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- Lavender (Lavandula angustifolia)
- Aromatherapy
- Geriatrics
- Fall Prevention
| Date:
11-30-2012 | HC# 081256-461
|
Re: Lavender Aromatherapy Reduces Falls in Elderly Nursing Home Residents
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) 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-blinded
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 3 nursing homes in Aomori, Japan. It included subjects (n = 175;
aged ≥ 65 years) who had the ability to move independently regardless of
assistive devices used. 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 x 2 cm paper patch (Aromaseal Lavender;
Hakujuji Co.; Tokyo, Japan). The placebo was an identical unscented Aromaseal paper
patch. The Aromaseal lavender patch was originally 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 only be sensed by the person wearing
the patch. [Note: No information on the lavender source, concentration, or the
patch production was given.] The head nurse prepared the patches (no details
given) and distributed them to the nursing home staff who affixed the patch inside
the 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 defined 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 were trained to identify
falls according to this definition and recorded daily falls. Behavioral
measurements included the Cohen-Mansfield Agitation Inventory (CMAI) 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, 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; 1 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 1 fall (P = 0.08). The total number of falls in the placebo group
was 88 compared to 46 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 the behavior 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. No adverse events were reported.
The
authors conclude 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 sooth anxiety and
agitation, which may play a role in reducing falls. Lavender's previously
demonstrated stabilizing effects on balance may also be a factor. They also
suggest that the relationship between lavender stimulation, tranquilizers, and
Yokukansan warrants further investigation.
In
the final analysis though, only 2 of the 145 subjects incurred injurious falls;
this study was not large enough to detect clinically relevant reductions in
injurious falls. The study is also limited by its potential lack of adequate
blinding, which could have resulted in reporting biases; and there is also the possibility
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 in the community. 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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