Background: Shared decision-­ making aims to ensure that healthcare professionals and patients jointly make decisions regarding the patient's care. However, professionals often find it challenging to implement shared decision-­ making with older patients who have cognitive impairments or diminished decision-­making capacity. Research indicates a significant gap in the understanding of how decision-­ making processes unfold in prehospital settings.

Aim: The objective of this scoping review was to explore how decision-­making involving older patients in acute prehospital situations is characterized.

Design and Method: This scoping review is based on the Joanna Briggs Institute's guidelines for scoping reviews and is reportedusing the Preferred Reporting Items for Systematic Reviews and Meta-­Analyses extension for Scoping Review (PRISMA-­ScR).

Data Sources: CINAHL, PubMed, Scopus, PsychINFO and Web of Science were searched to identify relevant studies published between the years 2000 and 2024.

Results: The results are based on 26 studies and indicate that decision-­making among older patients is a conditional process,characterised by collaborative support involving the patient, significant others and healthcare professionals. Barriers to this process include hierarchical dynamics, fear of reprisals and uncertainty regarding the risk–benefit ratio. Factors that support decision-­making include situationally relevant competence, organisational resources and the presence of specific symptoms and signs.

Conclusion: Shared decision-­making with older patients in acute prehospital settings is conditional, often resulting in decisions being made primarily by healthcare professionals. There is considerable room for improvement in how this process is systematically approached. A structured approach is needed—one that assesses the older patient's decision-­ making capacity, considers the perspectives of family members, and incorporates input from individuals who know the patient well, all while minimizing hierarchical barriers.