In this episode, we delve into the complexities of managing feeding difficulties in patients with advanced dementia. Dr. Kostas, a seasoned clinician in geriatric medicine, shares insights and strategies for counseling patients and families facing these challenging situations. Then, we’ll turn to Dr. Kochar, a gastroenterologist with extensive experience in procedural medicine with a unique geriatric lens. She shares insights into the complexities of assessing patients for percutaneous endoscopic gastrostomy (PEG) tubes. Drawing from a case involving a 70-year-old patient with multiple comorbidities, Dr. Kochar, explores the nuanced considerations involved in deciding whether a PEG tube is appropriate in cases where it’s not severe dementia. Check out the show notes for more nuggets of wisdom and quick links & references: https://verigeripodcast.com/show-notes/f/goals-before-holes  Inspiration for episode: a question from Nicole Lum, MD Inspiration for episode title: Coined by Dr. Mark Watson and adopted by the Regional Palliative Fellows of Chicago 2023-2024  Gurus: Tia Kostas, MD, and Bharati Kochar, MD, MS Hosts and Co-Producers: Patty Lee, MD & Samantha Ing, MD Guest Host: Marissa Korte, MS Editor: Patty Lee, MD Peer reviewer: Katherine Thompson, MD  Show notes creator: Marissa Korte, BS Faculty Mentor: Christopher Chiu, MD, FAAP, FACP Music:  - Theme Song: Samantha Ing and Patty Lee, mixed by Takakuni Ikuma - Piano transitions and background: Patty Lee 

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