Q Why is my grandfather with vascular dementia aggressive towards hospital staff?

Being a hospital patient is confusing and unsettling, and for someone whose brain is damaged and can’t make sense of much of everyday life, it can be terrifying. Take, for example, when your grandfather is woken in the morning by strangers who are trying to take his clothes off and wash him. He doesn’t remember that he’s in a hospital ward: he doesn’t know who they are, and he feels that he is being attacked. So he defends himself by shouting and trying to push them away.

A better way for someone with dementia is for a nurse to sit quietly next to him for a few minutes, holding his hand and saying gently, ‘Hello David. Good morning. Time to wake up and have some breakfast? My name is Jennifer and I’m a nurse in <NAME>-hospital. Your wife, Jane, told us to look after you…’ His wife’s name will be reassuring. Just ‘burbling’ soothingly until he wakes up without feeling threatened. And smiling at him, with friendly body language. Taking time, being gentle, and adjusting to David’s morning rhythm. Some people wake up instantly, like a startled cat, but others are like a machine turning over slowly.

And when it’s never been part of the person’s vocabulary where does the bad language come from? People are shocked when they hear a godly older person using language that would make a docker blush. It’s because the part of the brain that normally controls unacceptable behaviour has been damaged by the dementia, usually the frontal temporal lobes. Our brains record everything that we ever see, hear or do, and memories with the strongest recall are those laid down with intense emotion. We even remember where we were at the time. (Do you remember where you were when you heard of Queen Elizabeth’s death? Or of an accident involving a loved one?) Pastors’ work can take them into insalubrious places, and they hear shocking language from damaged people. These memories are laid down and suppressed because they are unpleasant and unacceptable, but they can emerge when the ‘control’ has been damaged or, alternatively, when the situation appears to be the same as the disturbing event(s) years earlier.

The answer is to reduce the person’s stress and fear, by reassuring them as described earlier.