Caring for elemented patients with eating difficulties poses formidable challenges to health care providers and family members. Tube feeding has been routinely used in this situation to improve survival and functional status, to prevent or decrease consequences of malnutrition and wasting, and to provide comfort and palliation. However, a recent comprehensive review on this issue provides convincing arguments against the routine use of tube feeding in advanced dementia. At present, no data exist to support the theory that tube feeding improves any of the important clinical outcomes. More importantly, tube feeding is associated with significant rates of morbidity and mortality. The use of tube feeding should be highly individualized and appropriately used after careful assessment of the benefits and risks of such therapy, and with specific short- and long-term goals in mind.