Death with dementia accounts for 1 in 3 deaths in an average general practice. End of life, and death with dementia may be complicated by distress, which is difficult to interpret and resolve. A positive, proactive approach using palliative care principles helps the patient, their family, and professional carers. General practitioners attending nursing homes is the best method for coordinating this work. Support should be available from local services for old-age psychiatry and palliative care.