In November 2006 a joint National Institute for Health and Clinical Excellence (NICE) and Social Care Institute for Excellence (SCIE) guideline to improve the care of people with dementia was released. This influential policy document reflects both a medicalized approach to care (emphasizing pharmacological management and health services) as well as one characterized by professional dominance (an emphasis on professional authority and control). Despite the involvement of social sciences in its development the policy reflects common biases in other areas of policy and practice in the care of older people. Furthermore, the idea that people with dementia have complex end of life care needs is addressed only with the most cursory and clinically oriented approaches to palliative care. A critical commentary about this policy approach is supplemented with a brief description of an alternative policy vision that connects older people's care with a wider public health approach to end of life care for older people.