14 Care of the elderly
Massage and essential oils
In 1988 Helen Passant introduced massage to what was then called the ‘geriatric ward’ at Churchill Hospital, Oxford. She discovered that not only did patients’ skin texture improve, becoming stronger and more resistant to bruising and tissue damage, but they became more alert (and calmer when anxious or noisy). Essential oils were later introduced to the treatment, enabling conventional sedative medicines to be reduced (Passant 1990).
The cost of dementia
The cost of dementia to the UK is twice that spent on cancer care, yet the amount spent on research into dementia is 12 times lower than that for cancer (www.dementia2010.org).
Dementia and its variations
In 2010 the BBC announced that around 500 people a day develop Alzheimer’s, and a University of Oxford report for an Alzheimer’s research trust suggests that there are now around 820 000 people in the UK with dementia (Ketteringham 2010). This is likely to double over the next 30 years, the numbers affected being far greater when one considers the family members of each sufferer.
Dementia is a decline in memory and thinking, present for 6 months or more, which is of a degree sufficient to impair functioning in daily living. Although attention is usually focused on cognitive deficits, more than 50% of people with dementia experience a decline in emotional control, with behavioural and psychological symptoms (BPSD) which are distressing to both the patient (Gilley et al. 1991) and their carers (Rabins et al. 1982). People with dementia may develop mood disorders such as anxiety, depression, aggression and restlessness. These changes can be confusing, irritating or difficult for family members and carers to deal with, leaving them feeling resentful, stressed and helpless. Consequently, treatment of not only the client but all his/her family should be considered.
Dementia can happen to anybody, but is more common after the age of 65 years, with 1 in 14 over the age of 65 being affected. However, people in their 40s and 50s (approximately 16 000) are now being diagnosed with early-stage dementia (www.alzheimers.org.uk). Another factor that may contribute to an increase in dementia in the near future is the increase in alcohol consumption, which can lead to alcohol-related dementia.
The most common cause of dementia is Alzheimer’s disease, although there are many categories:
• Alzheimer’s disease – accounts for between 50% and 70% of all cases – it is a progressive, degenerative illness that attacks the brain.
• Dementia with Lewy bodies – a form of dementia with similar characteristics to Alzheimer’s and Parkinson’s diseases. Professor Ian McKeith (2010) of Newcastle University tells us that it accounts for about 4% of all cases of dementia in older people and is more prevalent in the over-65s. Lewy bodies are tiny spherical protein deposits found inside nerve cells, disrupting the brain’s normal functioning (Mental Health Foundation 1999) and are found in approximately a quarter of people with Alzheimer’s disease when examined after death. Researchers have yet to understand fully why Lewy bodies occur in the brain and how they cause damage
• Vascular dementia – the broad term for dementia associated with problems of circulation to the brain.
• Huntington’s disease – an inherited, degenerative brain disease that affects the mind and body – dementia occurs in the majority of cases.
• Frontotemporal lobe degeneration (FTLD) – a group of dementias involving degeneration in one or both of the frontal or temporal lobes of the brain. This is often associated with motor neuron disease and is slightly more common in men.
• Alcohol-related dementia – caused by excess consumption of alcohol, especially with a diet low in vitamin B1 (thiamine).
• Parkinson’s disease – a progressive disorder of the central nervous system; some people with Parkinson’s disease may develop dementia in the late stages (see text on Parkinson’s disease.)
The value of touch with essential oils
Common symptoms of dementia include:
Behavioural symptoms in people with dementia (Alzheimer’s Society)
• Aggression (verbal or physical)
• Delusions (being disturbed by thoughts, and believing things that are not true)
• Hallucinations (seeing or hearing things that are not there)
• Irritability, anxiety or suspicion
• Loss of normal inhibitions – for example, touching their private parts.
• Restlessness or over-activity
• Tendency to shout repeatedly or become noisy.
Box 14.1
Aromatherapy and Dementia Study
Int J Nurs Pract 1998 Jun; 4(2): 70–83 Kilstoff K, Chenoweth L Faculty of Nursing, University of Technology, Sydney, Australia. For more information: kathy.kilstoff@uts.edu.au
Some successful studies and clinical trials
Controlled clinical trials of aromatherapy in dementia were initiated after promising results were obtained from open trials of historical medical remedies – in folklore, linen bags were filled with lavender flowers and placed under pillows in order to facilitate sleep – one showed that the use of lavender increased sleep patterns in dementia patients who were in residential care (Henry et al. 1994).
Other studies showing that aromatherapy works when used to treat agitated people with dementia:
• Geranium, lavender and mandarin essential oils in an almond oil base applied to the skin of 39 patients over an unspecified period resulted in increased alertness, contentment and sleeping at night – with reduced levels of agitation, withdrawal and wandering (Kilstoff & Chenoweth 1998).
• Essential oils including ylang ylang, patchouli, rosemary and peppermint and others produced a marked decrease in disturbed behaviour in most participants. This led to a reduction in prescribed conventional medicines (Beshara & Giddings 2003).
• Researchers at Oldham Cottage Hospital investigated the potential of essential oil of lavender to aid rest and relaxation, thereby encouraging the healing process. Patients were monitored for 7 days, during which time their sleep patterns, dozing and alertness during the day were recorded. For the following 7 days one drop of Lavender angustifolia was put on each patient’s pillow at night. No other changes were made to the patients’ daily routine or medications that they were receiving. At the end of the 7 days, patients’ records were collated and analysed. Interestingly, all patients reacted favourably to the treatment, with increased daytime alertness and improved sleep patterns, and those who had previously experienced confusion were observed to display as much as a 50% reduction in their symptoms (Hudson 1996).
• Lemon balm and lavender aroma were introduced to six patients and compared to a control
Box 14.2 Melisssa officinalis and agitation in dementia
Ballard et al. (2002) carried out a double-blind placebo-controlled trial to establish whether Melissa officinalis would have a positive effect on agitation in people with severe dementia. Seventy-two people with clinically significant agitation were randomly assigned either to an aromatherapy group, receiving massage on their hands and arms twice a day with a base lotion containing melissa essential oil, or a placebo group, receiving the same massage with a base lotion containing sunflower oil.
Results
The improvements were clear in the first week and continued so for a full 3 weeks.
Sixty per cent (21 out of 35) of the melissa group experienced a significant improvement in their agitation scores following treatment, compared to 14% (5 out of 36) of the placebo group. The authors concluded that aromatherapy with the essential oil of Melissa officinalis is safe and effective for clinically significant agitation in people with severe dementia, and that there is a need for further controlled trials (Ballard et al. 2002).
group using sunflower oil for 1 week. The treatment increased functional abilities and communication, and reduced difficult behaviour (Mitchell 1993).
• Lavender aroma and massage with 21 patients were compared to aroma or massage alone for 1 week. Aromatherapy with massage significantly reduced the frequency of excessive motor behaviour (Smallwood et al. 2001).
• Lavender oil was given to 15 patients via AromaStream and placebo (water) on alternate days for 10 days. Inhalation of the lavender significantly reduced agitated behaviour (as assessed using the Pittsburgh Agitation Scale) versus placebo (Holmes et al. 2002).
• Lemon balm (melissa) lotion was applied to the face and arms of 36 patients, and another 36 had sunflower oil applied. Melissa was associated with highly significant reductions measured on the Cohen–Mansfield Agitation Inventory (CMAI) and social withdrawal, together with an increase in constructive activities (dementia care mapping) (Ballard et al. 2002).
• Lavender, marjoram, patchouli and vetiver were applied as a cream to the body and limbs of 36 patients and compared with inert oil. The essential oil combination significantly increased the Mini Mental State Examination (MMSE) but also increased resistance to care (considered to be due to increase in alertness), compared to inert oil (Bowles-Dilys 2002).
What is remarkable is that all treatments resulted in significant benefit, including (in most instances) reductions in agitation, sleeplessness, wandering and unsociable behaviour (Snow et al. 2004) www.alzheimers.org.uk 2007.
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