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 (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.

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.

Although home is frequently the preferred place of death, little is known regarding how home healthcare (HHC) influences this outcome for people with dementia (PWD), particularly within Asian contexts. This study investigates the impact of HHC and its 2016 “Integrated Home-Based Medical Care” reform on home death in Taiwan, explicitly accounting for the cultural phenomenon of “impending death discharge.”

This nationwide retrospective cohort study utilized Taiwan’s National Health Insurance Research Database. We identified PWD decedents from 2011 to 2022 and conducted a nested case–control analysis. Cases (home deaths) and controls (hospital deaths) were matched 1:1 using propensity scores to balance demographics and health status. HHC models included pre-2016 primary HHC, post-2016 primary HHC, and the reformed “HBPC Plus” (Home-Based Primary Care Plus). The outcome was adjusted to include patients discharged terminally to die at home, reflecting distinctive cultural practices.

Among 209,468 decedents, 95,594 were selected after matching. Overall, HHC use was associated with higher odds of home death (adjusted odds ratio [aOR]: 1.17; 95% CI: 1.13–1.21). The reformed HBPC Plus program showed the strongest association compared to pre-2016 primary HHC (aOR: 1.63; 95% CI: 1.34–1.98). Crucially, this association strengthened further when accounting for impending death discharge (aOR: 1.82; 95% CI: 1.40–2.35). Higher visit frequency and services from hospital-based teams were also significantly linked to home death.

HHC significantly increases the likelihood of home death among PWD in culturally influenced contexts. The 2016 reform, particularly the HBPC Plus program, proved highly effective. Policy components like flexible visit frequencies and enhanced hospital–physician coordination appear vital for supporting end-of-life care at home, offering key insights for policy planning in aging societies.

To investigate the reciprocal relationship between unhealthy eating behaviours and depressive symptoms from childhood to adolescence.

Unhealthy eating behaviours were measured by the frequencies of eating foods with excess salt, sugar or fat in the past week. Depressive symptoms in the past two weeks were measured using a seven-item scale. Hierarchical linear growth models were used to analyse longitudinal associations between unhealthy eating behaviours and depressive symptoms. Time-fixed variables (sex, parents’ education level and household monthly income) and time-varying variables (parents’ marital status, family activities, body weight, vegetable or fruit consumption, exercising and smoking) were controlled for.

The Child and Adolescent Behaviors in Long-Term Evolution study, which commenced in 2001 and has annual follow-up.

Students (n 2630) followed from 2nd grade (8 years old in 2002) to 11th grade.

The frequency of unhealthy eating behaviours in the previous year and the difference between the frequency in the previous and successive year were positively associated with the initiation and growth rate of depressive symptoms. Depressive symptoms in the previous year and the difference in depressive symptoms between the previous and successive year were positively associated with the initial state and growth rate of unhealthy eating behaviours.

Our results suggest a reciprocal relationship between depressive symptoms and unhealthy eating behaviours. This relationship should be considered when developing programmes targeting depressive symptoms and unhealthy diet in children and adolescents.