Clinicians face significant challenges when making surgical decisions for patients with dementia due to documentation and communication issues.

• Difficulty in identifying dementia and assessing patient capacity limits optimal decision-making, worsened by inconsistent electronic health record documentation.
• Caregivers often play a pivotal role but deal with misaligned expectations and burden, complicating the decision process.
• Clinicians frequently perceive dementia as detrimental to surgical outcomes, yet lack evidence-based references to substantiate these beliefs.

Improving EHR documentation and enhancing caregiver involvement could facilitate better surgical decisions for patients living with dementia.