Frailty and palliative care literacy: Factors associated with behavioral intentions of community-dwelling older adults through educational gerontology

As Taiwan enters a ‘super-aged society,’ understanding the potential challenges to end-of-life planning among older adults is critical. This study explores the associations between physiological frailty on hospice and palliative care (HPC) knowledge, attitudes, and behavioral intentions from the perspective of educational gerontology. A cross-sectional survey was conducted among 179 community-dwelling older adults (aged ≥ 60) recruited from Senior Citizens’ Universities in Pingtung, Taiwan, between May 1 and October 31, 2025. Research instruments included the Kihon Checklist-Chinese for frailty assessment and standardized scales for HPC knowledge, attitudes, and intentions. Data were analyzed using correlation and multiple linear regression. Higher education levels and better self-rated health were associated with lower frailty and more positive HPC attitudes. Multiple regression analysis revealed that the model accounted for 23.64% of the variance in HPC behavioral intentions. Physiological frailty (ß =−0.19, p = .006) was significantly and negatively associated with behavioral intentions, while HPC knowledge (β = 0.31, p < .001) and attitudes (β = 0.27, p < .001) were significant positive correlates. The findings suggest that physiological frailty may represent a potential barrier to end-of-life planning, while knowledge and positive attitudes are significantly linked to behavioral intention. To foster a ‘good death’ and enhance autonomy in a super-aged society, senior education programs should prioritize death education that addresses frailty-related obstacles, thereby bridging the ‘demand-participation’ gap in palliative care engagement.