Lavender and Old Lace

Benjamin Pearce, president of a chain of assisted living homes for people with dementia, puts his hand in a cardboard box, and in a split second has a string of rainbow-colored flowers around his neck. Here he stands in his office on a Monday morning, intense pale blue eyes set in a stern face, now wearing a white dress shirt, a tie — and a lei. “We use this sometimes as a delivery system,” he says, without cracking a smile. In a flash, the Hawaiian garland is back in the box.

The lei is one way Pearce delivers aromatherapy to the elderly residents in his 12 New Jersey facilities. He also instructs his staff to spritz lavender on their pillows and mix six drops with their bathwater. Other natural oils, such as citrus blends and rosemary, are added to humidifiers, massaged into patients’ skin or pumped into the air via diffusers. “I’m the most pragmatic person you’ll ever meet, and I am totally sold on aromatherapy,” Pearce says.

Aromatherapy is becoming an increasingly accepted treatment option for a group that frequently does not get the care it deserves: elderly, institutionalized dementia patients. Zoned out, without any appetite, dementia patients are sometimes agitated, violent, and driven to wander. They are often given sedatives or antipsychotics. But these drugs have serious side effects, including an increased risk that frail patients will fall and severely injure themselves.

Overreliance on sedatives, particularly off-label use of antipsychotics for sedation, is a growing problem in nursing homes nationwide. Last year an investigation reported that 28 percent of Massachusetts nursing home residents were given antipsychotics in 2009. This finding prompted the state to join 11 others in a federal lawsuit accusing Johnson & Johnson of aggressively marketing its antipsychotic Risperdal for use in this vulnerable population.

While antipsychotics are essential for the care of many patients with severe dementia, “drugs should never be used to sedate a patient for the convenience of the caregivers,” says Dr. Clifford Saper, chairman of the neurology department at Harvard Medical School.

Whether aromatherapy is truly an effective alternative treatment for dementia is still an open scientific question. Several studies have found it to be beneficial. But conclusive proof has been elusive, with skeptics noting that some people with Alzheimer’s disease or dementia quickly lose their ability to discern odors. However, other experts think both the advocates and the skeptics may be right: thanks to the unusual physiology of the human brain, aromatherapy may be working even in patients who cannot smell it.

“Odors can do much of their work without us being aware of them,” explains Andreas Keller, a neuroscientist at Rockefeller University who studies the sense of smell.

Other brain researchers are also believers. A May 2009 paper in the journal Nature Reviews Neurology evaluated a series of controlled studies, concluding that while there were methodological problems with most trials to date, aromatherapy “should be seriously considered as an alternative to pharmacological therapy” for dementia, in part because it has no known side effects.

Yet a diminished sense of smell is such a well-established early symptom of dementia and Alzheimer’s that some clinics use a 10-item scratch-and-sniff test to screen for these illnesses. A recent paper published in the journal Brain Research shows drastically decreased activation of Alzheimer’s patients’ brains while sniffing lavender scent, compared to healthy people of the same age. If this is true, then people with this disease could be uniquely insensitive to aromatherapy.

But unlike other sensory systems—vision, hearing, touch—smells are sent straight through to the regions of the brain considered to be responsible for mood and emotion. According to Keller, conscious recognition of smells may not be necessary for aromatherapy to have an effect.

Benjamin Pearce bases his treatments on experience, rather than science.  Five years ago, he was desperate. He had a resident who was violent and agitated, not responding to any of the usual interventions. Cruising the Internet, Pearce happened on an aromatherapeutic oil called “Peace and Calming.” It is a proprietary blend marketed by the company Young Living.  The juxtaposition of odors it contains is strangely jarring—a strong bright citrus mixed with the deep musk of patchouli—and seems to activate conflicting repulsions and attractions, as well as a desire to sniff it again.

Pearce purchased the oil, dabbed some on a handkerchief and put that in the pocket of his troublesome resident. He believes that the man, thanks to his dementia, quickly forgot about the source of the odor. Yet as the strange smell continued to waft up from his own shirt pocket, he seemed suddenly alert and more manageable. Aromatherapy is now a part of daily life for Pearce’s residents, from energizing citrus scents in the morning to calming lavender at night.

“There is some evidence that aromatherapy can reduce agitation in dementia patients, and I would encourage such non-pharmacological approaches,” says Saper, the Harvard neurologist. But he cautions, “Not all patients respond to such measures, and when a patient tries to run away, or to injure other patients or herself, there are only a limited number of choices to keep that patient safe.”

Benjamin Pearce says he will continue to advise his staff to reach for the lavender first, before resorting to the prescription bottle for his frail residents. “If it keeps them from falling, I win, and they win,” he says.