The growing use of essential oils in helping the elderly, especially those suffering from mental health problems, dementia, learning difficulties and other serious health conditions

Natural Touch has been supplying essential oils to therapists working in the NHS, social services and other clinical establishments for some time. Those therapists are practising ‘clinical aromatherapy’ defined as ‘using plant essential oils for their therapeutic effects on the body, mind and spirit.’

Because of the increased practice of clinical aromatherapy in recent years we at Natural Touch Aromatherapy have taken it upon ourselves to do some research to highlight some of the places and individuals involved in carrying out clinical aromatherapy, especially with elderly patients and clients. Many of the therapists are nurses who have given time to gain an aromatherapy qualification, others therapists brought in by the various hospitals on a part time basis where budget allows.

We talked to a number of therapists and asked why there was such an increase in clinical aromatherapy as a complementary practice. Was it because of cost savings over conventional drugs, in areas such as patients getting better sleep at night? Was it something new to try in the absence of success elsewhere? The resounding answer was real patient benefit, an improved quality of life, and the more success was proven the more hospital managements were encouraging its use, and finding budgets to provide the choice.

The elderly suffer from a whole variety of conditions, some of them listed above in the title. Each condition has its own characteristics but many of them overlap. Whether it be frustration, stress, bad behaviour (which can include shouting, screaming, aggression), grief, stiffness, pain, depression, lack of self esteem, breakdown of relationship with carer etc it appears there are therapists out there having success in alleviating the problems with essential oils, and giving real patient benefits.

Aromatherapy treatment for Dementia

There are a number of examples of research into the use of essential oils in such situations, and as this increases aromatherapy will continue to gain scientific credentials whilst maintaining its creative and holistic approach. One such study, by Joy Bowles, of The Aromatherapy Research Group, tested for the effects of essential oils on the resistance to nursing care procedures and other Dementia related behaviours in a residential care home.

Dementia is defined as the loss of cognitive or intellectual function. It may be caused by a number of disease such as Alzheimer’s, Huntington’s, Creutzfeldt-Jakob’s, Parkinson’s and multi-infarct or vascular disease in the brain.

Over 50 patients, aged 70 – 92 participated. During the research there were periods with no massage activity, periods of massage with no essential oils and periods with essential oil massage. Participants were split into different groups, each receiving varying activity at any one time.

The study used a blend of lavender, sweet marjoram, patchouli and vetiver intended to instil calm and encourage positive attitudes. This was mixed with an aqueous cream and gently applied via simple hand massage and later back, shoulder and arms. Normally the aromatherapy care plan at the centre would require an individually prescribed blend. However, to reduce variables the same blend was used for all patients. Each was tested for allergies first by putting a small amount on to the forearm and waiting 8 hours for any reaction. There were no adverse reactions.

The massages took place after the morning shower, during routine toileting and care rounds each day, and finally when putting the patient to bed. Each treatment consisted of no more than 5 minutes of light effleurage strokes using approx 5ml (one pump) of the cream. Each patient had their own individually labelled 250ml pump bottle at the start of each stage of the trial.

The behaviour monitored consisted of aggressive behaviour (swearing, intentional hitting, grabbing things, pushing, throwing things, biting, scratching) and excessive noisiness ( screaming, shouting ). The severity of this was agreed on by the nursing staff and graded using a recognised scale, and each piece of behaviour noted and graded on the patients chart. Staff were rotated so that any variance in subjectivity would be spread and not compromise the overall result.

Results overall showed that there was a significant decrease in average frequency and severity of dementia related behaviour. Even the simple hand massage used at the day centre showed an increased cheerfulness and alertness in patients. The carers also reported an improved relationship with the dementia sufferer and an increased ability to cope.

Mental Health

Another area where aromatherapy has made great strides is in the mental health and learning disabilities departments of Scottish Borders NHS Trust where physiotherapist and Aromatherapist, Jan Beattie, (together with Vivien Little and Shona Wilson, mental health nurse / aromatherapist) has achieved significant results. Six years previously the Trust banned the use of essential oils as its use was unregulated and considered unsafe. That situation turned around under Jan’s guidance to the extent that their aromatherapy programme is now fully integrated into its mental health services and was recognised with an award from The Prince’s Integrated Health Foundation.

Jan claimed that when she arrived there was tremendous enthusiasm for the use of oils but staff had received little or no training. Too much oil was being used in the bath making it too slippery or running the risk of skin irritation. New guidelines were drawn up for the safe use of essential oils and all staff interested in the rehabilitation and acute units were involved. They capitalised on the interest and enthusiasm to introduce safety, and now, once a patient has been assessed they can have aromatherapy treatments at anytime, 24 hours a day. The activity is audited every 3 months.

Trials are taking place in Borders too. One involved the use of lavender as a night time medication rather than using conventional drugs. Over a 6 month period they were able to reduce the amount of medication by 65%. Not only was that a huge saving in cost but the patients using lavender woke refreshed the next day with none of the lingering drowsiness associated with normal night time medication.

The treatments can vary but the team here is a mixture of mental health, physiotherapy and aromatherapy specialists and the combinations work well together. The nursing staff are only qualified to do hand and foot massage. Back massage would be done by the physiotherapist. Foot spas and room sprays are also popular.

Jan has a number of ideas that she has found useful. When someone in one of the elderly units is dying, for example, it can be very stressful for the visiting relatives. It is very difficult, they cannot communicate and feel a bit useless and helpless and just don’t know what to do. If someone is on morphine the smell is not particularly nice and the patient may also have difficulty breathing. The aromatherapists mixed a blend that helps relaxation and breathing and they have shown the relatives how to do simple hand massage. It is not known how much benefit it is to the dying patient but the relatives have found it helpful and comforting.

Another example that Jan recalls is a gentleman with dementia who could be very aggressive. The only way the medical staff have found to help him during these moods is to give him a high dose of sedative medication. This gives him a problem in walking so, someone has to sit with him. It takes up a lot of nursing time and it is also not good for his family to see him like this. So now what is done, when they realise he is getting a bit anxious, is to give him a massage with a relaxing blend and after a 10 minute nap he is fine. It has been good for the nursing staff too as they realise sedating patients isn’t always the best option.

Jan has her views on control and safety. There is two tier training plan for staff. Qualified nursing staff are trained to do assessments, look for allergies, do a tick sheet and make recommendations for a prescription for a blend. That will be signed off by an aromatherapist. A typical blend may be 30ml grapeseed, two drops of lavender, 4 of orange, I of chamomile. After the first treatment nursing assistants can normally apply the oils provided they have training in hand and foot massage.

All orders for essential oils go via the pharmacy. The pharmacists are also very interested and look for the chemical constituents of the oils. They were able to spot that normal night time medications contain similar chemical constituents as lavender essential oil.

Next I talked with Linda Blackburn who works with both Mental Health and Dementia patients for social services activity centre support groups in Fareham, Hampshire and also at the Uplands Residential Nursing Home for people with long term mental health problems, and The Meadows, for acute mental health problems, both in the same area.

Linda prefers to work with groups and not to get too involved in the medical history but always tries to ensure that medical staff, or activities organiser will highlight things she needs to know. She strongly believes everyone needs to be treated as an individual, as they present themselves on the day, and not a patient with a label. Anyone coming to the sessions has been signed off by a doctor and that process is vetted by the hospital.

The group sessions last up to 2 hours and have an average attendance of eight although there will always be a few people who will drift in and out.

The essential oils and the touch are very important but her belief is that the set up in the activities room, the background music and a warm, welcoming, safe environment are all important to people who generally are feeling very vulnerable.

Depending on where they are in their illness, or perhaps some day patients suffering temporary illness, she will try and get them interested in the oils, talk about the smells, what it makes them feel like; does it uplift or relax them? It is important to try and get the patient to tune into their senses and what makes them feel good. If they feel good she may suggest they use a few drops in a diffuser or in the bath at home. This gives the patients a great sense of responsibility.

The Benefits of Aromatherapy for the Elderly

Linda believes her patients benefit from the camaraderie and energy of the group as well as the oils and massage. In her experience often the men may be dragged along to a session by a wife or female carer and will initially sit aloof, with closed body language. But, in the right group, they will change, and, after a massage, become more comfortable and less threatened. Some participants in the group, with some basic training, will hand massage others and the feeling of trust and the response to that is excellent. Male patients will even massage other males, which is something Linda says she has difficulty getting male students to do.

Linda feels she always gets positive feedback. Anxiety and stress levels fall and her activity sessions are popular and the highlight of some patients week. She says it is particularly pleasing on occasions where hospital patients are asking for relaxation music tapes and a massage rather than choose a sleeping pill.

She recalls, one day, a lady coming into the group sobbing and talking about a weight, a thing in her head. She said I gently massaged her head, using lavender and light upward strokes and got her to imagine, like I was, this thing lifting. We talked and she took long slow breaths and within 10 minutes she was saying its better, its gone and minutes later she was the joker of the group, inspiring others. It is so rewarding when that happens and I have since showed her husband how to repeat this. She is still attending sessions and is a great source of help, trust and inspiration to others.

Vickie Lawday lives and works in West Wales where she specialises in treatments for those with learning and physical difficulties. She treats one gentleman once a month with massage at home. He really enjoys the treatment and values the one to one contact and the chance to talk about his concerns. The patient is epileptic and can become very anxious. The massage calms him down considerably. He gets a lot of tension in his neck and shoulders and Vickie pays particular attention to those areas using cedarwood and lavender which have become very recognisable and enjoyable for him.

Ty Cila is a residential home for physically disabled and Vickie visits every two weeks to give treatments. One of the residents has cerebral palsy and poor muscle control, with stiffness and rigidity in her muscles and some pain and stiffness in the shoulders. Vickie uses a blend of marjoram, for its analgesic, antispasmodic and warming properties; clary sage for its warming and muscle relaxant properties; black pepper because it is warming and stimulating; and lavender for its absolute versatility. After four treatments the shoulder started to slowly improve and after each subsequent treatment relaxation was noticeable.

Another gentleman has multiple sclerosis. He has little mobility and his left arm and shoulder are stiff, rigid and very cold to the touch, with poor circulation indicated by the skin tone and colour. He also had pain and tension on the right side of his neck.

Vickie massaged him using a similar blend with oils having the same properties as in the previous example. It was his first massage and he was amazed at the benefits he felt, saying he hadn’t felt so good in years. His cold, rigid shoulder became warm, flexible and less stiff, with greater movement and the tone and colour of his skin was much improved.
Generally, Vickie believes the main health problems she encounters are poor circulation, swollen legs and ankles, and general aches and pains. Many patients are getting over the loss of loved ones and trying to adjust and come to terms with living in a residential home. Aromatherapy massage and one to one caring and touch seems to help all of these situations.

Susan Mortimer works within social services in North Lincolnshire. She treats people with learning difficulties and also those with serious medical conditions such as epilepsy and stroke.
One example she gave was of a gentleman who had been discharged from hospital after having suffered a stroke. He had been given some physiotherapy sessions and then been told that was all they could do for him. It was obvious he needed some help and could do little on his own to improve his situation.

Susan says she started massaging him with a blend of oils thinking that just keeping his limbs moving would be an achievement. It soon got to the stage where he gave his wheelchair back to the hospital, got a walking stick and weeks later bought a car. He now drives to Susan for treatment. Only recently, at the age of 75 did he give up the car for an electric scooter. Susan recounts him saying “ you have given me back my life”

Janetta Bensouilah, who now works as senior aromatherapist and lecturer at the Raworth Centre in Surrey previously had a practice in the area treating the elderly. Her observations are that the number of elderly people in this country is increasing by about 2.5% per annum. Many can afford aromatherapy treatment but others are not so lucky and depend on limited budgets available through NHS trusts and social services.

She recalls many people who came to her having experienced medical treatments which left them with long term problems. Surgery, drugs, radiotherapy, chemotherapy, are by their very nature intrusive and despite the initial disease being attacked or removed, the patient invariably seems to be left with a profound inbalance in their overall state of health.

When giving aromatherapy treatments Janetta works with low dilutions of 1% – 2% as older skin tends to be thin, dry and very absorptive. It is also prudent to keep dosages low as substances are metabolised more slowly as we age and especially if long term medication is being taken.

Janetta likes to add the silkiness of jojoba to blends, not only for its nourishing effect on the skin but also for its wonderful ability to soothe the pain of arthritis. The deep red intensity of the infused oil of St Johns Wort adds its strong, analgesic action to blends to counter joint stiffness and pain.

Grief is frequently an issue that arises in any close work with the elderly. The emotional damage wrought by loss can remain for years, especially if the natural grieving process is impaired. Frankincense, an oil traditionally used to aid contemplation and prayer, has proved invaluable in helping clients to fully understand and accept the pain of bereavement. It can stir poignant memories and with sensitive guidance can be a powerful support at times of pain and loss. Frankincense has the ability to open the chest and deepen the breathing, those qualities alone making it an ideal essential oil to use with the elderly.

There are many more examples of clinical aromatherapy and of other complementary modalities being integrated with conventional care or where essential oils are currently being researched within the NHS to determine new uses, especially and inevitably involving the elderly.

Oncology and Aromatherapy

Over 70% of cancer centres in the UK offer at least one CT in palliative care for cancer patients and aromatherapy is the most common. The adult leukaemia unit at the Christie Hospital NHS, Manchester is a good example. They have two aromatherapists who offer support to patients, predominantly to improve the quality of life in a highly stressful environment. The unit is also carrying out long term research into essential oils and testing their effectiveness in a number of conditions and hospital situations says senior aromatherapist Jacqui Stringer

Essential Oil use in Hospice Care

There are increasing examples of aromatherapists being employed by a hospice trust. At the Oakhaven hospital in Lymington, Hants, essential oils are used to promote improved quality of life and to provide help with such conditions as nausea, anxiety and depression, stiff and aching joints, as well as pain.

Great care is taken to complement the variety of treatments individuals may be receiving, such as chemotherapy or radiotherapy, says aromatherapist Janina Johns.

Pain Management

There is increasing evidence that aromatherapy may offer a positive contribution as part of an integrated health approach to chronic pain management, one of the biggest challenges facing health care providers. For the past 8 years aromatherapy massage has been one of the main treatment strategies at the Royal Hallamshire hospital in Sheffield, where the treatment concerns the management of chronic pain in sufferers of Multiple Sclerosis.

Thanks for contributions from those mentioned above.

Duncan Bain, Natural Touch Aromatherapy