Informal caregivers for older adults undergoing major elective surgery face overwhelming demands and need more support.

• Caregivers reported feeling all-consuming pressure throughout the surgical process.
• 67% described increased strain on their relationship with the patient due to caregiving demands.
• A universal desire for greater perioperative guidance indicates a gap that can be addressed.

Surgeons should prioritize early identification of caregiver needs and implement targeted support to enhance patient and caregiver outcomes.