Geriatric Quick Consult      PEG Tube Decisions      Do #9

Discuss alternatives to PEG feeding.

Knowledge Action
By the time PEG placement is considered the patient has often had a trial of careful hand feeding.

However, this cannot be taken for granted in the hospital unless the family has been involved.

Since there is no data to show that tube feeding improves patient outcomes, it is perfectly acceptable to continue hand feeding.

Different foods and food consistencies should be tried.
  • Continuing hand feeding is acceptable.


  • Try different foods and consistencies.
Inessential medications should be discontinued and the remainder simplified as much as possible using transdermal (e.g. fentanyl, nitropatch, clonidine) or rectal (e.g. phenergan, tylenol) routes if available.

If the patient completely refuses oral intake it may be time to consider palliative care.

Dementia is a terminal illness and should be managed in the same way as the final stages of cancer.
  • Discontinue inessential medications.


  • Consider palliative care.
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