From pills to pathways: The global dementia care shift

For decades, dementia care leaned on medication, often sedating residents instead of addressing unmet needs. A growing international movement is challenging that model, pushing for person-centred care that prioritises well-being, connection and inclusion.

Geriatrician and author Dr Allen Power has been at the forefront of this shift since the 1990s. His 2010 book Dementia Beyond Drugs helped spark a rethink in the United States, where prescribing was routine.

“When somebody was distressed we would pick up the phone and call the doctor,” he said. “But if I could give the care team the tools and knowledge to solve problems, I had a better chance of breaking the cycle.”

Dr Power believes antipsychotics should only ever be used as a temporary measure in crisis.

“I have never seen a person with dementia, without a major psychiatric illness, who still needed a drug if the proper approach and supports were in place.”

A growing movement

Canadian consultant Jessica Luh Kim joined Dr Power’s advocacy more than a decade ago after questioning why so many residents were on “10-plus medications a day”.

“There’s a growing movement of people who want to offer support that is dignified and humanistic,” she said.

Yet culture and regulation remain hurdles. “The reimbursement system pushes people down the medicalised road. The legal system makes people afraid to innovate. It’s societal ageism and ableism,” Dr Power said.

For Ms Luh Kim, change depends on courageous leadership. “Aged care needs leaders who will articulate the why, confront the brutal truths and bring the right people along. If they’re not brave enough, we’ll fall back into what’s comfortable.”

Focusing on well-being

At the heart of Dr Power’s approach is the Eden Alternative and its seven Domains of Well-Being: identity, growth, autonomy, security, connectedness, meaning and joy.

He recalls an American lawyer who entered care angry, isolated and heavily medicated. By tapping into his unmet need for meaning — enabling Bible study, quality time with his wife and leadership of group activities — his behaviour shifted, friendships formed and his medication was discontinued within a month.

Similar results have been seen in Canada’s Aspen Lake, where antipsychotics were stopped for 19 of 20 residents.

“You’re not curing dementia,” Dr Power said, “but you’re building resilience and reserve.”

Pathways to inclusion

In a new book due in 2026, Dr Power and co-authors Dr Jennifer Carson and Pat Sprigg set out five pathways to inclusion:

1. Reframe dementia & enhance well-being – Move beyond viewing people as ‘fading away’ or defined by ‘difficult behaviours’.
2. Leverage collective capacity – Use daily staff huddles to share perspectives and build collaborative well-being plans.
   Create supportive environments – Combine physical design, technology and strong community involvement.
3. Negotiate risks and benefits – Shift from eliminating risk to enabling people to live well despite it.
4. Integrate approaches – Ensure all pathways connect to strengthen quality of life.

“The goal is not to eliminate risk, it’s about enabling people to live well,” Dr Power said.

For advocates like Power and Luh Kim, dementia care’s future rests on providers who reject quick pharmacological fixes and commit to reshaping cultures of care. “Every pathway leads to inclusion and better lives for people living with dementia,” Dr Power said.

Originally published in Hello Leaders winter print edition. Read the full article here or contact us on [email protected] to order your print copy.