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Efficacy of Aromatherapy (LavandulaAngustifolia) as an Intervention for Managing Agitated Behavior towards People with Dementia
By
Pamela W.K. Lin1, W. C. Chan2 , Bacon F.L. Ng 3, Linda C.W. Lam4
1,3Department of Occupational Therapy, Castle Peak Hospital, Hong Kong2Psychogeriatric Department, Castle Peak Hospital, Hong Kong4Department of Psychiatry, Chinese University of Hong Kong
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Dementia is a global health care issue
Prevalence in HK = 6.1% in elderly of aged > 70 (Chiu et al., 1998)
7.5% of total population is aged > 70 (HK Census & Statistics Dept., 2002)
Background (1) Background (1) -- DementiaDementia in Hong Kongin Hong Kong
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Background (2) Background (2) -- Clinical Picture of DementiaClinical Picture of Dementia
CognitiveFunction
Functional Aspect
Social Aspect
Psychological Aspect
BPSD
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Non-pharmacological intervention
Light Therapy (Burns et al., 2002)
Music Therapy (Gerdner 2000)
Aromatherapy (Holmes et al., 2002; Ballard et al., 2002; Smallwood et al.,2001; Gray S. 2002. )
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Application of Aromatherapy in Dementia
Reduce disturbing behavior
Promote sleep
Stimulate motivational behavior
(Holmes et al., 2002; Ballard et al., 2002; Smallwood et al., 2001; Gray S. 2002. )
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Objective of the Study
To investigate the effectiveness of Lavandula Angustifolia in treating the agitated behavior of demented people
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Sampling
Purposive sampling was adopted
Inclusive CriteriaSubjects with DSM- IV diagnosis of dementia Consent from the participants or their legal guardianClinically agitated
No exclusive criteriaConcurrent medication was allowed without restriction, but any changes in psychotropic prescription over the course of treatment period would be monitored.
Methods - SamplingMethods - Sampling
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Period 13 Weeks
2 Weeks
Period 2 3 Weeks
Group 1 Treatment A Treatment B
Wash out Period
Group 2 Treatment B Treatment A
* Cross-over randomized trial
Treatment A : Active Treatment (Lavandula angustifolia)Treatment B : Placebo (Sunflower)
Methods - Research DesignMethods - Research Design
wk0 wk 3 wk 5 wk8
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Chinese Cohen-Mansfield Agitation Inventory (CCMAI) (Choy, et al., 2001)
Chinese Neuropsychiatric Inventory (CNPI) (Leung, et al.,2001)
Methods - Efficacy AssessmentMethods - Efficacy Assessment
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70 people with dementias were recruitedParticipants were randomly assigned to Treatment Group 1 (n=35) and Treatment Group 2 (n=35)
Results - Demographic Characteristics of Participants
Characteristics All Subjects(n=70)
Treatment Group 1
(n=35)
Treatment Group 2
(n=35)
Comparison
SexWomenMen
41 (58.6%)29 (41.4%)
21 (60%)14 (40%)
20(57.1%)15 (42.9%)
Pearson Chi-Square=0.59df=1, p=0.81
AgeMeanSD
78.294.06
78.203.79
78.374.37
F= 0.52, df=68, p=0.47
Types of DementiaADVDMixed*
44 (62.9%)21 (30%)5 (7.1%)
20 (57.1%)13 (37.1%)2 (5.7%)
24(68.6%)8 (22.9%)3 (8.6%)
Pearson Chi-Square =1.58, df=1,
p=0.22
CMMSE ScoreMeanSD
7.883.36
8.282.87
7.973.23
F= 2.68, df=68, p=0.11
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Treatment Effectiveness of the Lavandula Angustifolia
* Statistical Analyses for Treatment A
Treatment A Level of significance
Before Treatment
CNPI Score(n=70)
After Treatment
24.68(SD=10.54)
17.77(SD=7.52)
t= 14.59, df=69, p< 0.0005, two tailed
Before Treatment
CCMAI Score
(n=70)After Treatment
63.17(SD=17.81)
58.77(SD=16.74))
t= 10.79, df=69, p< 0.0005, two tailed
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Statistical Analyses for Treatment B (Placebo)
Treatment B Level of significance
Before TreatmentCNPI Score(n=70)
After Treatment
24.33(SD=10.08)
24.41(SD=10.24
t= 1.18, df=69, p= 0.24, two tailed*
Before TreatmentCCMAI Score(n=70)
After Treatment
63.94 (SD=17.67)
63.90(SD=17.73)
t= 0.65, df=69, p=0.52, two tailed*
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Period Effect
Sequence 1Treatment Group 1
Sequence 2Treatment Group 2
Period 1 A1 B2
Period 2 B1 A2
Period Effect = (A1+B2) vs (B1+A2)
• No significant difference between two periods in CNPI score(t=0.16, df=34, p=0.87) and in CMAI (t=0.19, df=34, p=0.24)
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Sequential effect
Sequence 1Treatment Group 1
Sequence 2Treatment Group 2
Period 1 A1 B2
Period 2 B1 A2
Sequence Effect = (A1+B1) vs (B2+A2)
• No significant difference between two periods in CNPI score (t=0.83, df=34, p=0.41) and in CMAI (t=1.430, df=34, p=0.16).
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Treatment Effects Upon Different Categories in CCMAI
Category Level of significance
1) Physically Aggressive Behavior t= 3.32, df=69, p= 0.001
2) Physically Non-aggressive Behavior t= 3.59, df=69, p=0.001
3) Verbally Aggressive Behavior t= 5.43, df=69, p= 0.0005
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Treatment Effect Upon Different Items in CNPI
Item Level of significance
3) Agitation/ Aggression t = 6, df=69, p=0.0005
4) Dysphoria t = 2.77, df=69, p=0.03
9) Irritability t =5.19, df=69, p=0.0005
10) Aberrant motor behavior t =2.6, df=69, p=0.011
11) Sleep t =6.16, df=69, p=0.0005
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• No significant differences in the response to the treatment A (Lavender Angustifolia) in the CNPI score (p=0.28), and CCMAI (p=0.55)
Treatment Effects in Different Gender
Treatment Effects among Different Dementia Subtypes• No significant difference found among dementia subtypes in CNPI(p=0.49, one-way ANOVA) and CCMAI (p=0.11, one-way ANOVA)
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DISCUSSION (1)
Aromatherapy with lavandula angustifolia was well tolerated and resulted in a significant improvement in agitation of dementias.
‘Agitated/ Aggressive behaviour’, ‘irritability’ and ‘night-time behaviour’ were the domains with the greatest improvement as reflected from CNPI.
As illustrated by our findings, no significant period effect and sequential effect was identified.
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DISCUSSION (2)
Nighttime intervention
Difficult to supervise participants in a specific room for an hour at daytime.
Ease potential variable in affecting the standard concentration of essential oils, such as room size and ventilation system among different homes.
Moreover, the potential sedative effects of lavender oil could be enhanced if applications were done at night time.
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Limitations
Small sample size by purposive sampling
not all sub-types of dementia were recruited
Bias of staff
Aromatherapy was used as an adjunct to existing pharmacological and nonpharmacological interventions.
People with severe dementia had a varying degree of anosmia (Holmes et al., 2002).
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Suggestions for Further Study
Standardized the sample group to their diagnosis of dementia.
Larger sample size and a double-blind randomized control trial
Further studies should also be conducted on other essential oils
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Conclusion
Lavender is effective as an adjunct therapy in alleviating agitated behaviors in Chinese patients with dementia.
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ACKNOWLEDGEMENTS
Participated CA Homes Professor Linda LamDr WC ChanMs Amy ChanMr Bacon NgMs Carine ChanMs Cecilia Fan
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THANKS