14 Care of the elderly
This chapter is devoted mainly to dementia and its treatment, but as the elderly may suffer some of the specific conditions also suffered by those with dementia, the essential oils and treatments that apply to the general care of the elderly are also advocated.
For more than a decade a wide range of healthcare professionals in both hospitals and residential or nursing homes have realized the benefits of using essential oils to help elderly people suffering from various types of dementia. There is also awareness of the need to help those in a younger age group with early onset of dementia.
As many elderly people receive little or no caring touch from others, introducing massage can not only improve their quality of life but can also benefit those caring for them, a massage being relaxing for both parties, giving both warmth and comfort. Using essential oils enhances these benefits, as they can assist such problems as anxiety, depression, indigestion, insomnia, constipation etc.
Extra care is necessary when treating more mature clients, as ageing brings about numerous physical, mental and emotional changes. The span of concentration lessens when short-term memory deteriorates, and the massage time may therefore need adjusting.
In 1988 Helen Passant introduced massage to what was then called the ‘geriatric ward’ at Churchill Hospital, Oxford. She discovered that not only did patients' skin texture improve, becoming stronger and more resistant to bruising and tissue damage, but they became more alert (and calmer when anxious or noisy). Essential oils were later introduced to the treatment, enabling conventional sedative medicines to be reduced (Passant 1990).
The cost of dementia to the UK is twice that spent on cancer care, yet the amount spent on research into dementia is 12 times lower than that for cancer (www.dementia2010.org).
The Alzheimer's Research Trust has commissioned the Health Economics Research Centre at the University of Oxford to produce a report on the economic cost of dementia to the UK, and the country's investment in research to find new treatments, preventions and cures. The Oxford team's findings are astonishing, showing dementia to be the greatest medical challenge of our time.
• Over 820 000 people in the UK live with Alzheimer's and other dementias.
• Dementia costs the UK economy £23 billion per year: more than cancer and heart disease combined.
• Dementia research is severely underfunded, receiving 12 times less support than cancer research. www.dementia2010.org
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 (www.alzheimers.org.uk). 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
• 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.)
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.
• 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.
Box 14.1
Aromatherapy and Dementia Study
This study was conducted in a multicultural dementia daycare centre over a period of 18 months. It introduced a gentle hand treatment for clients, using three essential oils. The study evolved out of the process of action research, where the family carers and daycare staff participated with the researchers to choose, design, develop and evaluate a hand treatment programme. Data was collected through in-depth interviews pre- and post treatment, focus group discussions, client observation logbooks and a disability scale. The findings indicated a positive strengthening of the relationship between the person with dementia and their family carer, and an improvement in feelings of health and wellbeing for both. The specific improvements for clients include increased alertness, self-hygiene, contentment, initiation of toileting, sleeping at night and reduced levels of agitation, withdrawal and wandering. Family carers reported less distress, improved sleeping patterns and feelings of calm. They also found the treatment useful in helping them manage the difficult behaviours exhibited by their relative. The benefits of this treatment for nursing practice are that it is safe, effective and easily administered by staff in any setting.
Int J Nurs Pract 1998 Jun; 4(2): 70–83 Kilstoff K, Chenoweth L Faculty of Nursing, University of Technology, Sydney, Australia. For more information: kathy.kilstoff@uts.edu.au
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:
• Geranium, lavender and mandarin essential oils in an almond oil base applied to the skin of 39 patients over an unspecified period resulted in increased alertness, contentment and sleeping at night – with reduced levels of agitation, withdrawal and wandering (Kilstoff & Chenoweth 1998).
• Essential oils including ylang ylang, patchouli, rosemary and peppermint and others produced a marked decrease in disturbed behaviour in most participants. This led to a reduction in prescribed conventional medicines (Beshara & Giddings 2003).
• Researchers at Oldham Cottage Hospital investigated the potential of essential oil of lavender to aid rest and relaxation, thereby encouraging the healing process. Patients were monitored for 7 days, during which time their sleep patterns, dozing and alertness during the day were recorded. For the following 7 days one drop of Lavender angustifolia was put on each patient's pillow at night. No other changes were made to the patients' daily routine or medications that they were receiving. At the end of the 7 days, patients' records were collated and analysed. Interestingly, all patients reacted favourably to the treatment, with increased daytime alertness and improved sleep patterns, and those who had previously experienced confusion were observed to display as much as a 50% reduction in their symptoms (Hudson 1996).
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
Box 14.2 Melisssa officinalis and agitation in dementia
Ballard et al. (2002) carried out a double-blind placebo-controlled trial to establish whether Melissa officinalis would have a positive effect on agitation in people with severe dementia. Seventy-two people with clinically significant agitation were randomly assigned either to an aromatherapy group, receiving massage on their hands and arms twice a day with a base lotion containing melissa essential oil, or a placebo group, receiving the same massage with a base lotion containing sunflower oil.
The blends were applied to the faces and arms of the patients in both groups, twice a day. No significant side effects were observed and 71 patients completed the trial.
The results were compared between the groups over a period of 4 weeks. Those who received the lemon balm [melissa] treatment became less agitated than those who had the sunflower oil.
The improvements were clear in the first week and continued so for a full 3 weeks.
Sixty per cent (21 out of 35) of the melissa group experienced a significant improvement in their agitation scores following treatment, compared to 14% (5 out of 36) of the placebo group. The authors concluded that aromatherapy with the essential oil of Melissa officinalis is safe and effective for clinically significant agitation in people with severe dementia, and that there is a need for further controlled trials (Ballard et al. 2002).
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) www.alzheimers.org.uk 2007.
When treating elderly clients it is a good idea for the therapist to have the same pleasant-smelling oil blend on his/her hands at each visit, as this can help to create a bond with the client.
Each aromatherapy treatment needs to be adapted according to the health of the client; a full body massage may be too much for some elderly people, and if lying down is difficult or uncomfortable, targeting specific areas such as the hands or feet is also beneficial. If massage is inappropriate or not wanted, essential oils can be applied in a lotion daily, vaporized, used in the bath or with a compress.
As the skin of an elderly client may be wrinkled, slightly more carrier oil may be needed for a massage to minimize stretching. Care must be taken not to leave any oil residue on clients' hands or feet, as this could cause them to drop things or fall if they slip or lose their grip.
Older people may sometimes need encouragement to eat if they are suffering from a loss or lack of appetite. Unlike conventional drugs, essential oils do not have side effects; neither are they as invasive as inserting a feeding tube.
A blend of Citrus bergamia [bergamot] and Citrus aurantifolia [lime] produces a mouth-watering aroma when used in a vaporizer before meals.
Other oils useful in this respect include Carum carvi [caraway], Foeniculum vulgare [fennel], Mentha spicata [spearmint], Myristica fragrans [nutmeg] and Zingiber officinale [ginger].
A study using indirect inhalation and/or topical application proved to be effective in promoting patients' appetites, often within 24 hours. Meals monitored by staff showed an increase of food intake from zero the first day to 25% by the third day, and up to 75% and more by the 10th day. These are measurable, effective outcomes without harmful side effects (O'Haynes 2010).
Studies have shown that generalized anxiety disorder (GAD) may be the most common mental disorder among the elderly and is more common than depression in that group (7% and 3%, respectively) (Warner 2006). Anxiety can take many forms and have many causes, perhaps due to loss of mobility and independence, fear over finances, gradual deterioration in health or the decline of a loved one – when it is not surprising that anxiety disorders may develop. Aromatherapy with direct and indirect inhalation is able to reduce anxiety, agitation and other symptoms of the elderly, improving patients' quality of life and making them more relaxed and less stressed. Patients wander less, are more easily redirected by staff and less likely to fall (Perry 2007). Traditional drugs for Alzheimer's often have side effects such as dizziness, which can also be helped by the use of essential oils (O'Haynes (2010); therapeutic essential oils have no side effects and enhance psychological and physical wellbeing.
Some people with behavioural and mood changes due to dementia (more common in the middle and later stages) can become quite distressed if they are aware that they are acting inappropriately, but for those who are unaware this may not be a problem. Considerable distress may be seen in the family, friends and carers of those with dementia. Therefore it is important when treating dementia patients to be aware of their families and carers, giving them treatment too if necessary to relax their stress.
This is common when patients are stressed or anxious, and 1 drop of Thymus vulgaris ct. thymol [phenolic thyme] rubbed on the back of the hands is most effective. A blend of two or three of the following oils – which treat both anxiety and depression – can be given by inhalation, in the bath or by hand, foot or scalp massage: Abies balsamea [Canada fir], Aloysia triphylla [verbena], Chamaemelum nobile [Roman chamomile], Leptospermum scoparium [manuka], Litsea cubeba [may chang] – also helpful to insomnia and memory loss, Mentha spicata [spearmint], Nepeta cataria [catmint], Ocimum basilicum [European basil] and Origanum majorana [sweet marjoram].
As age progresses people move around less and the speed of circulation through the body is reduced, which can lead to health problems. An aromatherapy massage (towards the heart) stimulates the circulation, helping to maintain and improve health. Foot baths and foot massage are also helpful. To enhance the treatment the carer can be given a lotion to apply daily. Lower leg massage – not forgetting that pressure must be on the upward movement only – is also beneficial. Circulation-stimulating essential oils include: Citrus aurantium var. amara [bitter orange], Citrus limon [lemon], Cupressus sempervirens [cypress], Rosmarinus officinalis [rosemary], Foeniculum vulgare [fennel], Salvia officinalis [sage].
Foot baths can be given as a preliminary to aromatherapy massage, when the essential oils should be dissolved in a teaspoonful of honey, cream or white lotion before adding to the water, swishing well. The feet should be soaked for 10 minutes.
Many elderly people do not drink enough water, which can contribute to constipation. A blend of citrus essential oils in a carrier oil applied with gentle abdominal massage can be helpful, and they should also be encouraged to drink plenty of fluids to soften stools further. The digestive system reflex points on the feet can be massaged (see Swiss reflex treatment in Ch. 8), which may be a preferred treatment for some.
It has been said that clearing the bowels can rectify mild cases of confusion almost immediately.
Essential oils which both stimulate the digestive system and ease constipation are Rosmarinus officinalis, Zingiber officinale [ginger], Mentha spicata [spearmint]
Digestion-stimulating oils: Coriandrum sativum [coriander], Myristica fragrans [nutmeg], Piper nigrum [black pepper], Salvia officinalis [sage].
Oils that relieve constipation: Citrus aurantium var. amara [bitter orange], Citrus reticulata [mandarin], Citrus sinensis [sweet orange], Foeniculum vulgare [fennel].
A massage blend containing these oils can be applied to the abdomen. Massage should be in gentle circles in a clockwise direction around the abdomen following the line of the digestive tract. Alternatively, the relevant digestive reflex points on the feet or hands can be massaged. These treatments can easily be shown to carers so that they may continue the massage in the therapist's absence to ensure ongoing relief.
This condition can be just as upsetting to a patient as constipation, and the following essential oils will be found helpful:
Origanum majorana [sweet marjoram] and Citrus limon [lemon] are effective where the diarrhoea is of nervous origin, as they also have tranquillizing effects.
Melaleuca viridiflora [niaouli] – also anti-inflammatory
Mentha x piperita [peppermint] – also anti-inflammatory and will help against nausea
Pelargonium graveolens [geranium] – also anti-inflammatory and calming.
The anti-inflammatory oils above are useful where there is colitis or gastroenteritis, and Syzygium aromaticum (flos) [clove bud], Pimpinella anisum [aniseed], Melaleuca cajuputi [cajuput] and Myristica fragrans [nutmeg] relieve the spasms (Valnet 1992 pp. 114, 95, 101, 161).
A blend which has been found to work well for both enteritis and irritable bowel syndrome (frequently used with success by S Price) and mostly administered internally diluted in a dispersant e.g. honey, then water, is equal quantities of Foeniculum vulgare var. dulce [fennel], Mentha x piperita and Piper nigrum [black pepper].
This is where small, harmless bulges occur in weak points in the large intestine and exists in most elderly people (Wingate & Wingate 1996). It is only when one or more of these diverticula becomes inflamed that chronic diverticulitis can set in – and constipation, abdominal pain and bleeding may manifest.
The diet should be changed to one rich in fibre, and massage with anti-inflammatory essential oils such as rosemary and bitter orange (in Constipation above) would be beneficial. Other anti-inflammatory oils that act on the digestive system are: Commiphora myrrha [myrrh], Chamomilla recutita [German chamomile], Juniperus communis fruct. [juniper berry], Melissa officinalis [melissa].
The causes of headaches and migraines are many. To relieve symptoms, a few drops of essential oil can be vaporized or dropped onto a tissue or the palms of the hands (one drop in this case is sufficient) and then inhaled.
Lavandula angustifolia [lavender] (analgesic and anti-spasmodic) massaged into the temples can work wonders, or a cold compress of Mentha x piperita [peppermint] (analgesic and antispasmodic) applied to the forehead or the back of the neck can bring relief.
Migraines that appear to be caused by restricted blood supply may respond positively to warm compresses applied to the back of the neck, using Origanum majorana [sweet marjoram], which is a vasodilator.
Suitable oils for headache and migraine treatments include: Lavandula angustifolia [lavender], Chamaemelum nobile [Roman chamomile], Ocimum basilicum [basil], Mentha x piperita [peppermint],Origanum majorana [sweet marjoram], Rosmarinus officinalis [rosemary], Aniba rosaeodora [rosewood].
A small pilot study was conducted by Basnyet (1999), aromatherapist at the Natural Health Centre in Preston, Lancashire, UK. Twenty patients were divided into two groups of 10, the first group to receive five 45-minute aromatherapy treatments using 15 mL of unrefined grapeseed carrier oil containing one drop of each of Cananga odorata [ylang ylang], Salvia sclarea [clary sage] and Origanum majorana [sweet marjoram] over a period of 6 weeks. The second group received the same massage but without the essential oils.
The massage techniques used were effleurage (stroking), petrissage (kneading), gentle friction, vibration and feathering, using 15 mL of grapeseed carrier oil, which in the aromatherapy group contained one drop of each essential oil.
At the end of the treatment period the improvement in pulse rate of patients in the treatment group was consistently higher than that observed in the control group: seven out of 10 in the treatment group and six out of 10 in the control experienced a reduction in their raised blood pressure.
The report concludes that ‘overall blood pressure readings in both groups improved successfully, which would indicate that this type of tactile treatment can have a beneficial effect on the raised arterial blood pressure’ (Internet Health Library 2006).
The older and less active people become the less sleep they may require, especially as many have ‘forty winks' during the day, possibly detracting from a complete night's sleep. The amount of essential oils used for insomnia is important, as one or two drops of Lavandula angustifolia [lavender] can be relaxing and soporific, but a high dose can have the opposite effects. Two to four drops can be inhaled from a tissue or put into a vaporizer or bath. A simple neck and shoulder massage with – or application of – a blend of oils is very effective. Other oils beneficial for insomnia include: Cananga odorata [ylang ylang], Chamaemelum nobile [Roman chamomile], Origanum majorana [sweet marjoram], Citrus aurantium var. amara flos [neroli bigarade], Citrus bergamia [bergamot], Citrus limon [lemon], Citrus reticulata [mandarin], Citrus sinensis [sweet orange], Lavandula angustifolia [lavender].
Essential oils can stimulate the mind and improve memory recall (Moss et al. 2003), which is useful not only for students when revising but also for the elderly, especially those suffering from Alzheimer's disease. Introducing essential oils can trigger nostalgic memories, bringing them to the fore where they can be enjoyed by all – clients, carers and family.
Rosmarinus officinalis [rosemary] and Mentha x piperita [peppermint] are reputed to stimulate the memory, others often used being Litsea cubeba [cubeb], Mentha x piperita [peppermint], Rosmarinus officinalis [rosemary] and Syzygium aromaticum [clove bud].
In illnesses such as Alzheimer's disease, essential oils can help to stimulate the mind and improve the memory. Rosmarinus officinalis [rosemary] is reputed to stimulate the memory, as is Mentha x piperita [peppermint]. Salvia officinalis [sage] is also said to boost the memory – it has been found to possess acetylcholinesterase (Ach) enzyme inhibition activities, which help to raise Ach levels in the brain. Ach improves concentration and may play a role in the treatment methods for memory loss associated with diseases such as Alzheimer's. www.nutrition-and-you.com 2010. It has been shown that it acts as an enzyme inhibitor (cholinesterase) – as shown by three licensed drugs for Alzheimer's disease. www.betterhealth.vic.gov.au
Case 14.1 Pain and osteoporosis
Mrs O (aged 80) was diagnosed with osteoporosis in her late 60s. She had been very active and disliked being incapacitated and dependent on her family; however, as the years progressed she had to accept this more and more. By her early 80s Mrs O had had several fractures of the ribs and spine and was using a TENS machine for pain management, as well as paracetamol and Voltarol (diclofenac), although she tried to take as little medication as possible; other medicines included fosimax and lactulose. Owing to her lack of mobility her circulation was poor and she suffered from constipation. As her bone condition worsened her pain increased, and in the late stages, when it was severe, she was using morphine patches.
Mrs O's wish was always to feel less pain, and this was achieved by massaging her hands, arms and legs three times per week. The essential oils used were:
• Rosmarinus officinalis [rosemary] – analgesic, anti-inflammatory, circulation stimulant, laxative
• Citrus aurantium var. amara [bitter orange) – anti-inflammatory, circulation stimulant, laxative
• Lavandula angustifolia – analgesic, anti-inflammatory, calming
• Origanum majorana – analgesic, calming, digestive stimulant.
The blend was chosen to support the circulation and relieve the pain. A home application lotion was made with the same essential oils in a base enhanced with 10% wheatgerm and 10% avocado oils to feed her dry skin, and Mrs O applied this herself every day morning and night.
Although there was never to be a full recovery, Mrs O looked forward to her treatments – her face would light up, and afterwards she was able to move more easily; the daily application of the lotion and the regular massages meant she could go longer between pain relief medications, which pleased her greatly. The pleasure of being able to relieve Mrs O's severe pain through her final weeks of life was very rewarding for the therapist.
Patients with high levels of pain (after hip, knee or back surgery, or who suffer arthritis, rheumatism or osteoporosis) find it difficult to participate in their daily rehabilitation regime. The application of essential oils on or around the pain area(s) at designated times of the day and night results in a definite decline in the perception of pain and an increase in comfort levels. Compresses can also be applied, followed by warm towels or heat pads, or a bag of frozen peas wrapped in a tea towel if the joints are inflamed. After treatment, the client or carer should be given a lotion containing the relevant oils to apply twice a day to maintain the benefits – the overall effect is not only beneficial, but they respond better to the rehabilitative process and have a speedier recovery (O'Haynes 2010).
For problems such as these, therapists aim to help relieve inflammation and pain, and gentle massage and daily application of a lotion is beneficial. Analgesic and anti-inflammatory essential oils have been found to be helpful: Lavandula angustifolia [lavender], Origanum majorana [sweet marjoram], Rosmarinus officinalis [rosemary], Ocimum basilicum [basil], Citrus limon [lemon], Piper nigrum [black pepper], Zingiber officinale [ginger].
Mrs R (71 years) had had cellulitis and a leg ulcer 4 years previously and visited her GP when the symptoms recurred. She was prescribed antibiotics for 1 week, and on the second visit a cream for a further week, but the symptoms did not abate.
After 2 more weeks Mrs R was admitted to hospital – a small ulcer had appeared on lower left leg and she was put onto IV antibiotics for 4 days. The leg was so painful by this stage that she was unable to walk (the ulcer was treated and dressed each day).
Mrs R was moved to another hospital for a week then discharged with a course of oral antibiotics – doxycycline – for 11 days.
Because the situation was worsening rather than improving with medical intervention, Mrs R made an aromatology appointment: she was angry, saying the doctor just did not listen to her. After listening and taking notes, the therapist gave Mrs R a glass of rose hydrolat (10 mL in 100 mL water) while her legs were examined and a treatment plan was prepared. Her lower left leg was hot, reddish-purple and itchy, with dry flaky skin; one small area was slightly open; it was shiny and felt taut, and the ankle was swollen and stiff with oedema and poor circulation. The right leg felt soft and warm, with slight oedema round the ankle, and the circulation was sluggish.
The left leg was sprayed liberally with undiluted hydrolat of Chamaemelum nobile to cleanse the area. Within 5 minutes the leg felt softer and cooler, and Mrs R commented that the itchiness had gone. The open area was the size of a 10p coin, with five other pinhead areas that could break down. Mrs R, having finished her drink, was calmer and becoming relaxed, her face less tense and cooler.
A compress was made for the main ulcer, using oils for pain, inflammation, infection, circulation and cell regeneration (the main chemical components were alcohols, esters and sesquiterpenes). The essential oils chosen were:
• Aniba rosaedora [rosewood] – 95% linalool
• Chamaemelum nobile [Roman chamomile] – 80% esters,
• Matricaria recutita [German chamomile] – 35% sesquiterpenes, 20% alcohols, 35% oxides
• Piper nigrum [black pepper] – 30% sesquiterpenes, 60% monoterpenes.
After the compress a gentle massage was given using macerated passion flower, hypericum and calendula oils – 10 mL of each, with 2 drops each of the essential oils. The lower left leg was massaged, avoiding the ulcer and with particular care on the five pinhead areas (the right lower leg was also massaged to balance the body). Finally, a melonin dressing was put on the open ulcer, using 2 drops of Mentha arvensis [cornmint] to soothe and protect it; it was to be left open to the air when possible and covered with the dressing when moving or going out. Mrs R was given a bottle of rose hydrolat to make a daily drink with water.
Over the next 4 weeks Mrs R returned for weekly treatments following the same regime.
Bed sores can occur when long periods are spent in bed (often the case in an old peoples' home), the sacrum and buttocks being the most affected. If they are not treated early enough ulcers can form, which take longer to heal.
Always consult the client's GP before treating open wounds, and for methods of treatment and beneficial essential oils see Chapter 10, which deals specifically with wounds and pressure sores.
The conifer family is chiefly acknowledged in textbooks as having expectorant properties (Boyd & Pearson 1946), although essential oils from other families also possess them.
Elderly people suffering from catarrhal problems, chronic bronchitis or asthma can benefit from a daily application of essential oils in a carrier lotion onto the chest and neck, and the thin skin behind the ears facilitates percutaneous penetration.
Eucalyptus smithii [gully gum] is an excellent preventive measure for winter coughs and colds. Not only does it increase the resistance of the respiratory system to infection, it is also anticatarrhal, antiviral and an effective expectorant. It has a pleasant aroma, is inexpensive and can be vaporized daily in the lounge area of the ward, and/or in the ward (or bedrooms, as many of the newer hospitals name the rooms of the elderly or patients with learning difficulties).
Boswellia carteri [frankincense], Melaleuca viridiflora [niaouli] and Myrtus communis fol. [myrtle] are all anti-infectious, anticatarrhal and expectorant – niaouli is an excellent choice for chronic cases.
Other essential oils with useful properties for chest problems are:
• Abies alba fol. [silver fir] – anticatarrhal, expectorant
• Eucalyptus staigeriana [lemon scented iron bark] – anti-inflammatory
• Hyssopus officinalis [hyssop] – anticatarrhal, anti-infectious, anti-inflammatory antitussive, expectorant, mucolytic. NB Not suitable for epileptic patients
• Lavandula angustifolia [lavender] – antiseptic, antispasmodic
• Mentha x piperita [peppermint] – anti-infectious, anti-inflammatory, antispasmodic, expectorant and mucolytic (useful where there are sinus problems)
• Ravansara aromatica [ravensara] – anti-infectious, expectorant
• Thymus vulgaris ct. linalool [sweet thyme] – anti-infectious, antispasmodic.
Eight drops of essential oils selected from the above (see also Appendix B1 on the CD-ROM) should be added to 50 mL carrier lotion for application.
As people get older the skin loses its tone and elasticity owing to a decrease in collagen and elastin, the skin of elderly people becoming thinner and often deeply wrinkled. Because of this more oil needs to be applied for massage, to prevent dragging the skin, preferably selecting carrier oils that will benefit the skin, such as apricot or peach, avocado, calendula, evening primrose and wheatgerm. Essential oils which help to improve dryness and elasticity are Aniba rosaeodora [rosewood], Chamaemelum nobile [Roman chamomile], Helichrysum angustifolium [everlasting], Rosa centifolia [rose], Salvia sclarea [clary sage] (helps cell regeneration), Santalum album [sandalwood].
In 2008 Mary (90) was referred to the Day Hospice with a primary cancer of the thyroid, plus several other medical issues, including a hiatus hernia. When she first came she was apprehensive, thinking she would not ‘fit in’, but after a while she relaxed and joined in with a number of activities. Mary lives on her own, with a weekly visit from her daughter-in-law.
After 3 months of attending the Day Hospice Mary started a course of chemotherapy, which caused a widespread itchy rash on her back. Because of her age her skin was very dry and wafer thin; she had been rubbing the area with a small stick to obtain relief from the itching, which had caused the skin to break and become sore, bleeding in places.
She was prescribed Conotrane cream by her GP, but after using it for more than 2 weeks there was no improvement, so a nurse asked whether anything could be done with aromatherapy.
Aromatherapy can be of benefit in Parkinson's disease to promote general relaxation and relieve muscular rigidity. In a preliminary trials S Price (1993) used the following oils with a good measure of success (100% in two of the symptoms) and the blend was found to give relief to several symptomatic side effects. The aim was to achieve relaxation in the patients and help relieve anxiety, with the added effects of reducing pain, improving digestive functioning and aiding sleep.
Equal quantities of the three essential oils below were blended together and added at a concentration of 1.5% to either carrier oil for a weekly massage or base lotion for daily application:
• Salvia sclarea (clary) – relaxant, nerve tonic, phlebotonic
• Origanum majorana (sweet marjoram) – analgesic, antispasmodic, digestive tonic, hypotensor, nerve tonic, relaxant, sleep inducing
• Lavandula angustifolia – analgesic, antispasmodic, digestive stimulant, hypotensor, sedative, sleep inducing.
Muscular rigidity and changes in gait are a major difficulty for Parkinson's disease sufferers and aromatic baths have been found to be helpful (the use of a specialist hoist for bathing may be needed for safety). Regular massage to promote general relaxation will also help stimulate functional ability, and regular facial massage can help to relieve the lack of facial expression caused by neuromuscular change.
As people today are living well beyond three score years and ten, a greater number will probably develop some form of dementia, and the value of essential oils can be considerable – their aroma and specific chemical properties may be applied to many conditions and aspects of life and care.
Aromatherapy is an effective complementary therapy in the care of the elderly and is increasingly accepted at varying levels in care homes. The aromatic qualities of essential oils can be used to deliver their therapeutic qualities through vaporizers to improve the mood and atmosphere of the home, and are invaluable when used directly on clients for their individual needs. Aromatherapy and massage can provide a useful addition to psychological therapeutic interventions with clients suffering from dementia.
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