Aromatherapy

Aromatherapy is a centuries-old complementary therapy that uses fragrant essential oils from plants such as lavender, lemon balm, and cedar to promote health and wellbeing. These oils can be applied directly to the skin or infused into the air using a diffuser or burner. Aromatherapy is popular with patients and health professionals, especially in the context of birth [1] and at the end of life where it is thought to reduce pain and anxiety. [2] It is generally considered safe with no harmful side effects.

This evidence theme on aromatherapy is a summary of one of the key topics identified by a scoping review of dementia research. If you need more information on this topic, try using the PubMed search below.

We found four systematic reviews that examined the impact of aromatherapy on responsive behaviours, agitation, quality of life, mood and the thinking of people living with dementia. Overall, these reviews concluded that there is no evidence that aromatherapy affects: 

• Quality of life
• Mood
• Sleep
• Thinking processes [3]
• Resistance to care [4]
• Agitation [5]

There is also conflicting evidence for the effectiveness of aromatherapy in reducing responsive behaviours such as aggression and agitation. [6-8] Furthermore, the reviews did not find any studies that had measured the harmful effects of aromatherapy. This leaves us unable to conclude that aromatherapy is always safe. 

Some reviews highlighted concerns about the methods used to assess the impact of aromatherapy. This may reduce the degree of certainty we might have about the benefits of aromatherapy overall. For example: 

• Studies differed in the types of aromatherapy oils they tested.
• Some studies only had a small number of participants.
• Studies did not report important information about how they were conducted.

Despite the lack of evidence supporting this therapy, aromatherapy can still have a place in the aged care setting. It could be used:

• To create pleasing aromas in the living environment
• As part of a personal massage session
• To create better social connections and opportunities for the person with dementia to communicate with others 
• To grant carers time to get to know a person with dementia.

It is important to check people’s preferences for aromatherapy before trying this approach. Some people with dementia may find certain scents pleasant and enjoy the sensation of having them massaged into their skin. Others may find them a physical irritant or too pungent. Certain scents might also trigger autobiographic memories of past experiences, good and bad, for some people. [9]

Aromatherapy is relatively inexpensive and may bring calm or pleasure to certain people with dementia. Its use in aged care settings might be justified on this basis, despite a lack of conclusive evidence of specific health or behavioural benefits. Organisations might, therefore:

• Support volunteers to provide aromatherapy safely, perhaps via short, gentle hand massages
• Provide guidelines to family and friends on how to safely provide aromatherapy. This activity can help visitors to feel they have a useful role when they are with their loved ones. It also supports continuing relationships between the older person and their family and friends.

1. Smith CA, Collins CT, Crowther CA. Aromatherapy for pain management in labour. Cochrane Database Syst Rev. 2011(7):Cd009215.
2. Candy B, Armstrong M, Flemming K, Kupeli N, Stone P, Vickerstaff V, et al. The effectiveness of aromatherapy, massage and reflexology in people with palliative care needs: A systematic review. Palliat Med. 2020;34(2):179-94.
3. Ball EL, Owen-Booth B, Gray A, Shenkin SD, Hewitt J, McCleery J. Aromatherapy for dementia. Cochrane Database Syst Rev. 2020;8(8):Cd003150.
4. Backhouse T, Dudzinski E, Killett A, Mioshi E. Strategies and interventions to reduce or manage refusals in personal care in dementia: A systematic review. Int J Nurs Stud. 2020;109:103640.
5. Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, et al. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technol Assess. 2014;18(39):1-226.
6. Ballard CG, O'Brien JT, Reichelt K, Perry EK. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: The results of a double-blind, placebo-controlled trial with Melissa. J Clin Psychiatry. 2002;63(7):553-8.
7. Burns A, Perry E, Holmes C, Francis P, Morris J, Howes MJ, et al. A double-blind placebo-controlled randomized trial of Melissa officinalis oil and donepezil for the treatment of agitation in Alzheimer's disease. Dement Geriatr Cogn Disord. 2011;31(2):158-64.
8. Wang G, Albayrak A, van der Cammen TJM. A systematic review of non-pharmacological interventions for BPSD in nursing home residents with dementia: From a perspective of ergonomics. Int Psychogeriatr. 2019;31(8):1137-49.
9. D'Andrea F, Tischler V, Dening T, Churchill A. Olfactory stimulation for people with dementia: A rapid review. Dementia (London). 2022:14713012221082377.