Mr T, 88, with dementia, became "aggressive at night" on the ward: shouting, striking out during personal care. The word "behavioural" was already in the notes, and sedation was already written up. Thankfully, someone questioned it. A nurse noticed he winced when rolled. The unwitnessed fall from the week before had been documented and forgotten. X-ray: an impacted hip fracture. He had been walking on it, after a fashion, and hurting every time anyone touched him. Regular analgesia transformed the nights within 48 hours. No antipsychotic needed. In dementia, pain rarely announces itself in words. It shows up as fight, or as silence. Examine before you sedate, and ask what the "behaviour" is trying to say. #delirium #dementia