# Regional differences in frailty among older adults with type 2 diabetes: a multicenter cross-sectional study in Japan

## TL;DR

Older adults with diabetes in rural Japan are more likely to be frail than those in urban areas due to lower daily living abilities.

## Contribution

This study identifies rural living as a risk factor for frailty in older adults with diabetes through a multicenter cross-sectional analysis.

## Key findings

- Rural residents had significantly lower robustness prevalence compared to urban residents.
- Living in rural areas was associated with higher odds of frailty and pre-frailty.
- Rural participants showed lower instrumental and social ADL scores.

## Abstract

Social environment may broadly impact multifaceted frailty; however, how environmental differences influence frailty in older adults with diabetes remains unclear. This study aimed to investigate regional differences in frailty in urban and rural areas among older adults with diabetes.

This cross-sectional study was conducted as part of the frailty prevention program for older adults with diabetes study. Older adults aged 60–80 years who could independently perform basic activities of daily living (ADLs) were enrolled sequentially. Trained nurses obtained patient background, complications, body weight, body composition, blood tests, grip strength, frailty assessment, and self-care score results. Regional differences in frailty were evaluated using logistic and multiple linear regression analyses.

This study included 417 participants (269 urban and 148 rural). The prevalence of robustness was significantly lower in rural areas than in urban areas (29.7% vs. 43.9%, p = 0.018). Living in rural areas was associated with frailty (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.38–4.71) and pre-frailty (OR 2.10, 95%CI 1.30–3.41). Lower instrumental ADL (B 0.28, standard error [SE] 0.073) and social ADL (B 0.265, SE 0.097) were characteristics of rural residents.

Regional differences in frailty were observed. Older adults with diabetes living in rural areas have a higher risk of frailty owing to a decline in instrumental and social ADLs. Social environment assessment and intervention programs that include communication strategies to enable care and social participation across environments are crucial to the effective and early prevention of frailty.