Factors associated with quality of life among elderly patients with type 2 diabetes mellitus: the role of family caregivers

This cross-sectional study examines the level of QoL of patients with T2DM and its relationship with general demographic characteristics of both the patient and the caregiver, the caregiver’s SOC, and caregiver competence. The data depicted that the total score of QoL among elderly patients with T2DM was 61.14 ± 7.37, which was similar to another study conducted in China that used the same measurement among patients with T2DM [28], and indicates that the patients with T2DM had a medium QoL in both studies, but higher than reported in an Iran and Ethiopia study [8, 29]. This difference might be explained by the improved financial status and the availability of primary medical insurance [30].

Variable results have been found in the literature addressing the QoL of patients with T2DM and its relationship to sociodemographic parameters. It is common knowledge that age has become a definitive factor in the QoL of patients [31, 32]. Research from other studies has confirmed our finding that younger patients had higher QoL scores [33]. Previous reports found that lower educational level, belonging to the female sex, long duration of illness, and complications were associated with poor QoL in patients with T2DM [34‐36]. Similar to our finding, it may be that higher literacy levels in patients may possess better life skills, more capacity for managing their diseases, and superior informatics proficiency. However, with the prolongation of the course of the disease and complications arise, the patient’s insulin resistance is gradually weakened and the risk factors are increased, resulting in poor blood sugar control and overall decline in patients’ QoL. Our investigation, in contrast to other studies [37, 38], did not reach the conclusion that patients with comorbidities had lower QoL. This may be because the scale used in this study was more focused and less sensitive to the impact of other conditions on QoL [39] as well as individual reporting differences. Healthcare professionals must exercise extra caution when managing the comorbidities of T2DM, despite the fact that we did not find an effect, as other research has demonstrated that QoL deteriorates and lifespan dramatically declines as the number of comorbidities grows [40].

The factors that influence the QoL of people with T2DM are widely known, but this study argues that there is still a need to identify which of the variables attributable to carers may improve the QoL of patients. Therefore, our study included caregiver-related factors in the analysis as well. The study’s findings revealed that the patient’s QoL was impacted by the caregiver’s gender. As part of the custom, males typically hold positions of authority and control the family economy, while women are mostly in charge of managing the household’s daily operations, such as caring for children and elderly parents. Over time, they might develop their caregiving abilities and gain expertise [41]. Women are more inclined to adopt the position of caregiver and take on caring responsibilities when a family member is in danger of becoming unwell. In this study, 61.2% of the caregivers were female, and compared to male caregivers, they did a better job of enhancing patients’ quality of life. The results of this study suggest that patients show better QoL when the caregiver is their spouse. Our findings were in accordance with Potier [42]. A possible explanation is that some individuals can view providing care as a natural part of life and a responsibility to their families. These kinds of perceptions may be more prevalent in spouses than in sons or daughters [43]. In China, the current predicament facing the children of this generation is that of having both the old and children. They not only have to consider the health of the elderly and the raising of children, but also have to face their work, which will lead to a lack of energy under the multiple pressures, and the traditional Chinese filial piety will aggravate their anxiety, which will in turn increase the burden of caregiving and affect the quality of caregiving. In addition, patients typically have a lower QoL when their caregivers have been providing care for more than five years, on average for eight hours or more per day. The caregiver’s assumption of the caregiving task will have an impact on the original life, and with the prolongation of the caregiving time, the patient’s dependence on him or her increases, and the prolonged time spent facing the patient leads to stress and anxiety, which in turn affects the quality of care and leads to a lowering of the patient’s QoL [44].

This study confirmed that the SOC of the caregiver was negatively associated with patients’ QoL. But it can predict them positively. This is consistent with research from Taiwan that showed older patients with hip fractures were more likely to have a poorer QoL following surgery if their caregivers had lower psychological functioning [45]. This implies that when caregivers are in better physical and mental health, their actions give patients a sense of security and support, which influences their mood and boosts their self-assurance in beating the illness. All of this enhances the patients’ quality of life, particularly the psychological part of it. Furthermore, we also found that caregiver competence was positively correlated with patients’ QoL. In line with our findings, Huang et al. [46] studied hemodialysis patients and showed that patients’ QoL was associated with caregivers’ caregiver competence. This was also a consistent discovery in a study of elderly adults with disabilities [47]. High levels of caregiver competence among family caregivers indicate a certain amount of knowledge about illness susceptibility factors, fundamental skills, and preventing complications, all of which help to somewhat slow down the patient’s disease progression. In this study, family caregivers’ SOC was negatively correlated with, but positively predictive of, caregiver competence. A Dutch study reached a similar conclusion [48]: caregivers who experience low levels of SOC are more likely to believe that the care conditions they face are complex and challenging to comprehend and manage, and they may not be motivated to strive for higher levels of care.

Regression analysis showed that age, disease duration, ADL scores, SOC and FCTI were the major predictors of QoL in patients with T2DM. This finding supports research on another chronic disease [49], demonstrating that SOC has a positive predictive effect on the QoL of T2DM patients. SOC is expected to assist caregivers in making better use of resources. Those who care for others with an optimistic outlook on caring may be better able to handle a difficult situation. Antonovsky’s theory encourages people to reflect on stressful situations so that they can understand stress, think about how to make coping with them and identify the best ways to deal with them that make sense [14]. Therefore, one plausible explanation is that caregivers with a strong sense of coherence are better able to manage difficulties and chronic stress in the caregiving process, making the best use of the social resources available to them and enhancing caregiving capacity and quality of care [50]. A survey in Japan concluded that the sense of care burden was lower when the mental health status was high [51]. This means that high levels of psychological consistency in caregiving tend to be accompanied by less caregiving burden and higher levels of caregiving capacity. In this study, the QoL in T2DM was significantly predicted by caregiver competence as well. Nobahar et al. identified that the therapeutic effect and QoL of hemodialysis patients may be directly impacted by the caregivers’ ability to provide care [52]. Additionally, higher skill levels imply that carers can combine their own lives with caring responsibilities. This means that in the future, in addition to focusing on the mental health of family caregivers, we should also work to enhance the caregivers’ capacity to provide for their patients by coordinating resources for healthcare and promoting health in order to enhance the patients’ QoL.

T2DM is an incurable disease, so improving the QoL of patients is particularly crucial [53]. Elderly patients have an increased dependence on their caregivers and studies have confirmed that caregivers often have a direct or indirect impact on the QoL of patients [51, 54]. The above findings suggest that clinical interventions should give some attention to carers to improve patients’ quality of life in many ways.

The study’s limitations are convenience sampling and the cross-sectional nature of the study, both of which could not identify the causal link. Another potential drawback associated with the questionnaires’ self-reporting nature is recall bias. Finally, this study’s findings were derived from T2DM patients and their caregivers using healthcare resources from two hospitals in Jinzhou. The findings may, therefore, be transferable to different similar settings or conditions but are not generalizable to the population in a positivist sense.