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2015 | Volume 10 | Issue 1 Elderly Care ISSN 1961-7623 INTERNATIONAL JOURNAL OF clinical aromatherapy Editor: Rhiannon Lewis  Associate Editor: Gabriel Mojay A unique resource for enhancing clinical practice Written by practitioners for practitioners www.ijca.net IJCA | 2015 | Vol 10 | Issue 1 1 INTERNATIONAL JOURNAL OF 2015 | Volume 10 | Issue 1 clinical aromatherapy Elderly Care Editor: Rhiannon Lewis www.ijca.net Associate Editor: Gabriel Mojay Contents Editorial Gabriel Mojay 1 Letters Linda Weihbrecht and Julies Jones; Rhiannon Lewis 2 Developing a community housing project for wintergreen farmers in Nepal Kailash Dixit 4 Effect of aromatherapy on patients with Alzheimer’s disease Daiki Jimbo, Yuki Kimura, Miyako Taniguchi, Masashi Inoue and Katsuya Urakami 6 The HEARTS Process and its potential role in elderly care Ann Carter 14 Reducing anxiety and restlessness in institutionalised elderly care patients in Finland: A qualitative update on four years of treatment Ulla-Maija Grace 22 Aromatherapy Service Report: The use of essential oils in the geriatric departments of Valenciennes Hospital Centre, France Geraldine Gommez-Mazaingue 30 Towards defining clinical aromatherapy: the essence of Rhiannon Lewis 35 Care versus Cure: Aromacare for body, mind and spirit in the last stages of dementia Interview with Madeleine Kerkhof-Knapp Hayes 48 Book reviews Ann Carter, Pey Colborne, Rhiannon Lewis and Gabriel Mojay 58 Rédaction/Publication: Disclaimer Essential Oil Resource Consultants EURL The Publisher cannot accept responsibility for any injury or mishap to persons or property from the use of any methods, Chemin des Achaps products, instructions or ideas referred to within this publication. 83840 La Martre The views expressed in the IJCA are not necessarily those of the FRANCE Publisher or members of the Editorial Board. Tel/fax: (+33) 483118703 Advertising Rédactrice/Editor: Rhiannon Harris Lewis Advertising enquiries should be addressed to the Editor. Email: [email protected] Although all advertising material is expected to conform to ethical standards, and inclusion in this publication does not Depot legal: à parution constitute guarantee or endorsement of the quality or value of ISSN: 1961-7623 such product or of the claims made of it by the manufacturer. The Publisher reserves the right to refuse any advertising that is Cover image: copyright © 2015 Pascal Duvet considered inappropriate. www.pascal-duvet-photographie.com Copyright © 2015 Essential Oil Resource Consultants EURL an No part of this publication may be reproduced, stored in a essential oil resource consultants retrieval system or transmitted in any form, or by any means, electronic, mechanical, photocopying or otherwise, without prior publication written permission of the Publisher. Editorial “An unbending tree breaks in the wind aromatic interventions have been “adapted for the thus the rigid and inflexible will surely fail often medicated, frail and vulnerable patient” (pg 36). while the soft and flowing will prevail” I am honoured in this issue of the IJCA - my second From Tao Teh Ching by Lao Tzu (6th century bc) as its Associate Editor - to introduce the work of those such as Ann Carter, Ulla-Maija Grace and Integral to the origin of the word ‘clinical’ is the act Madeleine Kerkhof-Knapp Hayes who unite both of bending or inclining — deriving as it does from the rigour and compassion of clinical aromatherapy, the Ancient Greek klinikós, “pertaining to a bed”, and who combine firm clinical knowledge with a and from klínein, “to bend, incline”. sensitive flexibility... characterized by the conviction that “any form of care to achieve optimal wellbeing Nowhere more does the therapeutically sensitive, and comfort is appropriate, as long as it is safe, “inclining” aspect of aromatherapy come to the fore evidence-based and/or experience-based, and than in its use in the care of the elderly. Practitioners focuses on the whole patient” (Kerkhof-Knapp of aromatic elderly care - such as those who share Hayes, pg 49). their work in this issue - therefore take a ‘clinical’ approach in more than one sense of the word: In the astute hands of these caring professionals, first, in terms of their “focus on evidence-based essential oils with their capacity to address the wide practice, safety, and methods of evaluating care range of conditions common in elderly patients effectiveness” (Lewis, pg 36); and secondly, in the more subtle sense of the gentleness and flexibility find perhaps their consummate implementation. which elderly care calls for. This eminently professional yet attentively caring core development With best aromatic wishes, of clinical aromatherapy “been largely driven by Gabriel Mojay nurses or allied health professionals” through whom Associate Editor Editorial Advisory Board Pat Antoniak (Canada) Ann Carter (UK) Pam Conrad (USA) Trish Dunning (Australia) Jeannie Dyer (UK) Ann Harman (USA) Bob Harris (UK) Wendy Maddocks-Jennings (New Zealand) Naho Maruyama (Japan) Mark Moss (UK) Sandi Nye (South Africa) Lara Orafidiya (Nigeria) Laraine Pounds (USA) Jürgen Reichling (Germany) Marianne Tavares (Canada) Sandy van Vuuren (South Africa) IJCA | 2015 | Vol 10 | Issue 1 1 Letters Mapping Aromatherapy Use in Hospitals in USA The survey is anonymous and no identifying information will be collected. Confidentiality will Dear IJCA Readers, be protected by collecting only information needed to assess study outcomes. The Alliance of International Aromatherapists (AIA) Hospital Working Group is asking for help The Alliance of International Aromatherapists with distributing a survey for a research study would like to serve as a resource center and develop entitled: ‘Mapping Aromatherapy Use in Hospitals in standards on education, policies, procedures, and USA’. This study is being conducted by Wake Forest essential oils. The AIA and the Research Committee/ Baptist Medical Center, in cooperation with the AIA. Hospital Working Group of AIA is seeking s information specific to aromatherapy utse in acute n The purpose of this research study is to gain an care hospitals in the USA to develop a database for a understanding of the current use of essential oils collaboration between the medical community and t in acute care hospitals in the USA or identify the aromatherapists. l 5 u barriers to the use of essential oils in acute care 1 s hospitals in the USA. If you are interested in participating in this study, 0 n please use the following link to access the informed 2 o Any acute care hospital can participate in the consent and survey: C survey. All information about essential oil use in © USA acute care hospitals is valuable. Whether a https://wwwe. surveymonkey.com/s/RYR8W3M t hospital has a current aromatherapy program, had c h an aromatherapy program and disbanded it, or Complretion of the survey implies your voluntary g u doesn’t have an aromatherapy program, aill acute consent to participate in this study. r o care hospitals are invited to take part in this survey. y s Thank you for your time and consideration. p e It is important to know that this letter is notR to o tell you to join this study. It is your decision. Your Sincerely, C l participation is voluntary. You do not have to i respond if you are not interested in partOicipating in Linda Weihbrecht BSN,RN,CCAP,LMT this study. You are free to ask any questions about the study or about being a paratilcipant by calling Chairperson, Alliance of International Julie Jones MSN,RN at 336-71i6-3556 or by email at Aromatherapists Hospital Working Group t [email protected] [email protected] n e For Institutional Rseview Board (IRB) research Julie Jones MSN,RN,CHTP,CA questions, the IRBs is a group of people who review E Primary Investigator, Wake Forest Baptist Medical the research to protect your rights. If you have a Center question about your rights as a research participant, [email protected] or you would like to discuss problems or concerns, have questions or want to offer input, or you want to obtain additional information, you should contact the Chairman of the IRB at 336-716-4542. In addition, please forward this letter to colleagues in your area (USA only) who work at acute care hospitals who may also be interested in participating in this research study. IJCA | 2015 | Vol 10 | Issue 1 2 Letters Letter from the Editor Kailash is seeking financial support from the international aromatic community to fund this project, where all funds donated go directly to Dear Readers, the area of need in a transparent and constructive fashion. He will personally coordinate, monitor At botanica2014 participants had the joy of meeting and supervise the project himself and report to with Kailash Dixit and his beautiful wife Deepa international contributors through regular reports of Aarya Aroma (www.essencenepal.com), and shared through emails. learning of their valuable contributions to the lives and livelihoods of local and indigenous people Aromatherapist and author Mollie Jensen, a friend s in Nepal. Many of you have also been using their of Kailash, has employed the popular ftund-raising n wonderful quality essential oils. website Crowdrise to setup a campaign in support a of his project, Help Rebuild a Village in Nepal: t Aarya Aroma are known for their provision of l 5 u https://www.crowdrise.com/rebuildavillageinnepal/ excellent quality essential oils that meets both local 1 s fundraiser/MollieJensen and international demand. An essential part of their 0 n work is supporting the lives of less privileged farmers 2 o The IJCA is delighted to endorse and promote this and indigenous people by guaranteeing a market C ca©mpaign, and we urge to you to kindly donate to it. for collected or cultivated Medicinal and Aromatic All sums, no matter the amount, are welcome, and e Plants (MAPs). They have done so through formingt will direcctly support this important project. h a farmer’s cooperative where local and indigenous r g u people participate in the cultivation and production I sincerely trust that you will be moved to assist i of MAPs. The impact of the cooperativer on local Koailash secure the necessary funding for this project, y s and thank you in advance for your generosity. communities has been enormous, as pit has equippede local people with the opportunity of employmRent o Please read further details about the project from and sustainable land use and hCas significantly raised l Kailash himself, on the following pages. their socio-economic status. i O Sincerely and aromatically yours, The earthquake in April 2015 essenltially demolished Rhiannon Lewis a much of this far reaching project; homes and [email protected] i livelihoods of innumerabtle local people have n effectively been erased. e s s Through Aarya Aroma and in collaboration with E experts in construction and eco-technology, Kailash has established a project to develop community housing for local people in Okhaldhunga, a wintergreen sourcing area in a remote district of Nepal where 100% of homes were lost. Kailash has been supporting local people in Okhaldhunga for the past five years. He recently returned from a visit to the area to assess the extent of the devastation and to identify the immediate and long-term needs of the local communities. IJCA | 2015 | Vol 10 | Issue 1 3 Developing a community housing project for Pokali, Okhaldhunga, a wintergreen sourcing area where earthquake victims live in one of Nepal’s most remote districts Kailash Dixit Producer, harvester, distiller Aarya Aroma, Kathmandu, Nepal [email protected] www.essencenepal.com Background Unfortunately, the deadly earthquake that hit Nepal Nepal on April 25 and April 26 left 17,000 families homeless in Okhaldhunga-district. According to the data collected by the District Natural Disaster Committee, 8084 houses has been completely destroyed and 9800 houses incurred damage and are unfit for living. The earthquake victims are spending their days and nights in the open spaces. Eighteen people have died after being buried in their houses and 88 people are injured. Similarly, five health posts and one area police office have Wintergreen harvest, 2014. been completely destroyed. As a result, many of our farmers have been left with no home, food or water, or basic services. The government relief work has not been able to reach there yet, and these farmers are far from having any stable shelter in the near future; and with the rainy season coming, they are likely to endure even more hardship. Quick Assessment Recently, we made an assessment of the part of the districts with the following objectives: • To assess the devastation in the area where our farmers make their living. Wintergreen at the distillery, 2014. • To collect indigenous ideas to design a project to help the farmers rebuild their houses Strategy and Plan It was found that in the wintergreen harvesting area where our farmers reside and cultivate, only Since we cannot reach out to everyone, we envision 25% have the financial means and have taken supporting the poorest of the poor community who the initiative to rebuild their homes at their own live on less than US $5.00 per day. With my own expense. The remaining residents are extremely contribution and the contribution from international poor and now homeless. community, I propose the following strategy. IJCA | 2015 | Vol 10 | Issue 1 4 1. To help plan, and build a model community low cost housing of 7-8 houses, with a separate community bathroom and kitchen using local state of art technology such as solar or peltric set to produce electrify, biogas to produce necessary energy needed for domestic use. The idea is to create a model that attracts other inhabitants, government and donors to follow the same to extend the support to other part of and district. 2. To help rebuild community houses of approximately 500sq ft, mostly with recycling debris. These houses will be rebuilt from the reuse of stone, woods, and corrugated sheets from debris of damages houses, with utmost attention Demolished home, 2014. to structural safety, as well as reusing salvageable doors and windows. In my estimation, 50% of the debris materials are reusable. 3. The structure and design of these homes will be improvised to make it earthquake friendly. The initial estimated of cost of subsidy to build one house would be US $6,000 per house. Families will only be relocated within a radius of 1-1.5 km to reduce their hardship, keeping them 10-15 minutes walking distance to their farms. 4. The model community housing will be designed to be as sustainable as possible using their natural resources. One example is to construct micro hydropower plants at a cost of US $4-5,000k, which could provide lighting for 15-20 homes. Some materials can be salvaged and reused, 2015. 5. Bio-gas plants will be built using human waste and/or cattle dung — an alternative source of My appeal to the donor foundations is that it is of cooking fuel that would alleviate the need to the utmost importance that the appropriate funding consume precious trees for fire. reaches the neediest families. We do not yet have a local government, and so it is imperative we do 6. The people in this locality are unable to shower a model job as good citizens. In turn, we will be because of extreme cold, so for proactive hygienic teaching by example, and it will increase the capacity reasons, we would build a common bathing area to learn from this catastrophe. We must be equally for the families. The water will be heated using transparent on how money is allocated, while being solar energy and be partitioned by a common most economical in all endeavours. wall for males and females. Budgeting and financial plan 7. In the mountains, there are no playgrounds for the children. There would be a designated area I am meeting with of structural engineers, bio-gas built for their playtime and recreation. experts, micro-hydro experts, and many more, for completing the community model housing Plans are already underway for this project. In order planning. I am expecting the project to be completed to establish a sense of ownership and responsibility, rapidly, and welcome your support. our financial support will be 80%, with the remaining 20% paid by the villagers themselves. Photos supplied by Kailash Dixit. IJCA | 2015 | Vol 10 | Issue 1 5 Effect of aromatherapy on patients with Alzheimer’s disease Daiki Jimbo, Yuki Kimura, Miyako Taniguchi, Masashi Inoue and Katsuya Urakami Section of Environment & Health Science, Department of Biological Regulation, School of Health Science, Faculty of Medicine & Information Media Center, Tottori University, Yonago, Japan [email protected] Objective: Recently, the importance of non-pharmacological therapies for dementia has come to the fore. In the present study, we examined the curative effects of aromatherapy in dementia in 28 elderly people, 17 of whom had Alzheimer’s disease (AD). Methods: After a control period of 28 days, aromatherapy was performed over the following 28 days, with a wash out period of another 28 days. Aromatherapy consisted of the use of rosemary and lemon essential oils in the morning, and lavender and orange in the evening. To determine the effects of aromatherapy, patients were evaluated using the Japanese version of the Gottfries, Brane, Steen scale (GBSS-J), Functional Assessment Staging of Alzheimer’s disease (FAST), a revised version of Hasegawa’s Dementia Scale (HDS-R), and the Touch Panel-type Dementia Assessment Scale (TDAS) four times: before the control period, after the control period, after aromatherapy, and after the washout period. Results: All patients showed significant improvement in personal orientation related to cognitive function on both the GBSS-J and TDAS after therapy. In particular, patients with AD showed significant improvement in total TDAS scores. Result of routine laboratory tests showed no significant changes, suggesting that there were no side-effects associated with the use of aromatherapy. Results from Zarit’s score showed no significant changes, suggesting that caregivers had no effect on the improved patient scores seen in the other tests. Conclusions: In conclusion, we found aromatherapy an efficacious nonpharmacological therapy for dementia. Aromatherapy may have some potential for improving cognitive function, especially in AD patients. Introduction of senile dementia after the introduction of elderly care insurance. These treatments are performed to Japan, having the highest life expectancy in the complement the effects of pharmacotherapeutics world, has seen a remarkable increase in senile and health care services, such as nursing home, day dementia in recent years. This has become a big social care etc, for elderly patients. Aromatherapy is one problem, with Alzheimer’s disease (AD) accounting of the therapies used in complementary alternative for approximately half the number of cases of medicine (Ballard et al., 2002; Smallwood et al., 2001). dementia (Urakami et al., 1998; Yamada et al., 2001). In recent years, non-pharmacological intervention Thus, preventive medicine for dementia has has been based on the viewpoint of brain become more important (Urakami, 2007). Recently, rehabilitation and the possible prevention of complementary alternative medicine, which, in senile dementia has also been reported and addition to using medications, also makes use of non-pharmacological treatments other than various ‘non-pharmacological’ approaches, has aromatherapy, such as memory training, music become an attractive alternative in the treatment therapy, the recollection method, animal-assisted IJCA | 2015 | Vol 10 | Issue 1 6 therapy, and optical treatment, have been studied aromatherapy is the result of the vital reaction that (Kawamura et al., 2007; Yamamoto-Mitani et occurs through the smell molecule. al., 2007; Yamagami et al., 2007). Aromatherapy experientially classifies the effect of the scent Although some reports have proposed that the through the essential oil extracted from the plant, sense of smell is decreased in AD patients, nerve a traditional treatment used according to its effect, rebirth through smell is possible (Peters et al., and is used in many fields. In the present study, the 2002; Eriksson et al., 1998). We also suspected that aromatherapy applied did not include mainstream patients’ cognitive function could be improved by aroma massage, aroma baths etc. (including touch stimulation through the sense of smell. therapy) because physical problems, such as low temperature burns, may occur in some cases The aromatherapy treatment used in the present (Maddocks-Jennings et al., 2004; Lee, 2005; Hur et study is is physically safer and easier to apply than al., 2004). The mechanism(s) of action of underlying mainstream treatments, such as massage and baths, s the effects of aromatherapy are not known for so the operator feels no limitation because he or she t certain. In healthy people, essential oils of rosemary can work through purely aromatic menans. and lavender are commonly used and there is at a least one report showing that these oils influence Initially, the level of congnittive function was l feelings about a person’s surroundings (Wheatley, assessed using5 the Gottfries,u Brane, Steen (GBSS-J) 2005). Moreover, lavender oil has been reported to and Touch-1panel type Desmentia Assessment Scale improve sleep disorders (Lewith, 2005; Moss, 2003). (TDAS). 0Aromatherapyn was applied to AD patients It has also been reported that the essential oil of using 2a combinatioon of a lavender oil–orange oil lemon affects the anti-oxidant action of vitamin E solu tion, whichC activates the parasympathetic © and improves the state of blood vessels near the skin nervous system, with a rosemary oil–lemon oil (Grassman, 2001). Although there are few reports e tsolution used to relieve depression and heighten on aromatherapy in senile dementia, it has behen c concentration. In this preliminary phase of the r suggested that aromatherapy may bring about some g invesutigation, the possibility that the cognitive feeling of relief and the ability to act on outside i r fuonction could improve in AD patients following influences such that the obstacle to action in senile y saromatherapy was discovered and the validity of dementia can be coped with (Lee, 2005). However, p e using aromatherapy in AD patients was examine there are no reports of the effects of aromatherapy R o further. on cognitive functional disorder, often seem in C cases of dementia and the central feature lof senile i Methods dementia. Disorders of cognitive funOction pose considerable problems for both AD patients and Patients care workers. l a i In total, 28 elderly people (mean age 86.1 ± 6.9 The action of aromatherapty begins from a smell n years) were involved in the study. Seventeen molecule combined with an acceptor peculiar e patients had AD (two men, 15 women; mean age to each specific odor. The smell molecule passes s 86.3 ± 6.4 years), three had vascular dementia along the nasal cavity and adheres to the olfactory s (VaD; all women; mean age 89.7 ± 5.5 years), and epithelium. TheE stimulus is transmitted to the eight had other diagnoses, including, among others, hippocampus or cerebral limbic system and a mixed case of AD and cerebrovascular lesions amygdaloid body through the olfactory nerve system currently concentrated on the olfactory epithelium. (CVL; all women; mean age 84.5 ± 8.3 years). Although this process is deeply related to cognitive We provided patients and their families with detailed function, the odor is recognized and the stimulus information regarding the methods and purpose sends information to the hypothalamus on which it of the study (Table 1) and informed consent was was projected by the cerebral limbic system, which obtained. Patients with AD were diagnosed by the then adjusts the autonomic nervous system and the DSM-IV (American Psychiatric Association, 1987) internal secretory system, guiding a series of vital and NINCDS-ADRDA (McKhann et al., 1984), reactions in the hippocampus or amygdaloid body, whereas patients with CVL were diagnosed using such as the discharge of neurotransmitters. In brief, DSM-IV and NINCDS-AIREN (Roman et al., 1993). IJCA | 2015 | Vol 10 | Issue 1 7 Table 1. Distribution of subjects according to Functional Assessment Staging of Alzheimer’s disease (FAST) assessment Mean (±SD) FAST3-5 FAST3-5 Total age (years) AD 5 (0/5) 12 (2/10) 17 (2/15) 86.3 ± 6.4 VaD 1 (0/1) 2 (0/2) 3 (0/3) 89.7 ± 5.5 Others 3 (0/3) 5 (0/5) 8 (0/8) 84.5 ± 8.3 Total 9 (0/9) 19 (2/17) 28 (2/26) 86.1 ± 6.9 Mean (±SD) age (years) 83 1 6.9 87 1 6.2 86.1 1 6.9 Data show the number of patients in each group, with the number of men/women given in parentheses. FAST3-5, mild to moderate Alzheimer’s disease (AD); FAST6-7, severe AD; AD, Alzheimer’s disease; VaD, cerebrovascular dementia; Others, mixed dementia and other dementia. Methodology Table 2. Study schedule The examine the effect of mixed aromas, a crossover Before 1 1 week method was used in the present study. To evaluate Control period 4 weeks the persistence of any effect of the aromatherapy, a Before 2 1 week washout period of 28 days was included after the 28 Aromatherapy period 4 weeks days of aromatherapy. Furthermore, to examine in After 1 1 week detail how the aromatherapy influenced cognitive Wash out period 4 weeks function in dementia patients, the TDAS was applied as a highly sensitive test with little influence After 2 1 week from the investigator. To evaluate the effects of aromatherapy, tests were performed up to four times throughout the schedule. After a control period of 28 days, aromatherapy was performed over the following 28 days, followed by a 28-day wash out period. During the control Table 3. Tests used in the present study and wash out periods, patients did not receive any treatment. During the 28 days of aromatherapy, Before 1 Before 2 After 1 After 2 patients were exposed to the aroma of 0.04 mL HDS-R ✓ ✓ ✓ ✓ lemon and 0.08 mL rosemary essential oil in the GBS ✓ ✓ ✓ ✓ morning from 0900 to 1100 hours and to 0.08 mL FAST ✓ ✓ ✓ ✓ lavender and 0.04 mL orange essential oils in the CT ✓ x x x evening from 1930 to 2100 hours. The oils were Blood placed on a piece of gauze in diffusers with an ✓ x ✓ x Examination electric fan. (All essential oils and diffusers used in the present study were produced by the Peace Biochemical ✓ x ✓ x Examination of Mind Company (Tokyo, Japan).) Two diffusers were set up in each room where patients had been TDAS ✓ ✓ ✓ ✓ moved. The essential oils (rosemary and lemon; Zarit ✓ ✓ ✓ ✓ lavender and orange) were then mixed as described above. The lemon and rosemary mix activates ✓, test performed; x, test not performed; FAST, Functional the sympathetic nervous system to strengthen Assessment Staging of Alzheimer’s disease; HDS-R, revised version of Hasegawa’s Dementia Scale; GBSS-J, Japanese version concentration and memory, whereas the lavender of the Gottfries, Brane, Steen scale; CT, computed tomography; and orange fragrance activates the parasympathetic TDAS, Touch Panel-type Dementia Assessment Scale. nervous system to calm patients’ nerves. IJCA | 2015 | Vol 10 | Issue 1 8

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Aromatherapy Service Report: The use of essential oils in the geriatric departments of. Valenciennes Towards defining clinical aromatherapy: the essence of. Rhiannon .. mainstream treatments, such as massage and baths,.
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