Care of the elderly

14 Care of the elderly

Dementia and its variations

Dementia and related illnesses are a financial strain on the health service and healthcare resources. The Alzheimer’s Society states that: ‘a quarter of all hospital beds are used by people with dementia but many are not getting the quality of care they deserve’. A British Medical Journal editorial of December 2002 states: ‘People with dementia are among the most vulnerable in our society. Symptoms often need to be treated and drugs, although moderately effective, can be hazardous. Aromatherapy and bright light treatment seem to be safe and effective and may have an important role in managing behavioural problems in people with dementia.’

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 ( 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

The sense of smell of people with ‘Lewy bodies’ is inferior to that of those without them (Alzheimer’s Society newsletter 2004). This work involved a detailed series of experiments where the ability to detect the scent of lavender was correlated with changes found in the brain post mortem; in time, it was hoped that by inhalation, a simple patient-friendly’ smell test (using lavender) could hopefully make diagnosis of dementia with LBD more accurate (Petit-Zeman (2004).

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:

It is essential to discriminate between symptoms of dementia and those of a different treatable condition, such as vitamin deficiency, depression, infection, a medication problem or a brain tumour.

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.

Tendency to wander.

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:

Results of placebo-controlled clinical trials using essential oils for the treatment of residential care residents with advanced dementia:

Lemon balm and lavender aroma were introduced to six patients and compared to a control

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) 2007.

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Dec 12, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Care of the elderly

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