Shared decision-making for older adults in the peri-operative setting: A narrative review

Older adults undergoing surgery often face numerous challenges to healthcare decisions due to frailty, comorbidities and varying personal priorities. Shared decision-making (SDM) is a patient-centred approach that enhances peri-operative care by aligning medical decisions with individual values and preferences. When considering surgery for an older adult, SDM can ensure that the surgical treatment plan focuses on what older adults find important, such as quality of life (QOL), functional independence, long-term well being and survival. This narrative review explores the role of SDM in peri-operative care of older adults and strategies for increasing SDM in this context. SDM fosters collaboration between patients, families and healthcare teams; as a result, it can lead to improved patient satisfaction, reduced decisional conflict and greater trust between patients and their medical teams. However, integrating SDM into routine practice remains complex due to cognitive impairment, communication barriers, time constraints and gaps in evidence. Effective SDM strategies include enhancing interdisciplinary collaboration, improving clinician and staff training, developing decision aids tailored to older adults considering surgery and leveraging technology to support patient engagement. Future efforts should focus on expanding SDM research, refining implementation frameworks and advocating for policy changes that facilitate patient-centred surgical decision-making in older adults. As the global population ages, prioritising SDM in peri-operative care will be critical to optimising patient outcomes, ensuring ethical, informed decision-making and aligning care plans with the patient's goals and values.