling older adults with type 2 diabetes: a cross-sectional survey. BMJ Open. 2021;11(3):041578. [DOI:10.1136/bmjopen-2020-041578] [PMID] []

41. García-Esquinas E, Graciani A, Guallar-Castillón P, López-García E, Rodríguez-Mañas L, Rodríguez-Artalejo F. Diabetes and risk of frailty and its potential mechanisms: a prospective cohort study of older adults. J Am Med Dir Assoc. 2015;16(9):748-54. [DOI:10.1016/j.jamda.2015.04.008] [PMID]

42. Thein FS, Li Y, Nyunt MSZ, Gao Q, Wee SL, Ng TP. Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality. Postgrad Med. 2018;130(6):561-7. [DOI:10.1080/00325481.2018.1491779] [PMID]

43. Tsai M-D, Tsai J-P, Chen M-L, Chang L-C. Frailty, health literacy, and self-care in patients with chronic kidney disease in Taiwan. Int J Environ Res Public Health. 2022;19(9):5350. [DOI:10.3390/ijerph19095350] [PMID] []

44. Son Y-J, Shim DK, Seo EK, Seo EJ. Health literacy but not frailty predict self-care behaviors in patients with heart failure. Int J Environ Res Public Health. 2018;15(11):2474. [DOI:10.3390/ijerph15112474] [PMID] []

45. Jafarian Yazdi A, Hasani MM. Prevalence of frailty and factors associated with frailty in the hospitalized elderly. J Nurs Res. 2021;16(1):1-9. [Full text in Persian]

46. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487-92. [DOI:10.1111/j.1532-5415.2012.04054.x] [PMID]

47. Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2018;8(3):e018195. [DOI:10.1136/bmjopen-2017-018195] [PMID] []

48. Qin Y, Hao X, Lv M, Zhao X, Wu S, Li K. A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2023;105:104844. [DOI:10.1016/j.archger.2022.104844] [PMID]

49. Yanagita I, Fujihara Y, Eda T, Tajima M, Yonemura K, Kawajiri T, et al. Low glycated hemoglobin level is associated with severity of frailty in Japanese elderly diabetes patients. J Diabetes Investig. 2018;9(2):419-25. [DOI:10.1111/jdi.12698] [PMID] []

50. Zeng X, Jia N, Meng L, Shi J, Li Y, Hu X, et al. A study on the prevalence and related factors of frailty and pre-frailty in the older population with diabetes in China: a national cross-sectional study. Front Public Health. 2022;10:996190. [DOI:10.3389/fpubh.2022.996190] [PMID] []

51. Delbari A, Zanjari N, Momtaz YA, Rahim F, Saeidimehr S. Prevalence of frailty and associated socio-demographic factors among community-dwelling older people in southwestern Iran: a cross-sectional study. J Diabetes Metab Disord. 2021;20:601-10. [Full text in Persian] [DOI:10.1007/s40200-021-00787-2] [PMID] []

52. Boucham M, Salhi A, El Hajji N, Gbenonsi GY, Belyamani L, Khalis M. Factors associated with frailty in older people: an umbrella review. BMC Geriatr. 2024;24(1):737. [DOI:10.1186/s12877-024-05288-4] [PMID] []

53. Lee L, Patel T, Hillier LM, Maulkhan N, Slonim K, Costa A. Identifying frailty in primary care: a systematic review. Geriatr Gerontol Int. 2017;17(10):1358-77. [DOI:10.1111/ggi.12955] [PMID]

54. Dugravot A, Fayosse A, Dumurgier J, Bouillon K, Rayana TB, Schnitzler A, et al. Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study. Lancet Public Health. 2020;5(1):e42-e50. [DOI:10.1016/S2468-2667(19)30226-9] [PMID]

55. Lima Filho BFd, Gama AGD, Dias VdN, Silva EMTd, Cavalcanti FAdC, Gazzola JM. The frailty syndrome in older adults with type 2 diabetes mellitus and associated factors. Rev Bras Geriatr Gerontol. 2020;23: e200001. [DOI:10.1590/1981-22562020023.200196]

56. Lee H-J, Son Y-J. Associated factors and health outcomes of health literacy and physical frailty among older adults: a systematic review. Res Gerontol Nurs. 2022;15(1):39-52. [DOI:10.3928/19404921-20211117-01] [PMID]

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