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This study tracked care received by 133 Older People with Dementia (OPWD) over 18 months in six residential care homes, including medication review and economic evaluation. An important output of this study is the development of a framework that defines the different manifestations or levels of uncertainty, and that can be used to test the comprehensiveness and strengths of future interventions designed to improve end-of-life care for people with dementia in care homes.