With an increasingly elderly population, Primary Care physicians are involved in the complex care of the elderly patients with co-morbidity and often complex needs. Most people with advanced dementia in the UK live and die in care homes. In the later stages of dementia, people are profoundly physically and cognitively disabled. Especially this vulnerable group of patients benefits from a close collaboration between the primary care physician and the old age psychiatrist. Clear protocols for end of life palliative care and emergency care should be in place for all patients and discussed and agreed with clinicians, nursing staff, relatives and if possible with the patient.