Palliative Care, Psychiatry, and Dementia: A Holistic Approach to Living Well
By Dr. Michelle King – Psychiatrist with a special interest in palliative medicine and dementia care
Dementia is more than memory loss. It’s a progressive neurological condition that affects every part of a person’s life — from thinking and communication to mood, behaviour, and identity. It also deeply affects family members and caregivers. As a psychiatrist with training in palliative care, I believe strongly in a holistic, person-centred approach to dementia.
That’s where the principles of palliative care come in — not just at the end of life, but from the time of diagnosis, to support quality of life, dignity, and meaning.
Where Psychiatry Meets Palliative Care
Psychiatrists working in palliative care bring a unique perspective. We’re trained to understand both the medical and emotional complexities of serious illnesses like dementia — helping to manage mental health, support decision-making, and guide families through uncertain terrain.
Here’s how psychiatric palliative care can support people living with dementia:
1. Managing Mood and Behavioural Changes
Dementia often comes with emotional symptoms — anxiety, depression, agitation, even paranoia. These are distressing for both the person and those who love them. A psychiatrist can help by:
Differentiating between psychiatric illness and dementia-related changes
Prescribing carefully chosen medications when appropriate
Offering behavioural strategies to reduce distress without over medication
2. Supporting Families in Navigating the Journey
Caring for someone with dementia can be exhausting and overwhelming. Palliative psychiatry includes supporting caregivers to:
Understand what’s happening
Cope with grief, guilt, and burnout
Access community resources and respite options
Make decisions that align with their loved one’s values
3. Advance Care Planning and Communication
Palliative care helps families and patients make important decisions before a crisis occurs. As psychiatrists, we help assess capacity, facilitate conversations about future care, and ensure that each person’s wishes are respected. This includes:
Talking through goals of care
Planning for later stages of the illness
Documenting choices around medical interventions
4. Honouring the Person — Not Just the Illness
Palliative psychiatry recognises that even as abilities change, the person remains. Meaning, dignity, and connection are central to care. This might include:
Reminiscence therapy or legacy projects
Music, art, or sensory-based interventions
Adapting the environment to promote comfort and autonomy
A South African Context: Dementia and Access to Care
In South Africa, many families manage dementia with limited access to home-based care, respite facilities, or specialised support. Psychiatrists with a background in palliative care can advocate for a more compassionate, accessible system, particularly in rural and underserved areas.
A Final Word
Dementia is a long journey — one that can be filled with loss, but also with moments of meaning, love, and presence. Palliative psychiatry brings together clinical knowledge, emotional insight, and practical support to ensure that no one walks this path alone.
If you or a loved one is living with dementia, reach out. Whether you’re seeking support, guidance, or just a place to be heard — I’m here to help.
