Recorded: Wednesday, November 7, 2018

Speaker: T.S. Dharmarajan MD, MACP, AGSF


PEGs are excessively utilized in the elderly at the terminal stages of life, without a proper awareness of the risks and benefits involved. This presentation will offer an understanding of the short-term and long-term outcomes following PEG placement. An approach to the discussions that take place prior to placement, the indications, alternatives and contraindications to tube placement will be provided. Ethical aspects and outcomes will be discussed.

When feeding difficulties arise, feeding tubes are not the recommendation for older adults with advanced dementia. Careful hand feeding should be offered, because hand feeding has been shown to be as good as tube feeding in terms of outcomes, including mortality, aspiration pneumonia, functional status, and comfort.


Learning Objectives:

  • Develop an awareness of feeding issues in the final stages of life in dementia.
  • Understand the benefits, risks and outcomes relating to PEG placement.
  • Recognize the patient’s wishes and autonomy in terms of decision making for PEG placement.
  • Understand the suggested discussions that must take place, prior to placement of PEG.And the alternatives to PEG.

Credits: Information:

1.5 CME, 1.5 CMD Clinical, 1.5 Maintenance of Certification (MOC)

Credits available until November 2021


Speaker Biography:

T. S. Dharmarajan MD is the Vice-Chairman, Department of Medicine, Clinical Director, Division of Geriatrics and the Program Director, Geriatric Medicine Fellowship Program at Montefiore Medical Center (Wakefield Campus) Bronx, a University Hospital of Albert Einstein College of Medicine (AECOM), Bronx, New York. He is currently Professor of Medicine, AECOM.

Dr. Dharmarajan is certified by the American Boards in Internal Medicine, Nephrology and Geriatric Medicine. He is a Fellow of the American Geriatrics Society, In April 2013, he was awarded the prestigious Mastership of the American College of Physicians (MACP), an honor accorded only to a handful of physicians in the country each year.

Dr. Dharmarajan was instrumental in developing a large inpatient geriatric medicine program at Our Lady of Mercy Medical Center in the Bronx (currently Montefiore Medical Center, Wakefield Campus), with clinical, academic and research components, and an accredited fellowship program in Geriatrics

Dr. Dharmarajan co-edited the textbook Clinical Geriatrics (CRC Press / Parthenon Publishing) released in 2003. His second textbook, Geriatric Gastroenterology (Springer), co-edited with CS Pitchumoni, was released in July 2012. The latter became a best seller in the Springer category of text books. He will next co-edit Geriatric Gastroenterology as a Major Reference Work through Springer. His publications in peer reviewed journals and text books number close to 200. He has nearly 500 scientific presentations (abstracts) in county, state, national and international meetings. He has been a Principal Investigator for several research projects, including national multi-center studies for the AMDA Foundation.

Besides winning the Howard Gutterman Award for best research project in the Annual AMDA (2006) meeting; he received the first prize for best Clinical Science Paper published in 2016 at Montefiore; in April 2013, he was featured on the cover of AgingWell magazine, as one of five noteworthy geriatricians.


Speaker Disclosures: All members of the education and online education committees have no financial relationships to disclose. The speaker has no financial relationships to disclose.