Percutaneous endoscopic gastrostomy is offered to many elderly, ill, debilitated patients. Nurses are key individuals in helping patients and families decide if this is the appropriate choice given the prognosis, goals of therapy, and patient wishes. In this article the author presents a review of the literature on percutaneous endoscopic gastrostomy including indications, contraindications, outcomes, and complications. Special risk factors in the aged, such as aspiration pneumonia and morbidity due to underlying diseases, are addressed. The decision to start, continue, or stop enteral feedings is difficult. Advance directives as well as open discussion with all involved parties are helpful. An educated prediction of lifespan, given underlying pathology, and patient/family wishes needs to be considered by knowledgeable practitioners before offering a percutaneous endoscopic gastrostomy as a therapeutic option.