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Background: As people living with dementia (PLWD) gradually lose their ability to manage their medicines appropriately, family members or friends step in to assist them. A variety of medication and person-related factors affect the medication use process. Aim: To identify and examine the factors contributing to the challenges to medication use from the perspective of PLWD and from their caregivers in the community and care home setting, in order to help maintain optimal therapy for this patient population, with a focus on the use of appropriate drug formulations, along dementia progression. In addition, to make recommendations for assistance for PLWD and caregivers to help alleviate caregiver burden and optimise the medication use process. Methods: To enable a comprehensive examination of issues from perspectives of PLWD and their caregivers, in relation to care setting and dementia severity, participants were recruited from the community and care homes in London. Semi-structured interviews were conducted, and medicines administration was observed in 4 care homes providing different types of care (nursing, residential, and mixed). Interviews were audio-recorded and transcribed verbatim. A conceptual model was developed based on a review of the literature; the domains provided the framework for thematic analysis of the data to achieve the research aim. Analysis was an iterative process and constant comparison was employed across interview transcripts. Results: Community results identified 6 areas that affect medication use; these are caregiver burden, the PLWD’s autonomy, scheduling and administering of medications, choice of formulations, interactions with formal care, and lack of medication information. Care home results also identified 6 areas; organisational aspects of the medication round, interactions between staff and residents, the residents’ autonomy, choice of formulation, staff knowledge, and interactions within the care home. Findings have also identified how key changes along dementia progression affect medication use. These include the development of swallowing difficulties, increase in the number and variety of medications, appropriateness of formulations, decline in cognition and communication, behaviour changes, caregiver expectations for the future, the PLWD’s autonomy, transition from self to caregiver-led care, and changes in support needs. Conclusion: The study has identified challenges to medication use in PLWD and their caregivers along dementia progression and informed recommendations to optimise medication use and alleviate caregiver burden. Recommendations include a proposed medicines optimisation model for PLWD and their caregivers, suggestions for tailored consultations and medication use reviews, improvements for care home organisation, and specific recommendations for the pharmaceutical industry for the development of dementia-friendly formulations. Furthermore, suggestions are proposed to adapt the Family Caregiver Medication Administration Hassles Scale for caregivers of PLWD based on the findings.