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Effects of Aromatherapy on Agitation in Patients with Dementia: A Systematic Literature Review and Meta-analysis

Article information

Res Community Public Health Nurs. 2019;30(2):183-194
Publication date (electronic) : 2019 June 28
doi : https://doi.org/10.12799/jkachn.2019.30.2.183
Eun Kyung Kim1orcid_icon, Heeok Park2orcid_icon, Chun Hee Lee3orcid_icon, Eunsil Park4orcid_icon
1Researcher Assistant, College of Nursing, Research Institute of Nursing Science, Keimyung University, Daegu, Korea.
2Associate Professor, College of Nursing, Research Institute of Nursing Science, Keimyung University, Daegu, Korea.
3Assistant Professor, Department of Nursing, Sunlin University, Pohang, Korea.
4Assistant Professor, Department of Nursing, Yeungjin University, Daegu, Korea.
Corresponding author: Park, Heeok. College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3924, Fax: +82-53-580-3916, hopark@kmu.ac.kr
Received 2018 December 14; Revised 2019 May 01; Accepted 2019 May 01.

Abstract

Purpose

The purpose of this study is to identify the effects of aromatherapy on agitation in patients with dementia using a meta-analysis and systemic literature review.

Methods

The EMBASE, CINAHL, MEDLINE, and other databases were searched up to November 2017.

Results

Of 419 publications identified, 12 met inclusion criteria, and 9 studies were used to estimate the effect size of aromatherapy. A total of 837 participants across all studies were included. The commonly applied methods were massage (50%), type of oil lavender (75%), and instrument Cohen-Mansfield Agitation Inventory (75%). A medium effect size of aromatherapy on agitation was identified (d=−0.56, I2=65.0%, p=.001). The massage group has lower effect size than the other group (d=−0.98, I2=0.0%, p=.001).

Conclusion

Aromatherapy appears to be effective in improving agitation in patients with dementia. However, further studies for home-dwelling patients with dementia and with different types of aroma oil should be conducted in the future. In addition, research with well-designed are needed to assess the effects or aromatherapy on agitation.

Keywords: Aromatherapy; Psychomotor agitation; Dementia; Review; Meta-analysis

Notes

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by Ministry of Education (No. 2017R1D1A3B03032896).

Appendices

Appendix 1

List of Studies Included in a Systemic Review

1. Akhondzadeh S, Noroozian M, Mohammadi M, Ohadinia S, Jamshidi AH, Khani M. Melissa officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: A double blind, randomised, placebo controlled trial. Journal of Neurology, Neurosurgery, and Psychiatry. 2003;74(7):863–866. https://doi.org/10.1136/jnnp.74.7.863

2. Ballard CG, O'Brien JT, Reichelt K, Perry EK. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: The results of a double-blind, placebo-controlled trial with Melissa. The Journal of Clinical Psychiatry. 2002;63(7):553–558. https://doi.org/10.4088/JCP.v63n0703

3. Burns A, Perry E, Holmes C, Francis P, Morris J, Howes MJ, et al. A double-blind placebo-controlled randomized trial of Melissa officinalis oil and donepezil for the treatment of agitation in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders. 2011;31(2):158–164. https://doi.org/10.1159/000324438

4. Fu CY, Moyle W, Cooke M. A randomised controlled trial of the use of aromatherapy and hand massage to reduce disruptive behaviour in people with dementia. BioMed Central Complementary & Alternative Medicine. 2013;13(1):165–173. https://doi.org/10.1186/1472-6882-13-165

5. Holmes C, Hopkins V, Hensford C, MacLaughlin V, Wilkinson D, Rosenvinge H. Lavender oil as a treatment for agitated behaviour in severe dementia: A placebo controlled study. International Journal of Geriatric Psychiatry. 2002;17(4):305–308. https://doi.org/10.1002/gps.593

6. Lin PW, Chan W, Ng BF, Lam LC. Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: A crossover randomized trial. International Journal of Geriatric Psychiatry. 2007;22(5):405–410. https://doi.org/10.1002/gps.1688

7. O'Connor DW, Eppingstall B, Taffe J, Van Der Ploeg ES. A randomized, controlled cross-over trial of dermally-applied lavender (Lavandula angustifolia) oil as a treatment of agitated behaviour in dementia. BioMed Central Complementary & Alternative Medicine. 2013;13(1):315. https://doi.org/10.1186/1472-6882-13-315

8. Snow LA, Hovanec L, Brandt J. A controlled trial of aromatherapy for agitation in nursing home patients with dementia. Journal of Alternative & Complementary Medicine (New York, NY). 2004;10(3):431–437. https://doi.org/10.1089/1075553041323696

9. Yang MH, Lin LC, Wu SC, Chiu JH, Wang PN, Lin JG. Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation. BioMed Central Complementary & Alternative Medicine. 2015;15(1):93. https://doi.org/10.1186/s12906-015-0612-9

10. Yang YP, Lee FP, Chao HC, Hsu FY, Wang JJ. Comparing the effects of cognitive simulation, reminiscence, and aroma-massage on agitation and depressive mood in people with dementia. Journal of the American Medical Directors Association. 2016;17 (8):719–724. https://doi.org/10.1016/j.jamda.2016.03.021

11. Yang YP, Wang CJ, Wang JJ. Effect of aromatherapy massage on agitation and depressive mood in individuals with dementia. Journal of Gerontological Nursing. 2016;42(9):38–46. https://doi.org/10.3928/00989134-20160615-03

12. Yoshiyama K, Arita H, Suzuki J. The effect of aroma hand massage therapy for people with dementia. Journal of Alternative & Complementary Medicine (New York, NY). 2015;21(12):759–765. https://doi.org/10.1089/acm.2015.0158

References

1. Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, et al. Non-pharmacological interventions for agitation in dementia: Systematic review of randomized controlled trials. The British Journal of Psychiatry 2014;205(6):436–442. 10.1192/bjp.bp.113.141119.
2. Kong EH, Evans LK, Guevara JP. Non-pharmacological intervention for agitation in dementia: A systematic review and meta-analysis. Aging & Mental Health 2009;13(4):512–520. 10.1080/13607860902774394.
3. Yang MH, Lin LC, Wu SC, Chiu JH, Wang PN, Lin JG. Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation. BioMed Central Complementary and Alternative Medicine 2015;15:93. 10.1186/s12906-015-0612-9.
4. Cohen-Mansfield J, Billig N. Agitated behaviors in the elderly: I. conceptual review. Journal of the American Geriatrics Society. 1986;34(10):711–721.
5. Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioral and psychological symptoms of dementia. Frontiers in Neurology 2012;373. 10.3389/fneur.2012.00073.
6. Suh GH. Agitated behaviours among the institutionalized elderly with dementia: Validation of the Korean version of the Cohen-Mansfield Agitation Inventory. International Journal of Geriatric Psychiatry 2004;19(4):378–385. 10.1002/gps.1097.
7. Shin Y, Chung S. Anxiety and agitation in BPSD. Journal of Korean Geriatric Psychiatry 2000;4(1):24–33.
8. Lee SB, Kim KW. Nonpharmacological interventions for Alzheimer's disease. Journal of the Korean Medical Association 2009;52(11):1069–1076. 10.5124/jkma.2009.52.11.1069.
9. Kim CM, Park MS, Kim SH. Analysis of trends in non-pharmacological studies for elders with dementia in Korea. Journal of Korean Gerontological Nursing 2012;14(2):129–141.
10. Holmes C, Ballard C. Aromatherapy in dementia. Advanced in Psychiatric Treatment 2004;10(4):296–300.
11. Ballard CG, O'Brien JT, Reichelt K, Perry EK. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: The results of a double-blind, placebo-controlled trial with Melissa. The Journal of Clinical Psychiatry 2002;63(7):553–558.
12. Yoshiyama K, Arita H, Suzuki J. The effect of aroma hand massage therapy for people with dementia. Journal of Alternative and Complementary Medicine (New York, N.Y.) 2015;21(12):759–765. 10.1089/acm.2015.0158.
13. Burns A, Perry E, Holmes C, Francis P, Morris J, Howes MJ, et al. A double-blind placebo-controlled randomized trial of Melissa officinalis oil and donepezil for the treatment of agitation in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders 2011;31(2):158–164. 10.1159/000324438.
14. Forrester LT, Maayan N, Orrell M, Spector AE, Buchan LD, Soares Weiser K. Aromatherapy for dementia (Review). Cochrane Database of Systematic Reviews 2014;2:1–60.
15. Pedersen SKA, Andersen PN, Lugo RG, Andreassen M, Sütterlin S. Effects of music on agitation in dementia: A metaanalysis. Frontiers in psychology 2017;8:742. 10.3389/fpsyg.2017.00742.
16. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions: Version 5.1.0 [Internet] London, UK: The Cochrane Collaboration; 2011. cited 2018 September 7. Available from: http://handbook.cochrane.org/.
17. Kim SY, Park JE, Seo HJ, Lee YJ, Jang BH, Son HJ, et al. NECA's guidance for undertaking systematic reviews and meta-analyses for intervention Seoul: National Evidence-Based Healthcare Collaborating Agency; 2011. Report No.: 978-89-94581-59-0.
18. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis West Sussex: John Wiley and Sons; 2009. p. 421.
19. Cohen J. Statistical power analysis for the behavioral sciences 2nd edth ed. Mahwah. NJ: Lawrence Erlbaum Associates; 1998. p. 567.
20. Yang MH, Lin LC, Wu SC, Chiu JH, Wang PN, Lin JG. Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation. BMC Complementary and Alternative Medicine 2015;1593. 10.1186/s12906-015-0612-9.
21. Yang YP, Lee FP, Chao HC, Hsu FY, Wang JJ. Comparing the effects of cognitive simulation, reminiscence, and aroma-massage on agitation and depressive mood in people with dementia. Journal of the American Medical Directors Association 2016;17(8):719–724. 10.1016/j.jamda.2016.03.021.
22. Cohen-Mansfield J. Agitated behavior in persons with dementia: The relationship between type of behavior, its frequency, and its disruptiveness. Journal of Psychiatric Research 2008;43(1):64–69. 10.1016/j.jpsychires.2008.02.003.
23. Kim SJ, Ryoo EN, Park KS. A study on pain, physical function, cognitive function, depression and agitation in elderly women with dementia. Journal of Korean Academy of Adult Nursing 2007;19(3):401–412.
24. Oh BH, Kim YK, Kim JH, Shin YS. The effects of cognitive rehabilitation training on cognitive function of elderly dementia patients. Journal of Korean Neuropsychiatric Association 2003;42(4):514–519.
25. Shim YS, Kim BS, Shon YM, Kim KS, Yoon B, Yang DW. Clinical characteristics of demented patients in a geriatric institution: Focused on behavioral and psychological symptoms. Dementia and Neurocognitive Disorders 2005;4(1):35–40.
26. Hwang E, Shin S. The effects of aromatherapy on sleep improvement: A systematic literature review and meta-analysis. The Journal of Alternative and Complementary Medicine 2015;21(2):61–68.
27. Roh KH, Park H. A meta-analysis of the effects of aromatherapy on psychological variables in nursing. Journal of Korean Academy of Community Health Nursing 2009;20(2):113–122.
28. Buckley J. Massage and aromatherapy massage: Nursing art and science. International Journal of Palliative Nursing 2002;8(6):276–280.
29. Choi SW. Effect of aromatherapy on behavioral and psychological symptoms of dementia. Journal of the Korea Gerontological Society 2008;28(4):1069–1087.
30. Lee SY. Effects of aromatherapy and foot reflex massage on emotion, sleep disturbance, and wandering behavior in older adults with dementia. The Korean Journal of Rehabilitation Nursing 2013;16(1):9–17. 10.7587/kjrehn.2013.9.

Article information Continued

© 2019 Korean Academy of Community Health Nursing
Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Funded by : National Research Foundation of Koreahttps://doi.org/10.13039/501100003725
Award ID : 2017R1D1A3B03032896

Figure 1

Figure 1

Flowchart of study selection.

Table 1

Characteristics of Articles Analyzed in the Present Study (N=12)

Table 1

ADAS-Cog=Alzheimer's disease assessment scale-cognitive subscale; ADL=activities of daily living; CCMAI=chinese version of the cohen-mansfield agitation inventory; CA=care and attention; CDR=clinical dementia rating scale; CMAI=the cohen-mansfield agitation inventory; CMAI-SF=cohen-mansfield agitation inventory-short form; CNPI=chinese version of neuropsychiatric inventory; Con.=control group; CSDD=cornell scale for depression in dementia; DSM-IV=diagnostic and statistical manual of mental disorders-4th edition; ECG=electrocardiogram; Exp.=experimental group; FIM=functional independent measure; G=group; HRV=heart rate variability; MMSE=mini-mental state examination; NPI=neuropsychiatric inventory; NR=not reported; PAS=pittsburgh agitation scale; QOL=quality of life; RCT=randomized controlled trials; SIRS=severe impairment rating scale.

Table 2

Effect Size of Aromatherapy for Agitation in Patients with Dementia (N=9)

Table 2

CI=confidence interval; SD=standard deviation; SMD=standardized mean difference.

Table 3

Subgroup Analysis of Moderator Variables in Aromatherapy (N=9)

Table 3

CI=confidence interval; †n=6.