Rachel Adler, ScD, RD

Surgical decision-making is rarely straightforward, and it can become even more complex when candidates have cognitive impairment (CI) or dementia. Expanding on previous work, researchers Rachel Adler, ScD, RD, of Mass General Brigham, and Lara Traeger, PhD, of the University of Miami, spearheaded a qualitative study investigating the clinical, ethical and psychosocial challenges clinicians face in these cases.

Through a series of in-depth interviews and brief surveys, the team captured the thoughts and experiences of 178 participants, including surgeons, nurses, social workers, therapists and hospital administrators, from across 12 hospital sites in the United States.

Three main themes emerged from the surveys: First, it’s often difficult for clinicians to assess whether a surgical candidate has CI or dementia based on their medical record and preoperative encounters. Second, the interview participants tended to rely on caregivers and non-surgical clinicians who have varying levels of involvement and availability. Third, clinicians have significantly different views on how much “weight” to give dementia in surgical planning.

Another key finding was that many clinicians associate dementia with worse outcomes and recovery based on firsthand experience, even if they haven’t seen published evidence.

To improve surgical care for patients with dementia, the authors suggest health systems improve electronic health record documentation for older adults, strengthen communication between surgical teams and longitudinal providers, and support routine and meaningful involvement of caregivers.

Published in JAMA Surgery on August 19, 2026 | Read the paper: “Clinician Considerations about Surgical Decision-Making in the Context of Dementia(opens in new tab)”

Summary reviewed by: Rachel Adler, ScD, RD, lead author