Vascular surgeons regularly treat older adults facing the effects of aging, including frailty, cognitive decline, and multiple comorbidities. Older adults view their priorities differently than younger adults, given their shorter remaining life span, as such, extant life-limiting illness is an important context when considering burdensome treatments that have high potential to change the patient’s cognitive or functional status. Older adults undergoing surgery have less physiologic reserve and are vulnerable to serious complications and postoperative functional changes, for example, loss of independence, more so than younger patients. As such, presenting surgery as a life or death choice fails to address these concerns, forcing a treatment choice that may be inconsistent with the patient’s desire to avoid specific health states [1]. Therefore, nuanced strategies for engaging in decision making with older adult patients are critical.

The topics discussed herein are relevant and essential to promote respect for people and their views about what makes life worth living, given our society with pluralistic values where there are many different beliefs about what counts as a valuable health state. We cannot make one assumption about how to treat all patients with vascular disease. For example, treatments that prolong life may not be valuable to an individual because the treatments may feel overly burdensome to them or produce a functional outcome that is inconsistent with how they want to live their life. Challenges such as burdensome wound care or spending extended time in the hospital may significantly impact quality of life in ways individuals feel are not worth it to them, whereas others might consider simply being alive with extensive support from machines with no potential for improvement, valuable to them. Vascular surgeons can respect individual perspectives by applying the wide range of available treatment strategies to fit patient priorities in the ever-evolving field of vascular surgery. Through this lens, our narrative review will discuss the topics of advance care planning, decision-making capacity, futility, and communication strategies applicable to optimizing care for older adults with vascular disease.