clinical aromatherapy

76 Pages·2015·6.79 MB·English

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
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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
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in acute care hospitals in the USA or identify the aromatherapists. l
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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,
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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
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hospital has a current aromatherapy program, had c
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an aromatherapy program and disbanded it, or Complretion of the survey implies your voluntary
g
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doesn’t have an aromatherapy program, aill acute consent to participate in this study.
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care hospitals are invited to take part in this survey.
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Thank you for your time and consideration.
p e
It is important to know that this letter is notR to
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tell you to join this study. It is your decision. Your Sincerely,
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participation is voluntary. You do not have to
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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
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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
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wonderful quality essential oils. website Crowdrise to setup a campaign in support
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of his project, Help Rebuild a Village in Nepal:
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Aarya Aroma are known for their provision of l
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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
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people participate in the cultivation and production I sincerely trust that you will be moved to assist
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of MAPs. The impact of the cooperativer on local Koailash secure the necessary funding for this project,
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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
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Sincerely and aromatically yours,

The earthquake in April 2015 essenltially demolished Rhiannon Lewis
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much of this far reaching project; homes and [email protected]
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livelihoods of innumerabtle local people have
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effectively been erased.
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Through Aarya Aroma and in collaboration with
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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
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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
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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