This review examines the legal validity of consent to healthcare services given by older patients, with particular emphasis on cognitive impairment, the patient’s actual capacity to make healthcare decisions, and the protection of patient autonomy in the decision-making process. The study is based on a narrative literature review combined with a doctrinal legal analysis of Polish statutory provisions, case law, and literature in medical law, geriatrics, cognitive psychology, and bioethics. The analysis indicates that reaching 60 years of age does not create a separate legal regime for consent to healthcare services and must not be equated with lack of decision-making capacity. The decisive factor is the patient’s actual ability, assessed individually, contextually, and proportionately, to understand relevant information, relate it to their own health situation, appreciate the consequences of the proposed course of action, and make and communicate a voluntary decision. Particular attention is paid to patients who are not legally incapacitated and therefore formally retain their decision-making rights, but who, due to dementia, delirium, memory impairment, disturbances of consciousness, aphasia, depression, multimorbidity, or drug-related cognitive disturbances, may in specific circumstances lack sufficient actual capacity to make healthcare decisions. The article discusses practical implications for healthcare professionals in planned procedures and emergencies, conservative treatment, pharmacotherapy, diagnostic tests, and nursing or physiotherapy activities. It explains the legal significance of statutory representatives, guardianship courts, and statutory exceptions, as well as the limited role of informal carers and close relatives, who may support communication and help identify the patient’s preferences but generally do not substitute patient consent. The conclusions emphasise the need to avoid ageism, adapt communication to the patient’s cognitive and perceptual abilities, document the information process and assessment of understanding, and develop instruments enabling representation of the patient’s prior will, including medical powers of attorney and registered powers of attorney. Med Pr Work Health Saf. 2026;77(4)