Title : Facilitators and barriers to cognitive frailty management in older adults with type 2 diabetes: A qualitative study
Abstract:
Objective: To explore the facilitators, barriers, and willingness of healthcare professionals, patients, and caregivers to participate in cognitive frailty management among older adults with type 2 diabetes, and to provide evidence for developing targeted nursing interventions.
Methods: A qualitative descriptive study was conducted. Using purposive sampling, clinical healthcare professionals from the Department of Geriatrics, older adults with type 2 diabetes, and their family caregivers were recruited from a tertiary Grade A hospital in Zhengzhou, Henan Province, China. Semi-structured interviews were conducted. A total of 38 interview transcripts were included, comprising 18 healthcare professionals, 14 patients, and 6 family caregivers. The interview data were transcribed verbatim and analyzed using thematic analysis, including open coding, category development, and theme generation, to identify facilitators, barriers, and intervention needs related to cognitive frailty management in older adults with type 2 diabetes.
Results: Cognitive frailty management among older adults with type 2 diabetes was influenced by multiple factors at the patient, family, healthcare provider, and organizational levels. Key facilitators included comprehensive geriatric assessment as a foundation for early identification of cognitive frailty; existing experience in chronic disease management and safety care, which supported intervention implementation; leadership support and multidisciplinary resources; strong willingness to participate among healthcare professionals, patients, and caregivers. Major barriers included limited awareness of cognitive frailty; weak motivation for active management; increased self-management difficulty due to functional decline and multimorbidity; insufficient family support; inadequate health guidance for patients and caregivers; insufficient specialized training for healthcare professionals; lack of a closed-loop departmental management pathway integrating screening, intervention, evaluation, and transitional care. Participants emphasized that future interventions should be simple, practical, life-oriented, sustainable, and minimally burdensome for patients and families.
Conclusion: Cognitive frailty management among older adults with type 2 diabetes has a feasible implementation basis, but it remains constrained by patient awareness, family support, professional competencies of healthcare providers, and system-level management processes. Future interventions should establish a nurse-led, multidisciplinary, family-engaged continuum-of-care model that integrates screening, health education, cognitive and physical training, dietary guidance, caregiver empowerment, and post-discharge follow-up.
Keywords: Older Adults, Type 2 Diabetes, Cognitive Frailty, Qualitative Research, Nursing Intervention
