Begin by …

• Assessing if there is a physical, environmental, or emotional cause to the anger.  
• Requesting the pharmacist consultant to review medications for potential side effects/ drug interactions including paradoxical agitation.  
• Ruling out pain as this can cause residents to be more easily frustrated.  Is pain management in place?  
• Ruling out vision, hearing, podiatry and dental issues.  Are there uncorrected concerns related to ancillary needs that may be causing the resident to misinterpret the environment and therefore strike out?
• Assessing the cause of the agitation.  Is the anger in response to a fear, feelings of helplessness, changes in lifestyle, loss of control, a response to an action by another resident or by staff, change in caregiver, in environment, is it communication issue – not understanding or being understood? 
• Sometimes keeping a log, journal, antecedent behavior monitoring form, is helpful in identifying why and when the person becomes agitated.

Ideas

• REDIRECT resident to another activity, topic.
• Create a calm environment, especially for those who may be manic.  
• Try lavender scents such as lotion as lavender has therapeutic calming components.  
• Simplify the environment by limiting noise, number of people, clutter 
• Maintain a consistent environment
• Promote exercise during the day and encourage rest periods
• Remove the resident to a more calmer environment when the resident appears to be getting increasingly frustrated
• Provide council on appropriate behaviors and responses when frustrated.  Attempt modeling and rehearsal exercises
• Encourage resident to verbalize feelings related to anger and powerlessness and offer validation, “I understand why you are upset and angry”
• Help the resident determine appropriate ways of expressing anger
• Provide positive reinforcement when resident expresses feelings and when socially appropriate
• Staff to verbally reinforce that resident is important and valued (compliment the resident’s strengths)
• Use a two-way problem solving approach by encouraging the resident to find ways to avoid future incidents.  Explain to the resident that his input is valued.
• Avoid arguing with the resident
• Consider providing room visits (Social Service support) on a routine base.  It can be care planned like, “Room visits --- times per week to encourage resident to express feelings”. 
• Follow though on correcting situations when there is a valid reason for the resident’s anger
• Introduce resident to peers with similar interests to increase interpersonal contacts
• Check on the resident’s location and status hourly
• Make sure there is nothing in the resident’s bedroom or possession that can be used to hurt self or others
• Tell the resident simply what behaviors will be accepted and not accepted (e.g., “Mr. Black, you can leave the dining room if Mrs. White’s singing is bothering you, but you must stop cursing at her.”)
• Promote activities of interest daily