Objective To investigate the status quo of kinesiophobia and exercise efficacy in elderly patients with diabetic peripheral neuropathy (DPN) at discharge and analyze their influencing factors. Methods A total of 102 elderly DPN patients admitted to Fuyang People′s Hospital of Anhui Medical University from January 2023 to July 2024 were enrolled as a DPN group, and 50 hospitalized patients with type 2 diabetes mellitus (T2DM) but without DPN admitted during the same period were selected as a control group. One day before discharge, the Tampa scale for kinesiophobia (TSK) was used to investigate the status quo of kinesiophobia, and the detection rate of kinesiophobia was compared between the DPN group and the control group. Exercise self-efficacy scale (ESE) was used to investigate the status quo of exercise efficacy in the elderly DPN group. Pearson correlation analysis was used to analyze the correlation between TSK score and ESE score. A binary logistic regression model was used to analyze the factors affecting the kinesiophobia in elderly DPN patients at discharge. SPSS statistics 27.0 was used for statistical analysis. Data comparison between two groups was performed using t test orχ² test depending on data type. Results A total of 102 questionnaires were distributed, and 96 (94.12%) valid questionnaires were recovered. All 50 questionnaires distributed in the control group were recovered. The TSK score and detection rate of kinesiophobia were higher in DPN group than those in control group [(35.45±5.13) vs (19.58±2.29) points, 44.79% (43/96) vs 4.00% (2/50), P<0.05)]. The TSK score [(35.45±5.13) vs (19.58±2.29) points] and the detection rate of kinesiophobia [(44.79%(43/96) vs 4.00%(2/50)] in DPN group at discharge were higher than those in the control group, and the differences were statistically significant (P<0.05). The ESE score in the DPN group at discharge was 16-69 (50.36±8.19) points, including 30 (31.25%) patients with low efficacy, 48 (50.00%) with middle efficacy, and 18 (18.75%) with high efficacy. Pearson correlation analysis indicated a negative correlation between TSK score and ESE score (r=-0.493; P<0.001). Using occurrence of kinesiophobia in elderly DPN patients as the dependent variable, binary logistic regression analysis suggested that comorbid cardiovascular disease (OR=1.752, 95%CI 1.132-2.713), history of falls in the last 1 year (OR=1.344, 95%CI1.231-1.468), sleep disorder (OR=1.206, 95%CI 1.143-1.271), visual analogue scale (VAS) score ≥4 points (OR=1.531, 95%CI 1.208-1.941), Toronto clinical scoring system (TCSS) score of 12-19 points (OR=1.418, 95%CI 1.195-1.681), and previous monthly frequency of hypoglycemia >6 times (OR=1.914, 95%CI 1.347-2.718) were risk factors, and that exercise ≥3 times/week (OR=0.733, 95%CI 0.592-0.907), diabetes mellitus and DPN-related health education (OR=0.760, 95%CI 0.660-0.876), and exercise efficacy (OR=0.742, 95%CI 0.625-0.879) were the protective factors(P<0.05). Conclusion The detection rate of kinesiophobia is high in elderly DPN patients at discharge, and comorbid cardiovascular disease, history of falls in the past 1 year, sleep disorder, VAS score ≥ 4 points, TCSS score of 12-19 points, and previous monthly frequency of hypoglycemia > 6 times are risk factors of kinesiophobia, and exercises ≥3 times/week, diabetes mellitus and DPN-related health education, and exercise efficacy are its protective factors.