“Aromatherapy is possibly the most simple of complementary therapies to integrate because when we inhale air, we inhale aroma, although we are usually unaware of it.” – Mehmet Oz, MD  

Did you know that our nose (and by default) the emotional center of our brain is working for us 24/7? Think about it – even when we’re asleep our nose is still doing it’s job.

And when our nose is doing it’s job, it’s communicating with the brain. The area of the brain known as the amygdala plays a major role in storing and releasing emotional trauma. The only way to stimulate this gland is with aroma or through the sense of smell. The emotional brain responds only to smell and not to words that are read, spoken, or heard. Our sense of smell links directly to emotional states and behaviors often stored since childhood.

Smell is the only one of the five physical senses that is directly linked to the limbic lobe of the brain, also known as our emotional control center. Anxiety, depression, fear, anger, and joy all physically originate from this region.

A certain aroma can evoke memories and emotions before we are even consciously aware of it. When smells are concerned, we react first and think later.

Essential oils enable us to access stored or forgotten memories and suppressed emotions so that we can acknowledge and integrate or release them. Emotional energy actually works at higher speed than thought. Thought and images can take seconds or minutes to evoke a memory while an aroma can evoke a memory in milliseconds.

For this reason the use of aromatherapy during palliative care & hospice care seems a perfect fit.  The non-invasive nature of non-pharmacologic aromatherapy is ideal in end of life comfort.

Let’s explore concerns which are common in hospice settings and the available research regarding the use of aromatherapy to mitigate these issues. Many individuals nearing the end of life have significant surges of emotions that are often difficult to express – take for instance depression, anxiety, or lack of energy. While aromatherapy cannot prolong life or cure a terminal illness, it can help make the situation more bearable for those involved. The use of aromatherapy can help promote a sense of well-being and comfort.

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Times, they are a changing…

The concept of hospice is not new, it’s been around for a long time. But the perception of hospice as “not being a bad word” is where the industry is gaining ground – and as our population ages, there is a corresponding increase in the need for hospice and palliative care.

The need for comfort and dignity takes center stage with our growing population of Alzheimer’s / dementia / Lewy Body, cancer related illnesses and beyond.

Not only for patients, but also for family members and care staff, aromatherapy is proving to be a valuable tool in end of life care. Let’s take a look at the role aromatherapy can play and explore current research which can prove to be beneficial. We’ll discuss aromatic interventions which are known to work and how to administer them in a hospice setting.

Essential oils used in aromatherapy are defined as volatile substances that are extracted from flowers, leaves, stems, seeds and other plant material. Essential oils are obtained through steam distillation or by means of mechanical pressing to remove aromatic molecules from the plant material  (Rhind, 2012). These aromatic molecules play a powerful role on our emotions.

Comfort is the goal of hospice care. Terminally ill patients have a different set of needs than those who are anticipated to get well (Hayes, M., 2015). Hospice patients require a significant ‘investment of care’, and since they are not expected to live, they require the assistance of those whose manner is compassionate yet not patronizing. Many nearing the end life suffer from depression or anxiety. This can make treatment difficult, not only in terms of supporting patients’ physical health but also their mental well-being (Bye, 1998; Faithfull, Cook, and Lucas, 2005).

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Misconceptions + Concerns

Since my start with aromatherapy (2014) I have heard a lot of questions directed at misconceptions and concerns and the efficacy of essential oils relating to the use of aromatherapy in the care setting. The relative lack of evidence-based research pertaining to essential oil use in hospice situations may interfere with the desire of staff to provide this service to their patients. Hospice staff may either doubt the efficacy of aromatherapy as a useful intervention or may lack confidence in how to administer it (van der Watt and Janca, 2008). Additionally, the limited amount of training available to nursing staff or family can limit the types of aromatic interventions available to patients (Boyd, 2011). However, with more recent publications like Complementary Nursing in End of Life Care: Integrative Care in Palliative Care by Madeleine Kerkhof-Knapp Hayes (2015), this will hopefully prove less of a concern in the future.

Evidence

There is a body of evidence which supports use of complementary/alternative medicine (CAM) therapies in hospice care, including massage, acupuncture, weighted blankets, music therapy, and the use of botanicals for physical and emotional concerns (Mansky and Wallerstedt, 2006, Hayes, M., 2015, van der Watt and Janca, 2008, Zollman and Vickers, 1999).  

Complementary health practitioners seek to tailor treatments to an individual patient’s needs, meaning they treat the whole person, including their mental well-being (Zollman and Vickers, 1999).  If practitioners choose to implement aromatherapeutic interventions, various options include diffusion, incorporating essential oils into physical therapy, or the use of aromatic massage (Mansky and Wallertedt, 2006).

How and when to implement aromatherapy is only part of the equation; the rest is choosing which essential oils are of benefit in the end of life environment.

Some of the ultimate goals of aromatherapy include reducing anxiety and depression. The following essential oils are relied upon for emotional support: Bergamot, cedarwood, geranium, grapefruit, lavender, lemon balm (melissa), neroli, patchouli, black pepper, Roman chamomile, rose and ylang ylang.

Aromatic massage is a popular way to administer essential oils to individuals while including family members in the process. Several studies or literature reviews mention the positive benefits of touch (Soden et al., 2004, Van der Watt and Janca, 2008, Sheldon et al., 2008, Rahim-Jamal et al., 2011). Nursing staff and family members can be taught simple massage techniques to use with individuals. Both Jane Buckle (2015) and Shirley Price (2012) teach easy, effective techniques that can be learned in a weekend workshop, and these have proven invaluable to those nearing the end of their lives. Not only is massage in and of itself beneficial, but combined with aromatherapy, the extra time spent with patients can boost mood, ease tension, and provide a way for family members to positively interact. When stress levels are reduced, anxiety and depression tend to decrease as well. Creating aromatic massage blends specific to each individual patient’s preferences can be a beautiful way to complement traditional medical interventions.

Administering aromatherapy during physical exercise can improve quality of life. By simply moving more, patients maintain muscle tone and mobility for longer periods (Tamrat, Huynh-Le, and Goyal, 2013). The idea of adding aromatherapy to physical exercise is one which can assist in releasing hormones that boost mood and improve mobility,  which in turn can reduce feelings of depression and anxiety. Why is this important? Individuals in hospice care who envision the end of life may not always see the point of being active. Providing some aromatic ‘encouragement’ can help them get moving so they remain more comfortable as they near the end of life.

Recommendations

If you were waiting for evidence… please read this post again.

The evidence is there. All we have to do is see it in action with our own two eyes to know that BY FAR aromatherapy is helpful in situations where the risks of emotional and mental distress exist. End of life care is greatly aided by the use of aromatherapy and assists all involved … the patient, the care staff, the family members and friends. The people who experience significant stress during the last few weeks or months of life can be aided by the fact that their nose is working for them 24/7.

As stated, increasingly, patients and caregivers alike are turning to aromatherapy and physicians are more willing to allow the use of complementary treatment alternatives in most circumstances. Essential oils that hold the best promise in helping reduce anxiety and depression, primarily through inhalation, are bergamot, cedarwood, geranium, grapefruit, lavender, melissa, neroli, patchouli, black pepper, roman chamomile, rose and ylang ylang.

References:

ACHS (2015) Aromatherapy Materia Medica Essential Oil Monograph. Part 1 edn. American Colllege Of Healthcare Sciences.

Boyd, D., Merkh, K., Rutledge, D. N. and Randall, V. (2011) ‘Nurses’ Perceptions and Experiences With End-of-Life Communication and Care’, Oncology Nursing Forum, 38(3), doi: 10.1188/11.onf.e229-e239

Buckle, J. (2003) Clinical Aromatherapy: Essential Oils in Practice. Philadelphia: Elsevier Health Sciences

Bye, R. (1998) ‘When Clients are Dying: Occupational Therapists’ Perspective’, The Occupational Therapy Journal of Research, 18(1), pp. 2–24.

Faithfull, S., Cook, K. and Lucas, C. (2005) ‘Palliative care of patients with a primary malignant brain tumour: case review of service use and support provided’, Palliative Medicine, 19(7), pp. 545–550. doi: 10.1191/0269216305pm1068oa

Hayes,  Madeleine Kerkhof-Knapp. (2015) Complementary Nursing in End of Life Care: Integrative care in palliative Care. The Netherlands: Kicozo-Knowledge Institute for Complementary Nursing 

Jensen, W., Bialy, L., Ketels, G., Baumann, F. T., Bokemeyer, C. and Oechsle, K. (2013) ‘Physical exercise and therapy in terminally ill cancer patients: a retrospective feasibility analysis’, Supportive Care in Cancer, 22(5), pp. 1261–1268. doi: 10.1007/s00520-013-2080-4

Mansky, P. J. and Wallerstedt, D. B. (2006) ‘Complementary Medicine in Palliative Care and Cancer Symptom Management’, The Cancer Journal, 12(5), pp. 425–431. doi: 10.1097/00130404-200609000-00011

Price, S. and Price, L. (2012) Aromatherapy for Health Professionals. Edinburgh: Churchill Livingstone/Elsevier

Rahim-Jamal, S., Sarte, A., Kozak, J., Bodell, K., Barroetavena, M.-C., Gallagher, R. and Leis, (2011) ‘Hospice residents interst in complementary and alternative medicine (CAM) at end of life: a pilot study in hospice residents in British Columbia’, Journal Of Palliative Care, 27(2), pp. 134–40.

Rhind, J. (2012) Essential Oils: A Handbook fro Aromatherapy Practice. London and Philadelphia: Singing Dragon

Salvensen, G. (2009) The Effects of Inhaled Bergamot and Geranium essential oils on Rat Behavior.

Sheldon, L. K., Swanson, S., Dolce, A., Marsh, K. and Summers, J. (2008) ‘Putting Evidence Into Practice®: Evidence-Based Interventions for Anxiety’, Clinical Journal of Oncology Nursing, 12(5), pp. 789–797. doi: 10.1188/08.cjon.789-797

Soden, K., Vincent, K., Craske, S., Lucas, C. and Ashley, S. (2004) ‘A randomized controlled trial of aromatherapy massage in a hospice setting’, Palliative Medicine, 18(2), pp. 87– 92 doi: 10.1191/0269216304pm874oa

Tamrat, R., Huynh-Le, M.-P. and Goyal, M. (2013) ‘Non-Pharmacologic Interventions to Improve the Sleep of Hospitalized Patients: A Systematic Review’, Journal of General Internal Medicine, 29(5), pp. 788–795. doi: 10.1007/s11606-013-2640-9

Van der Watt, G. and Janca, A. (2008) ‘Aromatherapy in nursing and mental health care’, Contemporary Nurse, 30(1), pp. 69–75. doi: 10.5172/conu.673.30.1.69

Zollman, C. and Vickers, A. (1999) ‘ABC of complementary medicine: Complementary medicine and the patient’, BMJ, 319(7223), pp. 1486–1489. doi: 10.1136/bmj.319.7223.1486