Use of Aromatherapy in End of Life Care

The use of aromatherapy in hospice settings seems a perfect fit.  The non-invasive nature of aromatherapy, coupled with its minimal side effects, is ideal in end of life care. 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 depression, anxiety, or lack of energy, and aromatherapy can help promote a sense of well-being. While aromatherapy cannot prolong life or cure a terminal illness, it can help make the situation more bearable for those involved.

Introduction

As the population ages, there is a corresponding increase in the need for hospice and end of life care. Facilities that cater to this special segment of the population are poised on the cutting edge of aromatherapy research. With significant growth in cancer and other long-term illnesses, the need for comfort and dignity takes center stage. Faced with their own approaching mortality, it is sometimes a challenge to keep patients’ attitudes positive while preparing them for the end of life.

Aromatherapy is proving to be a valuable tool in hospice care, not only for patients but also for family members and staff. Let’s define aromatherapy’s role and explore current research, noting improvements or future opportunities which can benefit all involved in end-of-life care. We’ll discuss aromatic interventions which are known to work and how to administer them in a hospice setting.

It’s important to define some terms to provide a basis for understanding the role aromatherapy can play in hospice care. 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). Hospice care refers to a facility or home-visiting nursing staff who provide comfort, care and pain management to individuals in their final stages of life (Rahim-Jamal et al., 2011).

People who are terminally ill have a different set of needs than those who are anticipated to get well (Hayes, M., 2015). These 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. As family members sometimes become overwhelmed with the challenges of caring for someone with a terminal diagnosis, individuals sometimes are forced to make the difficult choice to leave their home and move into a facility that is equipped to deal with their many concerns. Because patients may feel undervalued as their emotional health is increasingly left in the hands of hospice staff, 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).

In order to serve both patients and their families, nurses bear a double burden. The use of aromatherapy can be a lovely option for them to share with their charges during this difficult time in their lives. Providing patients with an easy-to-use option to help manage their own health can be empowering to them. This is especially true in the last stage of life where comfort and a positive mental attitude play a large part in preserving patient dignity (Zollman and Vickers, 1999).

There are some concerns, however, relating to the use of aromatherapy in the hospice 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 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.

Another hurdle to overcome is patients’ perception of their disease state. When patients choose complementary options like aromatherapy for relaxation or pain relief, they sometimes fear that by rejecting further medical interventions such as radiation or chemotherapy, they are hastening their decline. However, it should be made clear to patients that they are not wrong if they make this choice. Hospice staff need to be aware of the tendency of patients to internalize responsibility and should work to dissuade patients from this notion (Zollman and Vickers, 1999).

Discussion

There is a body of evidence which supports use of complementary/alternative medicine (CAM) therapies in hospice care, including massage, acupuncture, 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,  during gentle exercise (Jensen et al., 2013), 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 a hospice environment, with some of the ultimate goals being to reduce anxiety and depression. Bergamot, cedarwood, geranium, grapefruit, lavender, lemon balm (melissa), neroli, patchouli, black pepper, Roman chamomile, rose and ylang ylang are among those mentioned in various research studies. For example, bergamot is noted to be useful in reducing feelings of anxiety. Black pepper is helpful for muscular aches and reducing pain (Hayes, M., 2015, ACHS, 2015). When pain is relieved, patients are better equipped to deal with emotional issues. Cedarwood and patchouli essential oils are considered grounding and their deep, rich scents promote relaxation (ACHS, 2015). Geranium, known as a balancing oil, is well respected for its anti-depressant properties. When used in a massage, room mist, or aroma patch, geranium can be helpful in boosting mood. In a recent study conducted on rats, anxiety-indicating behavior was reduced when geranium was used as the rats performed a series of tests in an uncomfortable environment (Salvenson, 2009).

Lavender is well known for its relaxation effect and is often used in beauty and spa products, and these properties can be valuable in the hospice setting. Lavender is usually well tolerated and when used in a simple hand or arm massage has demonstrated improvement in patients’ perception of well being (Hayes, M., 2015, Buckle, 2003). Rose has been shown in laboratory studies to improve concentration and can also can provide a measure of protection against the oxidative stress associated with depression and anxiety (ACHS, 2105). Finally, ylang ylang has been shown to produce a reduction in systolic blood pressure. (ACHS, 2015) Since anxiety can adversely affect blood pressure, ylang ylang can be a valuable tool to assist individuals in healthy blood pressure support.

Essential Oil Therapeutic Properties Method of Use
Bergamot Anxiolytic, antidepressant Inhalation
Cedarwood Relaxing, sedative, calming Inhalation
Geranium Balancing, antidepressant Inhalation
Lavender Relaxing, calming Massage, inhalation
Neroli Uplifting, calming Massage, inhalation
Patchouli Relaxing, sedative Inhalation
Pepper (Black) Reduces pain Massage
Roman Chamomile Antispasmodic, relaxing Massage, inhalation
Rose Improve concentration Massage, inhalation
Ylang Ylang Reduce systolic blood pressure Massage, inhalation

(ACHS, 2015)

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.

Conclusions and Recommendations

There is a growing body of evidence that suggests aromatherapy is helpful in situations where the risks of emotional and mental distress exist. Hospice care in particular deserves a close look as patients often experience significant stress during the last few weeks or months of their lives. 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, lemon balm (melissa), neroli, patchouli, black pepper, Roman chamomile, rose and ylang ylang.

Although some studies exist, more randomized controlled trials (RCTs) and other quantitative studies are needed in order to validate the benefits of essential oil use with hospice patients (and their families) as they near the end of life. It is RCTs that drive the legitimacy of treatments using aromatherapy and validate the work of Aromatherapists. The hospice industry needs collaboration with aromatherapists to provide training and education in order to better serve their patients.

To this end, the following recommendations would be beneficial:

  • Hospice care facilities can incorporate aromatherapy in subtle yet effective ways such as through the use of diffusers throughout the facility (or passive diffusion with aroma patches to reduce family or staff exposure) using a selection of essential oils that are known to reduce anxiety and/or depression.
  • Allow for additional pilot studies and RCTs to be performed within hospice care facilities.
  • Include specialized training with aromatherapy for staff and family members to promote emotional wellness for individuals nearing the end of their lives.
  • Surveying patients, staff and family members can provide better insights into changes in emotional states and coping mechanisms with the use of aromatherapy.

Let’s discuss how we can continue to make strides toward greater implementation of aromatherapeutic therapies in hospice settings. Do you have fresh, new ideas? We’d love to hear from you and discuss more regarding this promising area of aromatherapy. Please leave your comments here or contact us at info@aromabridge.org and be sure to follow us on Facebook

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

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4 thoughts on “Use of Aromatherapy in End of Life Care

Add yours

  1. Hi Christina & Sue,
    I wanted to reach out and applaud you article!
    I would love to share this with my network of nurses.
    Do you have any guidelines around sharing I need to know about?
    I look forward to getting to know you and Sue more!
    JODI

    Jodi Baglien, CA, CST
    Aromatherapy + Training + Consulting
    612-802-9483
    [Jodi Baglien logo aroma_w_web_ for email]

    Liked by 1 person

    1. Hi Jodi, Thanks so much for your kind words, we appreciate it very much. We are also looking forward to more conversations & working with you!! No special guidelines, we only ask that you provide the link to aromabridge ~Christina

      Like

    1. Thank you, Madeleine, for this wonderful resource! Not only is it an amazing reference, but it has the potential to make such an impact. I appreciate your kind words! Blessings ~Christina

      Like

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