Dear Editor,

We read with great interest the article by Huang et al. (Reference Huang, Lin and Chen2026), “Frailty and the confidence to plan ahead: Decision-making self-efficacy and advance care planning among older adults receiving home healthcare.” The finding that greater frailty was associated with lower decision-making self-efficacy but higher readiness for advance care planning (ACP) is particularly important for palliative and geriatric care. It suggests that ACP readiness among frail older adults may not be driven only by decisional confidence, but also by deeper psychological, existential, and relational processes.

We would like to extend the authors’ interpretation by highlighting the possible role of spiritual well-being. Frailty is not merely a marker of physical decline; for many older adults, it may also represent an encounter with vulnerability, dependency, and mortality. In this context, ACP may function not only as a medical planning activity, but also as a process through which individuals clarify meaning, preserve dignity, communicate values, and maintain continuity in their life narratives. This view is consistent with existential and meaning-centered perspectives, including logotherapy, which emphasize the human capacity to find meaning despite suffering and unavoidable decline.

Spiritual well-being may help explain why some frail older adults become more willing to engage in ACP even when their confidence in decision-making decreases. Spiritual well-being encompasses meaning in life, inner peace, connectedness, social support, transcendence, and harmony with oneself and others. Recent studies have linked frailty with meaning in life and psychological resilience (Zhang et al. Reference Zhang, Xu and Zhou2024), and have also examined spiritual well-being in relation to quality of life, hopelessness, death anxiety, and social support among patients facing serious illness (Dıgrak and Akkoç Reference Dıgrak and Akkoç2025; Sezer Daşçikaran and Nazik Reference Sezer Daşçikaran and Nazik2026). These findings suggest that spiritual resources may support acceptance of mortality and emotional readiness for future care discussions.

This perspective also has implications for counseling and clinical practice. ACP discussions in home healthcare should not be limited to procedural documentation or treatment preferences. Older adults living with frailty may also need opportunities to express fears of dependency, anticipatory grief, existential loneliness, hopes, unfinished concerns, and sources of meaning. Therapeutic alliance, empathic communication, spiritual care, existential counseling, and meaning-centered interventions may help clinicians support both practical decision-making and psychological adaptation.

We therefore suggest that future studies examine spiritual well-being and existential adaptation as potential pathways linking frailty and ACP readiness. Longitudinal and qualitative research would be especially valuable for understanding how older adults develop readiness for ACP over time. Integrating these dimensions may advance a more person-centered and culturally sensitive approach to ACP among frail older adults receiving home healthcare.

Thank you for the opportunity to contribute to this important discussion.