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Background: Locomotive syndrome (LS) threatens mobility and functional independence among older adults with type 2 diabetes mellitus (T2DM). Evidence remains limited regarding multilevel factors associated with LS severity in community-based primary care settings. Objective: To examine social ecological model aligned factors associated with LS severity among community-dwelling older adults with T2DM. Methods: A cross-sectional analytical study was conducted in primary care units and community health centers in Suphan Buri province, Thailand. Multistage sampling recruited 253 adults aged 60 years or older with physician-diagnosed T2DM. LS severity was assessed using the 25-item Geriatric Locomotive Function Scale. Predictors included demographic and clinical characteristics, nutritional status, health literacy, family and social support, patient-provider communication (PPC), and access to healthcare services. Pearson correlation and hierarchical multiple linear regression were used. Results: Participants had a mean (SD) age of 68.5 (6.2) years, and 64.8% were female. Mean (SD) GLFS-25 score was 32.5 (14.8). In bivariate analyses, LS severity was positively correlated with neuropathy risk, age, and polypharmacy and negatively correlated with nutritional status, health literacy, access, PPC, and family and social support. The final hierarchical model was statistically significant (R = 0.568; R² = 0.323; adjusted R² = 0.300; F[8,244] = 14.55; P < .001). Greater LS severity was associated with neuropathy risk (B = 6.47; β = 0.22; P < .001), older age (B = 0.41; β = 0.17; P = .002), and polypharmacy (B = 0.66; β = 0.14; P = .010). Better nutritional status was associated with lower LS severity (B = -1.41; β = -0.20; P < .001). Conclusions: LS severity was associated mainly with clinical burden and nutritional status. Causal and temporal relationships cannot be inferred from these cross-sectional data.
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