Palliative & supportive care · 2026
Frailty and the confidence to plan ahead: Decision-making self-efficacy and advance care planning among older adults receiving home healthcare.
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Huang Chi Hsien, Lin Cheng-Pei, Chen Kelly Yen-Chih, Liao Jung-Yu, Cheng Shao-Yi, 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
Аннотация
OBJECTIVES: 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.
METHODS: A cross-sectional analysis was conducted using baseline data from a nationwide cohort in Taiwan. Participants (N = 358) were categorized by Clinical Frailty Scale (CFS): mildly frail (CFS 4-5, n = 60), moderately frail (CFS 6, n = 83), severely frail (CFS 7, n = 147), and very severely frail (CFS 8-9, n = 68). ACP engagement and decision-making self-efficacy were assessed using Likert scales.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: A cross-sectional analysis was conducted using baseline data from a nationwide cohort in Taiwan. Participants (N = 358) were categorized by Clinical Frailty Scale (CFS): mildly frail (CFS 4-5, n = 60), moderately frail (CFS 6, n = 83), severely frail (CFS 7, n = 147), and very severely frail (CFS 8-9, n = 68). ACP engagement and decision-making self-efficacy were assessed using Likert scales.
RESULTS: 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.
CONCLUSIONS: 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.