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?
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
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 (www.alliance-aromatherapists.org) and the National Association for Holistic Aromatherapy (www.naha.org) 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.
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
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.
Table 1: Plants Yielding Essential Oils4
Table 2: Essential Oils for Common Problems in Elder Care5-7
Note: This is not a complete list of conditions or essential oils used in clinical aromatherapy.
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.