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

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

Background (2) Background (2) -- Clinical Picture of DementiaClinical Picture of Dementia

CognitiveFunction

Functional Aspect

Social Aspect

Psychological Aspect

BPSD

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. )

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. )

Objective of the Study

To investigate the effectiveness of Lavandula Angustifolia in treating the agitated behavior of demented people

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

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

Chinese Cohen-Mansfield Agitation Inventory (CCMAI) (Choy, et al., 2001)

Chinese Neuropsychiatric Inventory (CNPI) (Leung, et al.,2001)

Methods - Efficacy AssessmentMethods - Efficacy Assessment

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

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

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*

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)

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).

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

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

• 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)

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.

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.

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).

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

Conclusion

Lavender is effective as an adjunct therapy in alleviating agitated behaviors in Chinese patients with dementia.

ACKNOWLEDGEMENTS

Participated CA Homes Professor Linda LamDr WC ChanMs Amy ChanMr Bacon NgMs Carine ChanMs Cecilia Fan

THANKS