People on average are now living longer than ever before, and with advancing age comes the associated risk of dementia. Patients with dementia may suffer the same symptoms and are entitled to the same level of care as their cognitively intact counterparts, but different principles must be applied. The cognitive impairment that results in dementia also makes adequate pain management challenging (Chang et al, 2009; Jordan, 2010). The author supports the use of a specialized pain assessment tool that incorporates behavioural cues as part of the assessment to prevent pain from being undertreated. An analgesic trial can act as a guide to the presence of pain: if the patient is observed to be more comfortable or less agitated after the administration of analgesia, it can logically be acknowledged that pain must have been present. Similarly, patients with advanced dementia may present with difficulties with nutrition/hydration and dysphagia, and these do not always signify that the patient is dying. Decision making regarding the administration of artificial fluids or nutrition is complex and requires knowledge about advanced dementia as a disease and the benefits and burdens of administration.