Lavender and Old Lace

To calm agitated dementia patients some caregivers are turning away from sedatives and toward aromatherapy

March 1, 2011

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.


About the Author

Madeleine Johnson

Madeleine Johnson received her B.A. in biology from the University of Pennsylvania and her Ph.D. in neurobiology from Columbia. She was most recently a postdoctoral fellow at the University of Texas Southwestern Medical Center. Her research has focused on the cellular basis of schizophrenia and drug addiction. When not using her brain to think about the brain, Madeleine can be found asking big questions and cobbling together grand scientific theories.



Lane Simonian says:

Peroxynitrite is a toxin which is responsible for much of the damage in Alzheimer’s disease. Peroxynitrites oxidize (take hydrogen away) from a variety of g protein-coupled receptors, including muscarinic, olfactory, serotonin, dopamine, and adrenergic receptors. As a result of this damage, Alzheimer’s patients suffer from impaired short-term memory, lack of smell, disturbed sleep and depression, decreased alertness and awareness, and sometimes aggression. The phenolic compounds in certain essential oils (clove, cinnamon leaf, oregano,thyme, rosemary, and sage, for instance) donate hydrogen back to these receptors and in doing so lead to improvements in short-term memory, smell, sleep, mood, alerteness, and awareness. The phenolic compounds also scavenge peroxynitrites converting them into water and a nitrogen dioxide anion. Aromatherapy is likely an effective treatment for Alzheimer’s disease (as has been shown by a few small-scale clinical trials and case studies) not only for the reasons listed above, but also because it helps to restore a sense of smell and because the chemicals in the essential oils can be directly inhaled into the part of the brain (the hippocampus) most directly affected by Alzheimer’s disease. This treatment requires more study, but holds great promise for people with the disease and for their loved ones.

Malaikat says:

I love that these folks are trying aromatherapy as an alternative to medication for the elderly! There are so many possibilities that can happen when using pure or blended essential oils as cited in this article. It seems that a real study can be conducted on the utility of EO’s and the elderly, particularly if it can mean the use of fewer pharmaceuticals and happier people in their golden years!

Bravo Benjamin Pearce!

Another point (I hit submit a moment too early!), I would love to see this great work expanded beyond Alzheimers and Dementia. Essential Oils and Aromatherapy have long been documented to have therapeutics value for things like burns, anxiety, headaches, acne and others…. In any case, it is good to see aromatherapy entering the main stream of society more and more.


Julie Diehl says:

I have been using essential oils on my husband who has moderate vascular dementia in conjuction with low photon light therapy. The oils help to calm him during periods of agitation and nervousness and sedate him at night. Other residents in the facility where he is are lethargic all day and sleep until dementia drugs and anti-anxiety meds start to wear off at night and then become confused and agitated, while my husband is alert and walking the halls looking for something to do. I know the oils can’t change the course of the disease, but it is a better alternative than chemical restraints and antipsychotic drugs. Essential oils are healing whether inhaled or topical and I am glad to see that they are getting acknowledged for use with dementia.

My friend of many years who is now in a nursing home with late stage Alzheimer’s has pretty much shut down, and except for a few semi-lucid moments, the best they can do, the nurses at the home say, is make her comfortable and keep her clean and safe. They are very attentive, I should add. Last week, I was visiting my friend, and when I leaned forward, she responded to the intense color of my shirt. She said in a whisper, “Jacket..jacket..” And I take that as a real win – a special moment. So, tomorrow when I stop by to see her, I will bring a bunch of dried lavender leaves, wrapped in a hanky, and put them where she can smell them. If there is any residue of her sense of smell left, she may very well respond. This was a lady who loved to cook, to enjoy the crisp autumn air, the odor of burning logs, baking apple pie –in short, her nose was very important. And I will try this. I think comfort, especially at this late stage of her illness, is critical, and may indeed soothe and bring her some peace and a calmer demeanor. Lavender was always a favorite scent of hers, too!

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