Issue:
97
Page: 27
Lavender Oil Aromatherapy Reduces Falls in Elderly Nursing Home Residents in Long-Term Trial
by Heather S. Oliff, PhD
HerbalGram.
2013; American Botanical Council
Reviewed: Sakamoto Y, Ebihara S, Ebihara T, et al. Fall prevention using olfactory stimulation with lavender odor in elderly nursing home residents: a randomized controlled trial. J Am Geriatr Soc. 2012;60(6):1005-1011.
Falls are a
major health problem for the elderly, as they are linked to increased morbidity
and mortality. Risk factors for falls include physical weakness, gait and
balance instability, sedating and psychotropic medications, and cognitive
impairment. The latter is a strong factor due to the multiple behavioral and
psychological symptoms of dementia (BPSD), such as pacing, wandering,
aggression, anxiety, and agitation. The essential oil of lavender (Lavandula angustifolia, Lamiaceae) is
used in aromatherapy to treat anxiety, nervousness, insomnia, and melancholy.
Studies have shown that aromatherapy using lavender can improve balance and
gait performance and reduce anxiety in elderly people. The purpose of this
randomized, placebo-controlled, double-blind study was to evaluate the effect
of continuous lavender olfactory stimulation on the incidence and risk of falls
in elderly nursing home residents.
The study was
conducted in three nursing homes in Aomori, Japan. It included 175 subjects,
aged 65 years or more, who had the ability to move independently — with or
without assistive devices. Subjects with pica disorder (appetite for
non-nutritive substances such as dirt or paper) were excluded. Lavender
olfactory stimulation was provided using a commercially available 1 cm by 2 cm
paper patch (Aromaseal Lavender, Hakujuji Co.; Tokyo, Japan). The placebo was
an identical unscented Aromaseal paper patch. The Aromaseal lavender patch
originally was developed to help busy and stressed people relax by providing
continuous olfactory exposure to lavender for 24 hours. The odor is so faint
that it can be sensed only by the person wearing the patch. (Note: No
information was provided on the lavender raw material source [i.e., the herb from which the lavender
oil was distilled], oil concentration or other chemical features of the oil, or
the patch production). The head nurse prepared the patches and distributed them
to the nursing home staff who affixed one patch inside each subject’s clothing
near the neck. The staff replaced the patch daily for 360 days.
The primary
outcome measure was the number of falls. A fall was determined in accordance
with the World Health Organization’s definition: “an event which results in a
person coming to rest inadvertently on the ground or floor or other lower
level.” The nursing home staff was trained to identify and record daily falls
according to this definition. Behavioral measurements included the
Cohen-Mansfield Agitation Inventory to quantify behavioral and psychological
symptoms, the Barthel Index to assess level of functional ability, the
mini-mental state exam (MMSE) to assess cognitive function, and the Vitality
Index to assess activity of daily living (ADL)-related vitality. The groups did
not significantly differ in age or risk factors for falls.
There were a total of 62 falls reported over the course of one year, with subjects in the
lavender group falling 0-5 times and subjects in the placebo group falling 0-7
times (only 2 falls resulted in injury; one in each group). In the lavender
group, 35.6% of subjects fell at least once, and 50% of the placebo group fell
at least once. In the placebo group, 47% had recurrent falls, while only 24% in
the lavender group had more than one fall (P=0.08). The total number of falls
in the placebo group was 88 compared to 46 falls in the lavender group. The
incidence rate ratio (IRR) for the lavender group was significantly lower than
for the placebo group (P<0.04). After adjusting for confounding variables
(such as age, sex, fall history, MMSE, tranquilizer use, etc.), the IRR
significance was even greater (P<0.02).
There were no between-group differences in behavioral and cognitive measurements at baseline.
At 12 months, the lavender group had a significant decrease from baseline in
agitated status (P=0.04); in contrast, the placebo group did not. There was no
significant difference between groups in the number of subjects who were given
newly prescribed tranquilizers. However, the frequency of tranquilizer use was
lower in this trial compared to other studies — a difference the authors
attributed to the use of Yokukansan, a traditional Asian medicine commonly
prescribed for BPSD. Yokukansan contains toki or Japanese dong quai (Angelica acutiloba, Apiaceae), cang-zhu atractylodes (Atractylodes lancea, Asteraceae),
Chinese thoroughwax (Bupleurum chinense,
Apiaceae), poria (Wolfiporia cocos syn.
Poria cocos, Polyporaceae), Chinese
licorice (Glycyrrhiza uralensis,
Fabaceae), marsh parsley (Ligusticum
ibukiense syn. Cnidium officinale,
Apiaceae), and gambir (Uncaria
rhynchophylla, Rubiaceae). No adverse events were reported.
The authors
concluded that daily olfactory stimulation with lavender may prevent falls in
elderly nursing home residents. Although the mechanism is unknown, the results
of this study support lavender’s traditional use to soothe anxiety and
agitation, which may play a role in reducing falls. Lavender’s previously
demonstrated stabilizing effects on balance also may be a factor. Additionally,
the authors suggested that the relationship between lavender stimulation,
tranquilizers, and Yokukansan warrants further investigation.
In the final
analysis, only two of the 145 subjects incurred injurious falls; this study was
not large enough to detect clinically relevant reductions in injurious falls.
The study also is limited by its potential lack of adequate blinding, which
could have resulted in reporting biases. The nurses applied the patches to the
patients, and there is the chance they could not remember which patient
received which patch. Also, the possibility exists that some subjects could not
detect the odor (olfactory functioning was not tested). The results cannot be
generalized because people in nursing homes are subjected to different, and
possibly fewer, environmental risks than the elderly dwelling outside of
nursing homes. Although no adverse events were reported, the authors did not
rigorously evaluate safety of long-term use.
—Heather S.
Oliff, PhD
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