Objective To understand the current situation of complication risk perception of the elderly with diabetes in elderly care institutions, analyze its influencing factors, and to provide references for targeted intervention measures. Methods Convenience sampling method was used to investigate 320 older adults with diabetes aged 60 years and over in 5 elderly care institutions in Hebei Province by using the general information questionnaire, the Diabetes Risk Perception Scale, the Generalized Anxiety Disorder Scale, and the simple version of Geriatric Depression Scale. Results The median total score was 2.03(1.89,2.24) points for perceived risk of complications, 6.00(5.00,8.00) points for anxiety, and 6.00(4.00,8.00) points for depression, among older adults with diabetes in nursing facilities.Multivariate analysis showed that age, education level, family history, course of disease, anxiety and depression were main influencing factors of risk perception level of elderly diabetes residents in nursing homes （all P＜0.05）. Conclusion Older adults with diabetes in elderly care institutions generally have a low level of risk perception of complications.Targeted intervention measures should be taken to improve their risk perception of complications, reduce the incidence rates of complications, and achieve healthy and active aging.