Article Archive
July/August 2014

Clinical Aromatherapy
By Linda Weihbrecht, BSN, RN, LMT, CCAP
Today’s Geriatric Medicine
Vol. 7 No. 4 P. 30

Holistic symptom management in geriatric care, advanced illness, and dementia care is an ever-increasing focus for hospitals and long term care facilities as the population continues to age. Symptom monitoring tools such as the Edmonton Symptom Assessment Scale (ESAS) are being used in long term care facilities to provide assessment and rapid treatment of frequently experienced symptoms. Brechtl et al conducted a pilot study using the ESAS for patients with advanced disease and found the most frequently reported symptoms were pain, tiredness, well-being, and appetite.1

There is a long history of empirical evidence supporting the use of aromatherapy as an adjunctive therapy to address these frequently reported symptoms. Aromatherapy also has been mentioned in dementia care as a preventive first-line treatment, as an environmental intervention/behavioral modification, and to address symptoms such as sundowning, memory loss, and sleep problems.2

What Is Clinical Aromatherapy?
Clinical aromatherapy is the controlled use of essential oils for therapeutic outcomes. Aromatherapy is both art and science, as is conventional medicine. It involves the chemistry of essential oils that provide therapeutic properties. Essential oils are highly concentrated and used in small quantities. It is possible for the same essential oil to be both relaxing and used to prevent cross-infection or to soothe pain and promote sleep, giving essential oils an increased value to address current health care needs.3

Essential oils are found in a wide range of aromatic plants, though not all. Often essential oils can be found only in one part of a plant, such as in the flowers of roses. Essential oils can be distilled from aromatic flowers, leaves, fruits, stems, seeds, bark, wood, peels, and berries.4 Table 1 below lists the parts of plants and some essential oils that can be derived from them.

Aromatherapy Benefits and Barriers
The field of aromatherapy is expansive and ranges from using essential oils to aid in wound healing to using them as a behavior modifier in dementia care.2 Aromatherapy goals can include reducing stress, stimulating the immune system, promoting healing, and reducing disease symptoms. A 2007 literature review showed the positive effects of aromatherapy interventions on wound care, nausea, agitation in dementia and elder psychiatric residents, phlebotomy, end-of-life agitation, and MRSA infections.5 Table 2 below lists essential oils for common problems in elder care.

Some barriers to implementing aromatherapy at clinical sites include inadequate staff education; safety issues; aromatherapy delivery methods; developing aromatherapy policies, procedures, and protocols; and payment/funding of aromatherapy services.

The Alliance of International Aromatherapists, through the Research Committee Hospital Working Group, has begun to develop resources to help clinical sites overcome the barriers they may experience in launching an on-site clinical aromatherapy program. Some of the resources the alliance employs are mapping clinical sites using aromatherapy; sample policies, procedures, and protocols for clinical aromatherapy; and a sample case study format. Both the Alliance of International Aromatherapists ( and the National Association for Holistic Aromatherapy ( have websites that offer solid aromatherapy information, such as approved aromatherapy education programs, safety information, and aromatherapy and essential oils resources.

Aromatherapy in the United States usually is administered through topical and inhalation applications. British aromatherapist, educator, and author Robert Tisserand, wrote in the second edition of Essential Oil Safety that “inhalation is an important route of exposure [in aromatherapy] because of the role of odor in aromatherapy, but from a safety standpoint it presents a very low level of risk to most people.”

Bioesse Technologies has developed a patented vapor delivery method applied to the skin that allows patients to breathe normally to inhale essential oil vapors. The essential oil scents travel through the nose and impact the body by activating receptor sites in the brain. The patented vapor delivery method can be applied to the skin, clothes, or hospital gowns, allowing a patient to breathe in the essential oil vapors. The inhalation patch uses an occlusive barrier to prevent oils from entering the skin, eliminating any potential for systemic effect. Additionally, the patch, which resembles an EKG pad, utilizes a hypoallergenic hydrogel adhesive that sticks to the skin without irritation. The patches come prefilled with single note essential oils, or blends, or as blank patches designed for aromatherapists to use with their own essential oil blends. The absorbent reservoir on the patch holds one or two drops of essential oil, with the scent lasting two to eight hours.

The new inhalation patches are expected to revolutionize and simplify the inhalation application method of delivering essential oils in clinical sites.

Final Thoughts
Clinical aromatherapy or essential oil therapy is an often-misunderstood adjunct to conventional medical treatment. Aromatherapy research is expanding, but larger, more rigorous studies are needed. Many patients are requesting aromatherapy services, and some clinical sites are listening and responding to these requests. Aromatherapy combines both art and science, and it can be utilized as a tool to bring the “care” back into health care.

Raphael d’Angelo, MD, a holistic physician and researcher who specializes in microbiology and parasitology, said of clinical aromatherapy via e-mail, “Although the sense of smell tends to diminish as we age, aromatic plant essential oils can still have profound effects. For example, a particular aroma may bring back to mind memories of events and feelings locked away for many decades. The limbic effects of essential oils can be readily used to defuse anxiety, increase appetite, aid in sleep, and provide a tranquil calmness for seniors as they face the uncertainties of aging.”

With the current and ongoing research studies supporting the use of clinical aromatherapy for conditions that affect older adults and the development of a new inhalation delivery system for clinical aromatherapy, it’s an exciting time for health care facilities to take another look at the benefits of aromatherapy for patients, caregivers, and staff.

— Linda Weihbrecht, BSN, RN, LMT, CCAP, is a nurse/massage therapist and certified aromatherapy and M technique practitioner, consultant, and educator. With specialization in intellectual and developmental disability nursing and stress management, she is the founder and facilitator of the support group Coping With Anxiety and Panic, associated with Pinnacle Health Hospitals in Mechanicsburg, Pennsylvania.

Learn More About Aromatherapy
The Alliance of International Aromatherapists and the National Association for Holistic Aromatherapy websites provide lists of approved aromatherapy schools. Aromatherapy publications include the NAHA Aromatherapy Journal, Aromatherapy Today, the International Journal of Clinical Aromatherapy, and the International Journal of Professional Holistic Aromatherapy. Additional information about aromatherapy is available at and

Both the American Herbalist Guild and the American Botanical Council offer information on herbal medicines, and the United Plant Savers provides medicinal plant conservation-related information. Organizations available to health care professionals include the American Holistic Nurses Association, the Associated Bodywork & Massage Professionals, the American Massage Therapy Association, and the Aromatherapy Registration Council.

Ongoing research and studies on olfaction and fragrance are being conducted at the Monell Chemical Senses Center and the Gattefossé Foundation. The Nobel Assembly at Karolinska Institutet awarded the 2004 Nobel Prize in Physiology or Medicine to researchers who discovered the odorant receptors and the organization of the olfactory system, with applicability to clinical aromatherapy use.

— LW

Table 1: Plants Yielding Essential Oils4

Parts of the Plant

Essential Oils


Jasmine, neroli (orange blossom), rose, ylang ylang


Citronella, lemongrass, petitgrain, palmarosa, patchouli




Ginger, vetiver

Entire plant

Geranium, lavender, rosemary, spike lavender

Fruit peel

Bergamot, lemon, lime, sweet orange, tangerine, mandarin


Table 2: Essential Oils for Common Problems in Elder Care5-7


Essential Oils

Anxiety, agitation, sundowning, challenging behaviors

Angelica archangelica rad. (angelica)
Cistus ladaniferus (labdanum)
Citrus aurantium var. amara fol. (petitgrain bigarade) Citrus aurantium var. amara per. (orange bigarade) Citrus bergamia (bergamot)
Citrus sinensis (sweet orange)
Cymbopogon martinii (palmarosa)
Eucalyptus staigeriana (lemon-scented ironbark) Lavandula angustifolia (lavender)
Litsea cubeba (may chang)
Ocimum basilicum (basil)
Origanum majorana (sweet marjoram)
Pelargonium graveolens (geranium)
Pogostemon patchouli (patchouli)
Valeriana officinalis (valerian)


Angelica archangelica rad. (angelica) (nervous)
Cistus ladaniferus (labdanum) (chronic)
Citrus aurantium var. amara (neroli bigarade)
Citrus paradisi (grapefruit) (exhaustion)
Coriandrum sativum (coriander) (including mental)
Cymbopogon nardus (citronella)
Eucalyptus radiata (black peppermint) (chronic)
Eucalyptus smithii (gully gum)
Juniperus communis ram. (juniper twig)
Mentha spicata (spearmint) (mental)
Pelargonium graveolens (geranium) (nervous)
Pinus sylvestris (Scots pine)
Rosmarinus officinalis ct. cineole, ct. camphor, ct. verbenone (rosemary)
Salvia sclarea (clary) (nervous)
Zingiber officinale (ginger)

Poor appetite or loss of appetite

Carum carvi (caraway)
Chamaemelum nobile (Roman chamomile)
Citrus aurantifolia (lime)
Citrus bergamia (bergamot)
Citrus limon (lemon)
Foeniculum vulgare (fennel)
Juniperus communis fruct. (juniper berry)
Mentha spicata (spearmint)
Zingiber officinale (ginger)

Memory loss

Litsea cubeba (may chang)
Mentha x piperita (peppermint)
Rosmarinus officinalis ct. cineole (rosemary)

Pain management

Eucalyptus smithii (gully gum)
Lavandula angustifolia (lavender)
Matricaria recutita (German chamomile)
Leptospermum scoparium (manuka)
Origanum majorana (sweet marjoram)
Pinus mugo var. pumilio (dwarf pine)
Rosmarinus officinalis ct. camphor (rosemary)
Zingiber officinale (ginger)


Angelica archangelica rad. (angelica)
Cananga odorata (ylang ylang)
Chamaemelum nobile (Roman chamomile)
Citrus aurantium var. amara (neroli bigarade)
Cistus ladaniferus (labdanum)
Citrus bergamia (bergamot)
Citrus limon (lemon)
Citrus reticulata (mandarin)
Citrus sinensis (sweet orange)
Cuminum cyminum (cumin)
Juniperus communis fruct. (juniper berry)
Lavandula angustifolia (lavender)
Litsea cubeba (may chang)
Melissa officinalis (lemon balm)
Myrtus communis (myrtle)
Ocimum basilicum (basil) (nervous)
Origanum majorana (sweet marjoram)
Ravensara aromatica (ravensara)
Thymus vulgaris ct. geraniol, ct. linalool (sweet thyme)
Valeriana officinalis (valerian)

End-of-life agitation

Lavandula angustifolia (lavender)
Santalum album (sandalwood)
Boswellia carteri (frankincense)

Caregiver support, mental exhaustion, burnout

Mentha x piperita (peppermint)
Ocimum basilicum (basil)
Helichrysum angustifolium (everlasting)

Note: This is not a complete list of conditions or essential oils used in clinical aromatherapy.

1. Brechtl JR, Murshed S, Homel P, Bookbinder M. Monitoring symptoms in patients with advanced illness in long-term care: a pilot study. J Pain Symptom Manage. 2006;32(2):168-174.

2. Khachiyants N, Trinkle D, Son SJ, Kim KY. Sundown syndrome in persons with dementia: an update. Psychiatry Investig. 2011;8(4):275-287.

3. Buckle J. Clinical Aromatherapy in Nursing. San Diego, CA: Singular Publishing Group; 1997.

4. Battaglia S. The Complete Guide to Aromatherapy. Brisbane, Australia: Watson Ferguson and Co; 2005.

5. Buckle J. Literature review: should nursing take aromatherapy more seriously? Br J Nurs. 2007;16(2):116-120.

6. Price S, Price L. Aromatherapy for Health Professionals. 4th ed. New York, NY: Elsevier Churchill Livingstone; 2012.

7. Varney, E, Buckle J. Effect of inhaled essential oils on mental exhaustion and moderate burnout: a small pilot study. J Altern Complement Med. 2013;19(1):69-71.