Ethical aspects, expectations, and outcomes associated with PEG in dementia

Percutaneous endoscopic gastrostomy (PEG) tubes are often placed as a means of feeding patients with terminal dementia who eat poorly. The decision to place a PEG involves ethical dilemmas and has become controversial, as data demonstrate that PEGs do not improve life expectancy, quality of life, or nutritional status in dementia, nor has it reduced the tendency to aspirate or heal pressure ulcers. Often, PEGs are placed prior to full evaluation for reversible factors. A multidisciplinary approach to evaluate the patient for reversible factors and alternate means of feeding should be utilized along with a meaningful discussion with the caregiver prior to using PEGs as a last resort. Undue expectations should not be put forth; a reasonable understanding of the process and outcomes by the providers and caregiver would be in the best interests of the patient.