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

Eun Kyung Kim; Heeok Park; Chun Hee Lee; Eunsil Park

doi:10.12799/jkachn.2019.30.2.183

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

Original Article

Journal of Korean Academy of Community Health Nursing 2019; 30(2): 183-194.

Published online: 28 June 2019

DOI: https://doi.org/10.12799/jkachn.2019.30.2.183

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

Eun Kyung Kim¹

, Heeok Park²

, Chun Hee Lee³

, Eunsil Park⁴

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 14 December 2018 Revised 1 May 2019 Accepted 1 May 2019

Korean Academy of Community Health Nursing

(open-access):

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.

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

Figures and Tables

Figure 1

Flowchart of study selection.

Table 1

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

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)

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

Table 3

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

CI=confidence interval; ^†n=6.

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).

Appendix

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

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ORCID iDs

Eun Kyung Kim
https://orcid.org/0000-0003-4775-1226

Heeok Park
https://orcid.org/0000-0002-8194-0373

Chun Hee Lee
https://orcid.org/0000-0001-5024-4781

Eunsil Park
https://orcid.org/0000-0001-6123-9937

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