Ethical Aspects, Expectations, and Outcomes Associated with PEG in Dementia

  • T. S. Dharmarajan
  • T. S. Dharmarajan
  • T. S. Dharmarajan
  • T. S. Dharmarajan
  • Krishna P. Aparanji
  • C. S. Pitchumoni
  • C. S. Pitchumoni
  • C. S. Pitchumoni


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.


Percutaneous Endoscopic Gastrostomy Pressure Ulcer Tube Feeding Advance Directive Percutaneous Endoscopic Gastrostomy Tube 


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • T. S. Dharmarajan
    • 1
  • T. S. Dharmarajan
    • 2
  • T. S. Dharmarajan
    • 3
  • T. S. Dharmarajan
    • 4
  • Krishna P. Aparanji
    • 5
  • C. S. Pitchumoni
    • 6
  • C. S. Pitchumoni
    • 1
  • C. S. Pitchumoni
    • 7
  1. 1.New York Medical CollegeValhallaUSA
  2. 2.Department of MedicineMontefiore Medical Center (North Division)BronxUSA
  3. 3.Division of GeriatricsMontefiore Medical Center (North Division)BronxUSA
  4. 4.Geriatric Medicine, Fellowship ProgramMontefiore Medical Center (North Division)BronxUSA
  5. 5.Division of GeriatricsMontefiore Medical Center (North Division)BronxUSA
  6. 6.Robert Wood Johnson School of Medicine, Drexel University School of MedicinePhiladelphiaUSA
  7. 7.Gastroenterology, Hepatology and NutritionSaint Peter’s University HospitalNew BrunswickUSA

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