Dementia is usually framed as a disease of memory. For patients and families, it is a progressive, life-limiting illness marked by years of functional dependence, distressing symptoms, and heavy caregiver burden. Over 180,000 people in Hong Kong are living with dementia and it is estimated that over 300,000 will carry this diagnosis in 2035 with the aging of the population.

Care for community-dwelling people with dementia alone costs an estimated HKD$12.6 billion a year, most of it in social and informal care. Disease-modifying therapies are limited to early disease and offer modest benefit, so most people living with dementia today will need years of supportive and palliative care. This talk will review the clinical course of dementia, outline sources of suffering, describe caregiver needs, and gaps in care.

The speaker argues that episodic, acute-care health systems and hospice models built around short prognoses are mismatched to dementia’s long, unpredictable trajectory. He will posit that palliative care integrated across early, moderate, and advanced disease, centred on ongoing goals-of-care conversations, home-based interdisciplinary care, caregiver support, and symptom management, provides a better model for dementia care. Clinical, system, and research priorities for getting to this outcome will be outlined.