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Advanced Dementia — RACP Adult Medicine MCQ

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ModerateGeriatric MedicineAdvanced DementiaRACP Adult Medicine

A 90-year-old man with advanced dementia and recurrent aspiration pneumonia is admitted. His family asks about artificial nutrition via a PEG tube. What does the evidence suggest about PEG feeding in advanced dementia?

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Correct answer: A — It does not reduce aspiration pneumonia or improve survival

Strong evidence demonstrates that PEG tube feeding in advanced dementia does NOT reduce aspiration risk, does NOT improve survival, does NOT prevent malnutrition, and does NOT improve function or quality of life. It may increase aspiration risk and cause complications including peritonitis. The Choosing Wisely Australia campaign and Australian palliative care guidelines recommend against routine PEG insertion in advanced dementia.

Reference: Choosing Wisely Australia – 2024 – Recommendations; Palliative Care Australia – 2023 – Guidelines