Medical care can be both “a blessing and a curse”. The contributions of medicines to increased human lifespan and falling mortality from the major cardiovascular diseases are undisputed. However, in lockstep with remarkable extension of human lifespan has been increase in the numbers of people living with chronic age related neurodegenerative conditions and frailty. In frail, multi-morbid populations, with limited homeostatic reserve and life expectancy, the balance between the risk and harms of medicines can be in equipoise. In this context the number of older people living with dementia is increasing, and understanding threats to the quality of life of people with dementia is of growing significance. Among the myriad potential causes of harm to older people with dementia, in this issue of the journal Mitchell and colleagues present new Australian data reminding us of the importance of admissions due to both intentional and unintentional poisoning.