The decision to place a feeding tube in a patient with advanced dementia is difficult for both family members and health care professionals. There is increasing evidence that the use of feeding tubes in these patients does not improve survival, prevent aspiration pneumonia, prevent or heal decubitus ulcers, or improve other clinical outcomes. Yet, despite this evidence, more than one third of nursing home residents with advanced dementia have feeding tubes, and many of these individuals have feeding tubes inserted on hospital admission for an acute care problem. Health care professionals need to examine the evidence carefully to identify practices that provide patients and families with information to make informed choices and respect their rights and dignity at end of life.