feature article effect of aromatherapy massage on...

9/8/2016 Effect of Aromatherapy Massage on Agitation and Depressive Mood in Individuals With Dementia

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Effect of Aromatherapy Massage on Agitationand Depressive Mood in Individuals WithDementia

Journal of Gerontological NursingSeptember 2016 Volume 42 · Issue 9: 3846Posted June 20, 2016

DOI: 10.3928/009891342016061503

Abstract

FEATURE ARTICLE

YaPing Yang, PhD, RN; ChiJane Wang, PhD, RN; JingJy Wang, PhD, RN

The current study examined the effects of aromatherapy massage on alleviating agitation anddepressive mood in individuals with dementia. A randomized controlled trial and repeatedmeasures design was conducted. A total of 59 participants were randomly assigned tointervention or control groups. The intervention group received aromatherapy massage once perweek for 8 weeks. Results indicated no significant changes over time in overall agitation foreither group, but agitation decreased from Week 1 to Week 5 for the intervention group. Inaddition, the overall depressive symptoms decreased significantly over time for the interventiongroup compared to the control group (p < 0.001). However, changes in agitation within 24 hoursfollowing aromatherapy massage showed some significant changes in Weeks 5 and 9.Aromatherapy massage can be an effective and safe intervention to alleviate specific agitatedbehaviors and depressive mood in individuals with dementia. [Journal of GerontologicalNursing, 42(9), 38–46.]

With the increasing aging population, dementia has become a public health problem worldwide.Behavioral and psychological symptoms of dementia (BPSD) are common in individuals with differenttypes of dementia. Studies have shown that BPSD are experienced by 12% to 74% of patients withAlzheimer's disease (Aalten et al., 2007; Ballard & Oyebode, 1995; Ropacki & Jeste, 2005). AmongBPSD, several agitative behaviors may result from dementia. Individuals with dementia may sometimesbehave aggressively, particularly those with moderate to severe dementia, which can be distressing forthe individual and caregiver. In studies conducted between 2005 and 2014, agitative behaviors werereported to occur in approximately 30% of individuals with dementia in American studies and 28.9% to71.4% of individuals in Taiwanese studies (Enache, Winblad, & Aarsland, 2011; Ford, 2014; Fuh, Wang,& Cummings, 2005). In addition, studies from the United States and Taiwan from 2002–2011 showed thatdepressive symptoms occurred in 20% to 32% and 39.1% to 70% of individuals with dementia,

respectively (Enache et al., 2011; Fuh et al., 2005; Lyketsos et al., 2002). Along with agitative behaviors,

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respectively (Enache et al., 2011; Fuh et al., 2005; Lyketsos et al., 2002). Along with agitative behaviors,depressive mood is a major cause of caregiver burden (Lin & Wang, 2008; Moyle, Murfield, O'Dwyer, &Van Wyk, 2013).

Psychotropic medications are widely used to manage agitation and depression in individuals withdementia. However, these medications have limited effects, a number of side effects, and a relativelyhigh cost, thus making them less attractive for health care providers. Therefore, nonpharmacologicalstrategies have been recommended to manage these behaviors and symptoms (Enache et al., 2011;WoodMitchell, James, Waterworth, Swann, & Ballard, 2008). Among the various complementarytherapies, massage and aromatherapy are commonly used and seen as relatively noninvasiveprocedures for managing a variety of symptoms (Holt et al., 2003).

Suzuki et al. (2010) conducted a randomized controlled trial of a 6week massage program in individualswith dementia and assessed its physical and psychological effects. The results showed that massagereduced aggressive behaviors and stress levels in these individuals, but did not affect emotionalfunctions. A systematic review of massagerelated studies (Moyle et al., 2013) discovered that only onestudy among 13 was considered to have adequate methodological quality, as based on the ValidityRating Tool. The study found that massage significantly reduced patients' agitated behaviors (HollidayWelsh, Gessert, & Renier, 2009). More recently, Moyle et al. (2014) conducted a randomized controlledtrial using 10minute foot massage versus quiet presence once daily during weekdays for 3 continuousweeks. They found that foot massage could promote relaxation and improve mood in individuals withdementia.

The positive effects of aromatherapy in patients with dementia were evidenced in some studies but notall. According to several systematic reviews (Forrester et al., 2014; Fung, Tsang, & Chung, 2012; Holt etal., 2003), aromatherapy not only reduced agitation and improved sleep but also reduced disturbedbehaviors and facilitated desirable behaviors. However, O'Connor, Eppingstall, Taffe, and van der Ploeg(2013) found that pure lavender oil had no discernible effect on affect and behavior in individuals withdementia residing in nursing homes. Snow, Hovanec, and Brandt (2004) found that use of a purelyolfactory form of aromatherapy to decrease agitation in individuals with severe dementia is not practicaldue to impaired olfactory sense in these patients; therefore, cutaneous application is needed to interpretthe effects of aromatherapy in individuals with dementia in previous controlled studies. Thus,aromatherapy in use with massage may strengthen the natural therapeutic properties of essential oilsand healing power of massage therapy (Clarke, 2008).

Aromatherapy massage is believed to increase oxygenation and nutrients of cells and tissue and releaseendorphins, which promote physical and mental relaxation (Clarke, 2008). Aromatherapy massage alsohas the potential to enhance comfort, sleep, and relaxation; provide immunological benefits (Rho, Han,Kim, & Lee, 2006); reduce levels of agitation (HollidayWelsh et al., 2009); and alleviate anxiety (Rho etal., 2006). However, evidence to support the effectiveness of aromatherapy massage for agitation anddepressive symptoms in individuals with dementia is limited. Only two studies involving botharomatherapy and massage have been identified. The first study conducted aromatherapy massagetwice per week for 3 weeks, and agitative behaviors were only observed twice (i.e., in two afternoons)during this period. Results showed that the intervention decreased agitative behaviors that occurredbetween 3:00 and 4:00 p.m. Sample size was too small for demonstrating statistical significance, witheach group having only seven participants (Smallwood, Brown, Coulter, Irvine, & Copland, 2001).Another study compared effects of medication, aromatherapy massage, and placebo on agitation,emotion behaviors (e.g., depression, dysphoria, anxiety, euphoria), and quality of life. Melissa oil (i.e.,

lemon balm) was rubbed on participants' faces and hands twice daily for 1 to 2 minutes for 12 weeks



MethodSample and Setting

Data Collection and Protection of Human Subjects

lemon balm) was rubbed on participants' faces and hands twice daily for 1 to 2 minutes for 12 weeks(Burns et al., 2011). The results showed that the occurrence of agitation and depression did notsignificantly decrease in the aromatherapy massage group. Although both studies applied aromatherapymassage to manage agitation behaviors and depressive mood, small sample size and dosage werelimitations. Additional scientific evidence of aromatherapy massage to manage agitation behaviors anddepressive mood in individuals with dementia must be gathered using randomized controlled trials(Forrester et al., 2014; Fung et al., 2012; Yim, Ng, Tsang, & Leung, 2009). Therefore, the current studyexamined the effectiveness of aromatherapy massage on alleviating agitative behaviors and depressivemood in individuals with dementia.

The current randomized controlled trial comprised individuals with dementia residing in fivelongterm care facilities in Taiwan. Participants with mild to severe dementia based on the ShortPortable Mental Status Questionnaire (score ≤8) (SPMSQ; Pfeiffer, 1975) or MiniMental StateExamination (score ≤17 for those with a high school education and ≤23 for those with a highschool education or higher) (MMSE; Folstein, Folstein, & McHugh, 1975; Guo et al., 1988) wererecruited. Of these individuals, those who demonstrated agitation or depressive symptoms in thepast 2 weeks as reported by caregivers using the Chinese version of the CohenMansfieldAgitation Inventory (CCMAI; Lin, Kao, Tzeng, & Lin, 2007) and Cornell Scale for Depression inDementia–Chinese Version (CSDDC; Lin & Wang, 2008) were included in the study.Individuals with dementia were excluded if the severity of their behavioral problems prohibitedinteraction with the researcher.

Individuals with dementia were randomly assigned to the control or intervention groups througha randomized block technique performed by the researcher (i.e., intervener [J.J.W.]). Datacollectors (i.e., caregivers) were blind to participant allocation. The sample size was estimatedusing Gpower 3.1. To achieve 20% effect size and 80% power for significance at an alpha levelof 5% while considering a 20% dropout rate for a trial with repeated measures design (Cohen,2013), at least 51 participants were needed.

After receiving approval from the participating university's institutional review board, theresearcher contacted the administrators of five longterm care facilities. The directors of thefacilities referred individuals with dementia based on the study criteria. Written informed consentwas obtained from the individuals with dementia or their surrogates. One staff member from eachstudy site (i.e., a nurse or supervisor of the nursing aide) collected data throughout the studyperiod. Staff data collectors were assigned by the nursing supervisor because they providedconstant, handson care to participants. They received consistency training prior to theobservation to minimize collection bias. Week 1 baseline data were collected using the CCMAI



Intervention

and CSDDC. The intervention group received aromatherapy massage for 8 continuous weeks,from Weeks 2 to 9. The main safety concerns with regard to essential oils are skin irritations,sensitizations, breathing difficulties, and oral toxicity (Clarke, 2008). However, most essentialoils available to aromatherapists present no problems, and lavenders, matricaria chamomila(German chamomile), and orange oil are especially safe and useful for relaxation. The outcomemeasurements were collected at Weeks 5 and 9. The day after aromatherapy massage, staff datacollectors were asked to rate the change in agitation using the 24hour CCMAI at Weeks 2, 5, and9.

Control and intervention groups participated in regular activities (e.g., group singing, watchingmovies) in the longterm care facilities. Based on a previous review study (Forrester, 2014),interventions were performed twice per day to once per week from 3 to 12 consecutive weeks.Through an expert review, 30 minutes of aromatherapy massage once per week for 8 continuousweeks was deemed appropriate for the intervention group. To address concerns about participantsin the control group not receiving the intervention, aromatherapy massage was provided to theseindividuals after completion of the study to receive additional feedback. Aromatherapy massagewas performed by trained research assistants. Two research assistants (Y.P.Y. and other)completed a 1day aromatherapy massage course taught by a certified aromatherapist. Theconsistency of massage techniques used by each research assistant was evaluated by sevenvolunteers who received the massage intervention. The aromatherapy massage technique andprocedure are described in Table 1.



Measurements

Table 1:

Protocol for

Aromatherapy

Massage in the

Current Study

Demographic characteristics, including age, gender, educational level, marital status, religiousbelief, presence of chronic disease, and psychiatric medication use, were collected. In addition,any changes in dosage of the psychotropic prescription over the course of the study period wererecorded.

The CCMAI was used to identify the level of agitation over the past 2 weeks. Participants wererated using 29 items related to a 7point frequency scale, ranging from 1 = never to 7 = severaltimes per hour. Internal reliability of the CMAI in longterm care facilities has been reported tobe 0.82 (CohenMansfield, Marx, & Rosenthal, 1989) with the Chinese version to be 0.7 (Lin,Kao, et al., 2007). Content validity was reported to be 0.99 by Lin, Kao, et al. (2007). Caregivers

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Data Analysis

ResultsDemographic Characteristics

were asked to rate the change in agitation following aromatherapy massage within 24 hours usingthe 24hour CCMAI. The researchers modified the scoring of the 24hour CCMAI to 1 =decrease, 2 = constancy, and 3 = increase.

The CSDDC was used to measure signs and symptoms of depression in participants over thepast 2 weeks using 19 items and five subscales: (a) moodrelated signs, (b) behavioraldisturbances, (c) physical signs, (d) cyclic functions, and (e) ideational disturbances. The internalreliability of the scale was 0.82, with content validity reported as 0.92 (Lin & Wang, 2008). Eachitem was measured on a 3point scale, where 0 = absent, 1 = mild or intermittent, and 2 = severe.After training with competency evaluation, the outcome measures were completed by thepatient's dayshift nurse or supervisor of nursing aides.

SPSS17 was used for descriptive analysis. A general linear model repeated measurement analysiswas used to determine the differences in outcome measures at three measurement times. Chisquare test was used to analyze changes of timely effects of aromatherapy massage in preferencesof each item of the 24hour CCMAI between the intervention and control groups.

A total of 61 individuals with dementia residing in five longterm care facilities were recruited.Two participants were hospitalized before data collection. The remaining 59 individuals wererandomly assigned into control (n = 30) or intervention (n = 29) groups. Participants were mostlyfemale (n = 36, 61%), ranging in age from 64 to 102 (mean age = 92, SD = 7 years). MeanMMSE score was 8.65 (SD = 6.7; range = 0 to 19), and mean SPMSQ score was 3.23 (SD = 2.7;range = 0 to 8). No significant differences in the degree of dementia or demographiccharacteristics were found between groups (Table 2). Fortyone (69.5%) participants werereceiving psychotropic medication; however, no difference in psychotropic medication use wasfound between groups.



Table 2:

Demographic

Characteristics

of Study

Participants (N

= 59)

Two participants in the intervention group withdrew due to discomfort after the firstaromatherapy massage session. One participant in the control group was discharged home inWeek 6. Fiftysix participants (control, n = 29; intervention, n = 27) completed the Week 9assessment (Figure). No adverse effect was reported by either staff or patients during theintervention period. No differences regarding demographic characteristics were found betweenparticipants who completed the 9week study and those who did not complete the study.Therefore, 56 individuals with dementia completed the 8week trial. Using a repeated measuresdesign, measurements were made at Weeks 2, 5, and 9 to test the effect of aromatherapy massage(93.1% power, p < 0.05).

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Outcome Measures of the Control and Intervention Groups Over Time

Figure.

Study

flow

chart.

Agitative Behaviors. No significant difference was noted between groups regarding overallagitation (Table 3). However, the frequency of overall agitation decreased from Week 1 to Week5 for the intervention group compared to the control group, but no additional change was noted atWeek 9. Significant changes were demonstrated in four specific agitative behaviors: grabbingonto people or things inappropriately (F = 6.51, p = 0.01) and eating or drinking inappropriatesubstances (F = 3.99, p = 0.048) decreased, whereas making strange noises (F = 4.19, p = 0.031)and negativism (F = 4.02, p = 0.031) increased.

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Table 3:

Outcome Measures

of the Control and

Intervention Groups

Over Time (N = 56)

Depressive Mood. Depressive symptoms decreased significantly over time for the interventiongroup compared to the control group (Table 3). Regarding the five subscales on the CSDDC,results showed moodrelated signs (F = 7.05, p = 0.001), behavioral disturbances (F = 12.3, p <0.001), physical signs (F = 14.27, p < 0.001), and cyclic functions (F = 6.47, p = 0.002) improvedsignificantly, but no significant change was found for ideational disturbances (F = 0.98, p =0.375). Therefore, four of the five subscales on the CSDDC showed decreases in theintervention group.

Timely Effect of Aromatherapy. Regarding the timely effect of aromatherapy massage,participants were assessed using the 24hour CCMAI on the day after aromatherapy massage inWeeks 2, 5, and 9 (Table 4). On the day after aromatherapy massage in Week 2, the number ofagitative behaviors in the control group increased significantly compared to the intervention

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Discussion

group (t = 2.36, p = 0.025). In Weeks 5 and 9, the number of agitative behaviors in theintervention group decreased significantly compared to the control group (t = −3.61, p = 0.001; t= −3.46, p = 0.002, respectively). However, in Week 9, the number of agitative behaviors in theintervention group remained constant compared to the control group (t = 2.42, p = 0.021). Afterthe intervention, the following changes in specific behaviors were demonstrated: constantunwarranted request for attention or help (χ = 5.99, p = 0.05), repetitive sentences or questions(χ = 7.9, p = 0.019), cursing or verbal aggression (χ = 8.27, p = 0.016), scratching (χ = 7.12, p= 0.028), and general restlessness (χ = 7.52, p = 0.023) decreased significantly in theintervention group in Week 5. However, only repetitive sentences or questions (χ = 6.02, p =0.049) decreased significantly in the intervention group in Week 9.

2

2 2 2

2

2

Table 4:

Changes in Agitation After

Aromatherapy Massage

According to the Chinese

Version of the 24Hour Cohen

Mansfield Agitation Inventory

The results of the current study showed that the occurrence of overall agitated behaviorsdecreased significantly in Week 5 compared to Week 1, but then remained unchanged in Week 9(i.e., there was no significant improvement over time). Regarding the timebased effects, thenumber of agitated behaviors decreased after aromatherapy massage in the intervention groupcompared to the control group. In addition, the overall instances of depressive symptomsdecreased significantly over time for the intervention group compared to the control group. Theperceived benefit of aromatherapy massage was partially supported by a previous study(Smallwood et al., 2001), but the current larger sample provides more powerful evidence tosupport the effects of aromatherapy massage on managing agitated behaviors in individuals withdementia. However, the current study's findings are inconsistent with those of Burns et al. (2011);these differences may be attributed to different essential oil use, approaches, and dosages of

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aromatherapy massage. In sum, the randomized controlled trial design in the current studycompensated for the limitations of previous studies and provided robust scientific evidence on theeffectiveness of aromatherapy massage.

Regarding specific agitated behaviors, the results showed that the occurrence of grabbing ontopeople or things inappropriately and eating or drinking inappropriate substances decreased,whereas making strange noises and negativism increased over time. Although these currentfindings cannot be compared with previous studies, they are reasonable because the agitatedbehaviors of individuals with dementia fluctuate over time due to unmet personal andenvironmental needs (Algase et al., 1996).

Regarding time, the results showed the occurrence of constant unwarranted request for attentionor help, repetitive sentences or questions, cursing or verbal aggression, scratching, and generalrestlessness decreased within 24 hours after aromatherapy massage. Although more decreases inagitated behaviors were found in the intervention group in the current study, the fluctuatingresults with regard to specific agitated behaviors for individuals with dementia can be attributedto a variety of personal and environmental factors. For example, the small room size and lack of aventilation system during high temperatures in the summer at some longterm care facilities mayhave motivated some agitated behaviors. In addition, such agitated behaviors often occur becausepatients' needs are not met appropriately. According to Cerejeira, Lagarto, and MukaetovaLadinska (2012), unmet needs are commonly associated with irritability, a pervasive feeling ofunease in response to a sense of threat or actions, which can be expressed as rapid emotionalshifts, within seconds or minutes, due to hunger, sleepiness, pain, or other variables.

The current findings show significant decreases in overall depressive symptoms occurred overtime in the intervention group, consistent with the results of the study by Lin, Chan, Ng, and Lam(2007) in which an aroma diffuser was used for at least 1 hour during nightly sleep of individualswith dementia. However, the findings are inconsistent with other studies—one that used Melissaoil massage on individuals with dementia (Burns et al., 2011) and one that used carrier oilmassage in Korean older women (Rho et al., 2006), both of which found that aromatherapymassage could alleviate anxiety but not depression. These inconsistent findings may be due to thedifferences in the carrier oil used, procedure, and dosage.

Previous studies examining the effectiveness of aromatherapy using lavender oil demonstratedinconsistent findings. O'Connor et al. (2013) found that pure lavender oil had no discernibleimpact on affect and behavior in individuals with dementia residing in nursing homes. However,Lin, Chan, et al. (2007) found lavender to be an effective essential oil to alleviate agitation inChinese individuals with dementia. Although direct support as to whether the current study's



Limitations

Implications for Clinical Practice

Conclusion

References

Aalten, P., Verhey, F.R.J., Boziki, M., Bullock, R., Byrne, E.J., Camus, V. & Robert, P.H. (2007).Neuropsychiatric syndromes in dementia: Results from the European Alzheimer DiseaseConsortium: Part I. Dementia and Geriatric Cognitive Disorders, 24, 457–463.doi:10.1159/000110738 [CrossRef]

Algase, D.L., Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K. & Beattie, E. (1996).Needdriven dementiacompromised behavior: An alternative view of disruptive behavior.American Journal of Alzheimer's Disease and Other Dementias, 11, 10–19.doi:10.1177/153331759601100603 [CrossRef]

Ballard, C. & Oyebode, F. (1995). Psychotic symptoms in patients with dementia. InternationalJournal of Geriatric Psychiatry, 10, 743–752. doi:10.1002/gps.930100904 [CrossRef]

effects were from the lavender oil or massage remains unknown, it may be inferred from theresults that using aromatherapy with cutaneous massage may be an effective treatment forindividuals with dementia.

There were some limitations to the current study. First, it is difficult to distinguish the effects dueto aromatherapy and massage. Second, observations were based on a total period of 2 weeks, butthe agitated behaviors of individuals with dementia fluctuate over time, and thus the observersmay have missed certain behaviors. Third, aromatherapy massage was only performed once perweek for 8 continuous weeks, and this intervention dosage may not be adequate. Thus,comparisons of the three group designs (i.e., aromatherapy, massage, and control) ofaromatherapy massage with different dosages of intervention are options for future research.

The findings of the current study can be referenced by health care providers in longterm carefacilities working to plan more effective interventions to alleviate agitation and depressive moodsof individuals with dementia. Aromatherapy massage can be applied quickly to alleviate agitatedbehavior and planned as a regular activity to improve depressive moods in these individuals.

The effectiveness of nonpharmacological approaches to BPSD has been raised in support ofdeveloping more multidisciplinary teams to manage individuals with dementia; however, theeffects of aromatherapy massage remain inconclusive in the literature. Longterm care facilitieslack the ability and time to manage all instances of agitation and depressive moods of individualswith dementia. Thus, it is necessary to plan effective interventions to help health care providersaddress the issues they face in this regard.

http://dx.doi.org/10.1159/000110738

http://dx.doi.org/10.1177/153331759601100603

http://dx.doi.org/10.1002/gps.930100904



Burns, A., Perry, E., Holmes, C., Francis, P., Morris, J., Howes, M.J. & Ballard, C. (2011). Adoubleblind placebocontrolled randomized trial of Melissa officinalis oil and donepezil for thetreatment of agitation in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 31,158–164. doi:10.1159/000324438 [CrossRef]

Cerejeira, J., Lagarto, L. & MukaetovaLadinska, E.B. (2012). Behavioral and psychologicalsymptoms of dementia. Frontiers in Neurology, 3, 73. doi:10.3389/fneur.2012.00073 [CrossRef]

Clarke, S. (2008). Handling, safety and practical applications for use of essential oils. In Essentialchemistry for aromatherapy (2nd ed., pp. 231–264). Edinburgh, Scotland: Elsevier HealthSciences. doi:10.1016/B9780443104039.00008X [CrossRef]

Cohen, J. (2013). Statistical power analysis for the behavioral sciences. New York, NY: RoutledgeAcademic.

CohenMansfield, J., Marx, M.S. & Rosenthal, A.S. (1989). A description of agitation in a nursinghome. Journal of Gerontology, 44, M77–M84. doi:10.1093/geronj/44.3.M77 [CrossRef]

Enache, D., Winblad, B. & Aarsland, D. (2011). Depression in dementia: Epidemiology,mechanisms, and treatment. Current Opinion in Psychiatry, 24, 461–472.doi:10.1097/YCO.0b013e32834bb9d4 [CrossRef]

Folstein, M.F., Folstein, S.E. & McHugh, P.R. (1975). “Minimental state.” A practical method forgrading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi:10.1016/00223956(75)900266 [CrossRef]

Ford, A.H. (2014). Neuropsychiatric aspects of dementia. Maturitas, 79, 209–215.doi:10.1016/j.maturitas.2014.04.005 [CrossRef]

Forrester, L.T., Maayan, N., Orrell, M., Spector, A.E., Buchan, L.D. & SoaresWeiser, K. (2014).Aromatherapy for dementia. Cochrane Database of Systematic Reviews, 2, CD003150.doi:10.1002/14651858.CD003150.pub2 [CrossRef]

Fuh, J.L., Wang, S.J. & Cummings, J.L. (2005). Neuropsychiatric profiles in patients withAlzheimer's disease and vascular dementia. Journal of Neurology, Neurosurgery, and Psychiatry,76, 1337–1341. doi:10.1136/jnnp.2004.056408 [CrossRef]

Fung, J.K., Tsang, H.W. & Chung, R.C. (2012). A systematic review of the use of aromatherapy intreatment of behavioral problems in dementia. Geriatrics & Gerontology International, 12, 372–382.doi:10.1111/j.14470594.2012.00849.x [CrossRef]

Guo, N.W., Liu, H.C., Wong, P.F., Liao, K.K., Yan, S.H., Lin, K.P. & Hsu, T.C. (1988). Chineseversion and norms of the minimental state examination. Journal of Chinese RehabilitativeMedicine, 15, 52–59.

HollidayWelsh, D.M., Gessert, C.E. & Renier, C.M. (2009). Massage in the management ofagitation in nursing home residents with cognitive impairment. Geriatric Nursing, 30, 108–117.doi:10.1016/j.gerinurse.2008.06.016 [CrossRef]

Holt, F.E., Birks, T.P.H., Thorgrimsen, L., Spector, A., Wiles, A. & Orrell, M. (2003). Aroma therapyfor dementia. Cochrane Database of Systematic Reviews, 3, CD003150.doi:10.1002/14651858.cd003150 [CrossRef]

Lin, J.N. & Wang, J.J. (2008). Psychometric evaluation of the Chinese version of the Cornell Scalefor Depression in dementia. Journal of Nursing Research, 16, 202–210.doi:10.1097/01.JNR.0000387307.34741.39 [CrossRef]

http://dx.doi.org/10.1159/000324438

http://dx.doi.org/10.3389/fneur.2012.00073

http://dx.doi.org/10.1016/B978-0-443-10403-9.00008-X

http://dx.doi.org/10.1093/geronj/44.3.M77

http://dx.doi.org/10.1097/YCO.0b013e32834bb9d4

http://dx.doi.org/10.1016/0022-3956(75)90026-6

http://dx.doi.org/10.1016/j.maturitas.2014.04.005

http://dx.doi.org/10.1002/14651858.CD003150.pub2

http://dx.doi.org/10.1136/jnnp.2004.056408

http://dx.doi.org/10.1111/j.1447-0594.2012.00849.x

http://dx.doi.org/10.1016/j.gerinurse.2008.06.016

http://dx.doi.org/10.1002/14651858.cd003150

http://dx.doi.org/10.1097/01.JNR.0000387307.34741.39



Lin, L.C., Kao, C.C., Tzeng, Y.L. & Lin, Y.J. (2007). Equivalence of Chinese version of the CohenMansfield Agitation Inventory. Journal of Advanced Nursing, 59, 178–185. doi:10.1111/j.13652648.2007.04303.x [CrossRef]

Lin, P.W.K., Chan, W.C., Ng, B.F.L. & Lam, L.C.W. (2007). Efficacy of aromatherapy (lavandulaangustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: Acrossover randomized trial. International Journal of Geriatric Psychiatry, 22, 405–410.doi:10.1002/gps.1688 [CrossRef]

Lyketsos, C.G., Lopez, O., Jones, B., Fitzpatrick, A.L., Breitner, J. & DeKosky, S. (2002).Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: Resultsfrom the cardiovascular health study. Journal of the American Medical Association, 288, 1475–1483. doi:10.1001/jama.288.12.1475 [CrossRef]

Moyle, W., Cooke, M.L., Beattie, E., Shum, D.H., O'Dwyer, S.T. & Barrett, S. (2014). Footmassage versus quiet presence on agitation and mood in people with dementia: A randomisedcontrolled trial. International Journal of Nursing Studies, 51, 856–864.doi:10.1016/j.ijnurstu.2013.10.019 [CrossRef]

Moyle, W., Murfield, J.E., O'Dwyer, S. & Van Wyk, S. (2013). The effect of massage on agitatedbehaviours in older people with dementia: A literature review. Journal of Clinical Nursing, 22, 601–610. doi:10.1111/j.13652702.2012.04234.x [CrossRef]

O'Connor, D.W., Eppingstall, B., Taffe, J. & van der Ploeg, E.S. (2013). A randomized, controlledcrossover trial of dermally applied lavender (lavandula angustifolia) oil as a treatment of agitatedbehaviour in dementia. BMC Complementary and Alternative Medicine, 13, 315. doi:10.1186/1472688213315 [CrossRef]

Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organicbrain deficit in elderly patients. Journal of the American Geriatrics Society, 23, 433–441.doi:10.1111/j.15325415.1975.tb00927.x [CrossRef]

Rho, K.H., Han, S.H., Kim, K.S. & Lee, M.S. (2006). Effects of aromatherapy massage on anxietyand selfesteem in Korean elderly women: A pilot study. International Journal of Neuroscience,116, 1447–1455. doi:10.1080/00207450500514268 [CrossRef]

Ropacki, S.A. & Jeste, D.V. (2005). Epidemiology of and risk factors for psychosis of Alzheimer'sdisease: A review of 55 studies published from 1990 to 2003. American Journal of Psychiatry,162, 2022–2030. doi:10.1176/appi.ajp.162.11.2022 [CrossRef]

Smallwood, J., Brown, R., Coulter, F., Irvine, E. & Copland, C. (2001). Aromatherapy andbehaviour disturbances in dementia: A randomized controlled trial. International Journal of GeriatricPsychiatry, 16, 1010–1013. doi:10.1002/gps.473 [CrossRef]

Snow, L.A., Hovanec, L. & Brandt, J. (2004). A controlled trial of aromatherapy for agitation innursing home patients with dementia. Journal of Alternative and Complementary Medicine, 10,431–437. doi:10.1089/1075553041323696 [CrossRef]

Suzuki, M., Tatsumi, A., Otsuka, T., Kikuchi, K., Mizuta, A., Makino, K. & Saruhara, T. (2010).Physical and psychological effects of 6week tactile massage on elderly patients with severedementia. American Journal of Alzheimer's Disease and Other Dementias, 25, 680–686.doi:10.1177/1533317510386215 [CrossRef]

http://dx.doi.org/10.1111/j.1365-2648.2007.04303.x


http://dx.doi.org/10.1001/jama.288.12.1475

http://dx.doi.org/10.1016/j.ijnurstu.2013.10.019

http://dx.doi.org/10.1111/j.1365-2702.2012.04234.x

http://dx.doi.org/10.1186/1472-6882-13-315

http://dx.doi.org/10.1111/j.1532-5415.1975.tb00927.x

http://dx.doi.org/10.1080/00207450500514268

http://dx.doi.org/10.1176/appi.ajp.162.11.2022


http://dx.doi.org/10.1089/1075553041323696

http://dx.doi.org/10.1177/1533317510386215



WoodMitchell, A., James, I.A., Waterworth, A., Swann, A. & Ballard, C. (2008). Factorsinfluencing the prescribing of medications by old age psychiatrists for behavioural andpsychological symptoms of dementia: A qualitative study. Age and Ageing, 37, 547–552.doi:10.1093/ageing/afn135 [CrossRef]

Yim, V.W.C., Ng, A.K.Y., Tsang, H.W.H. & Leung, A.Y. (2009). A review on the effects ofaromatherapy for patients with depressive symptoms. Journal of Alternative and ComplementaryMedicine, 15, 187–195. doi:10.1089/acm.2008.0333 [CrossRef]

Authors

Received: December 07, 2015Accepted: May 26, 2016Posted Online: June 20, 2016

Abstract

Article

Dr. Yang is Assistant Professor, Department of Nursing, Chang Jung Christian University, TainanCity; Dr. J.J. Wang is Professor, Institute of Allied Health Science and Department of Nursing,and Dr. C.J. Wang is Associate Professor, Department of Nursing, College of Medicine, NationalCheng Kung University, Tainan, Taiwan.

The authors have disclosed no potential conflicts of interest, financial or otherwise. The studyreceived financial support from the Ministry of Science and Technology of Taiwan (NSC1022314B006062MY2). The study has been registered with ClinicalTrials.gov (NCT02126059).

Address correspondence to JingJy Wang, PhD, RN, Professor, Institute of Allied Health Scienceand Department of Nursing, College of Medicine, National Cheng Kung University, 1 UniversityRoad, Tainan City, 701 Taiwan; email: [email protected].

Copyright 2016, SLACK Incorporated

10.3928/009891342016061503

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The current study examined the effects of aromatherapy massage on alleviating agitation anddepressive mood in individuals with dementia. A randomized controlled trial and repeated measuresdesign was conducted. A total of 59 participants were randomly assigned to intervention or controlgroups. The intervention group received aromatherapy massage once per week for 8 weeks.Results indicated no significant changes over time in overall agitation for either group, but agitationdecreased from Week 1 to Week 5 for the intervention group. In addition, the overall depressive

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