1 Introduction There is widespread debate and limited evidence for when and how to initiate palliative care in people living with dementia (PLWD). This is a critically important issue, as ongoing increases in the global prevalence of dementia are expected to lead to substantial increases in healthcare use and costs [1]. Studies of PLWD have reported variable effects on acute healthcare utilization with different strategies to initiate heterogeneous palliative care interventions [2-10].