Fear of complications in elderly patients with type 2 diabetes mellitus is dominated by generalized worry about long-term health risks: a cross-sectional study

Fear of complications is a common but easily neglected psychological issue in elderly patients with type 2 diabetes mellitus (T2DM), and excessive fear may impair self-management and glycemic control. Based on the stress and coping theory, this study aims to investigate the current status of fear of complications in elderly T2DM patients and analyze its influencing factors.

A cross-sectional study was conducted on 255 hospitalized elderly T2DM patients (≥60 years old) by multi-stage stratified cluster sampling from Department of Endocrinology and Department of Geriatrics of the First Affiliated Hospital of Wannan Medical University between March and May 2026. A general information questionnaire, Fear of Complications Questionnaire (FCQ), Social Support Rating Scale (SSRS), Diabetes Management Self-Efficacy Scale (DMSES), and Diabetes Health Literacy Scale (DHLS) were used for investigation. The scores of each FCQ dimension were calculated, and a total score ≥30 was defined as significant fear of complications; the incidence was then calculated. Univariate analysis, Spearman correlation analysis, and multiple linear regression analysis were employed to identify influencing factors.

The total FCQ score of the 255 elderly T2DM patients was 25.00 (18.00, 29.00), and the incidence of fear of complications was 23.5%. The scores of each dimension of FCQ were as follows: general fear 10.00 (7.00, 10.00), fear of cardiovascular complications 7.00 (5.00, 8.00), and both renal and ocular-foot complications fear 4.00 (3.00, 6.00). Among them, the general fear dimension had the highest score, while the scores of specific complication fears were relatively low. Univariate analysis showed that there were statistically significant differences in FCQ scores among elderly T2DM patients in terms of age, gender, marital status, occupation, monthly income, residence, medical expense payment method, number of complications, glucose-lowering regimen, and history of hypoglycemia in the past 6 months (P<0.05). Spearman correlation analysis indicated that social support (r=-0.643), self-efficacy (r=-0.593), and health literacy (r=-0.644) were significantly negatively correlated with FCQ scores (P<0.001). Multiple linear regression analysis revealed that age (B=1.831, 95%CI: 0.504 to 3.157), having 2 complications (B=2.157, 95%CI: 0.607 to 3.707) and ≥3 complications (B=5.356, 95%CI: 3.295 to 7.416), health literacy (B=-0.209, 95%CI:-0.299 to -0.119), and social support (B=-0.203, 95%CI:-0.338 to-0.069) were influencing factors for fear of complications (P<0.01).

Fear of complications in elderly T2DM patients is characterized by generalized worry about long-term health risks, and is jointly influenced by both stressor factors and coping resource factors. Nursing staff should focus on these patients with advanced age, multiple complications, insufficient health literacy, and low levels of social support. Targeted interventions should include education on specific complications to fill patients’ cognitive gaps, combined with improvement of health literacy and strengthening of social support.