Frailty and the confidence to plan ahead: Decision-making self-efficacy and advance care planning among older adults receiving home healthcare.
Journal
Palliative & supportive care
Journal Volume
24
ISSN
1478-9523
Date Issued
2026-05-21
Author(s)
Huang, Chi Hsien
Lin, Cheng-Pei
Chen, Kelly Yen-Chih
Liao, Jung-Yu
Tseng, Wei-Zhe
Umegaki, Hiroyuki
Chang, Hsien-Cheng
Li, Chia-Ming
Sun, Wen-Jung
Chiou, Hung-Yi
Yu, Sang-Ju
Hsiung, Chao A
Chen, Ping-Jen
Abstract
The relationship between frailty, self-efficacy, and advance care planning (ACP) remains unclear in Asia. This study examined how frailty status relates to decisional self-efficacy, ACP engagement, and advance directive completion among older adults receiving home healthcare in Taiwan.A cross-sectional analysis was conducted using baseline data from a nationwide cohort in Taiwan. Participants ( = 358) were categorized by Clinical Frailty Scale (CFS): mildly frail (CFS 4-5, = 60), moderately frail (CFS 6, = 83), severely frail (CFS 7, = 147), and very severely frail (CFS 8-9, = 68). ACP engagement and decision-making self-efficacy were assessed using Likert scales.Patients with greater frailty had lower odds of high decisional self-efficacy (CFS: 8-9: odds ratio [OR] = 0.38, 95% confidence interval [CI] = 0.14-1.07) but higher odds of ACP engagement (CFS: 6: OR = 3.38, 95% CI = 1.40-8.17; CFS: 7: OR = 2.52, 95% CI = 1.08-5.89) compared with mildly frail individuals. However, this increase did not extend linearly to the very severely frail group. Advance directive completion remained low across all frailty levels (4.8-10.0%) and was not significantly associated with frailty status. Frailty was associated with lower decisional self-efficacy but higher readiness for ACP, revealing a divergence between perceived confidence and planning motivation. Despite greater engagement, advance directive completion remained low. Stage-sensitive, values-based approaches may help bridge the gap between intention and documentation across the frailty spectrum.
Subjects
Frailty
advance care planning
decision-making
home healthcare
self-efficacy
Type
journal article