Purpose: This study was completed to provide evidence of effect for Lavender Angustifolia (Lavender) and Melissa Officinalis (Lemon Balm) essential oils as agitation managements for older people with and without a dementia diagnosis living in Residential Aged Care Facilities (RACFs). This research further sought to explore nurse understanding of agitation management and the viability for nurse administered essential oils for behaviour management in residents living in RACFs. Method: The research was a three-phase sequential design consisting of two phases of semi-structured nurse interviews and a single blind randomised controlled trial [RCT]. Phase I involved semi-structured interviews conducted with 11 nurse participants, focusing on their understanding of agitation management, including the use of essential oils, and their understanding of and attitudes toward the conduct of research in the RACF environment. Findings influenced pre-trial nurse education, timing of intervention and data collection procedures of the Phase II RCT to best support the nurse and the success of the research. Phase II consisted of a 2x3 factorial design single blind RCT that investigated 49 residents with a history of agitation. Participants were allocated to group 1 residents with a dementia diagnosis or group 2 residents without dementia, as determined by their MMSE score or dementia diagnosis. Each resident was randomised within the group to a treatment sequence of Lavender, Lemon Balm or placebo Sunflower oil using a computerised random number generator. All residents received all treatments and as such acted as their own control. The trial was conducted over a 10-week period with residents receiving two drops of the assigned treatment oil daily for two weeks followed by a two-week washout period before commencing the consecutive treatment. Post trial, Phase III, involved semi structured interviews conducted with 10 nurses to identify perceived changes in agitation identified on their ward and influencing factors that effecting the conduct of this research conducted in the RACF. Behavioural and quality of life data were collected using the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory (CMAI) and the Quality of Life-Alzheimer's Disease (QoL-AD) (Finkel et al. 1992; Smart, Hermann, & Lanctot, 2011; Thorgrimsen et al., 2014a). Content analysis used word and phrase frequency to organise qualitative data into key concepts and themes in Phases I and III. While SPSS statistical software version 23 (IBM Corp, 2015) was used to conduct within group and a between groups ANOVA in Phase II. Results: This research identified differences in essential oils effect on agitation in residents with dementia and without dementia. Further this study provided evidence for the factors that influence nurse compliance to research as well as the practicality for nurse administration of essential oils as agitation managements for residents in the RACF environment. Phase I: Nurse's identified various approaches to managing agitation in RACFs, the most frequently identified interventions being distraction (91%), providing space (64%) and medication (45%). More than two-thirds of nurses acknowledged agitation was managed differently in residents with and without a dementia diagnosis due to impaired communication (55%) or comprehension (55%). Nurses (50%) were supportive of research with barriers to compliance identified as demanding workload (50%), fear of reprisal (30%) and insufficient education on the research (20%). The provision of pre-trial nurse education (70%) was considered to facilitate compliance to research. Phase II: Despite reductions in agitation behaviours, Lavender or Lemon Balm did not significantly reduce agitation when compared independently to placebo. However, clinically significant difference was shown when Lavender and Lemon Balm treatments were compared in the effect difference between the with and without dementia groups on the NPI P=0.04, DF47 F(1, 4.39) Fc=4.05 and CMAI P=0.05 DF46.72 F(1,4.19) Fc=4.05. This significantly opposing difference is supported in the CMAI domain of physical aggressive behaviours P=0.02 DF47 F(1, 5.46) Fc=4.05 and NPI irritability P=0.02 DF37.56 F(1,5.65) Fc=4.11. A post hoc analyses demonstrates Lemon Balm to reduce NPI total agitation score P=0.02 DF35 T(1,5.61) Tc=2.03 and physical non-aggressive behaviours P=0.02 DF27 F(1,5.84) Tc=2.05 in residents without dementia when compared to Lavender and placebo. Lavender reduced physical non-aggressive behaviour in residents with dementia when compared to Lavender and placebo on post hoc analysis P=0.4 DF114 F(1,5.84) Tc=2.05. Lemon Balm was significantly less effective in reducing irritability in residents with dementia when compared to Lavender and placebo on post hoc analysis P=0.01 DF113 (1,7.75) Tc=1.98. Further a clinically significant reduction of physical non aggressive behaviour on the CMAI was demonstrated when the Lavender and Lemon Balm scores were combined in comparison to the placebo P=0.02 DF47 F(1,6.38) Fc=4.5. A clinically significant lower quality of life was reported in residents without dementia when compared to those with dementia independent of essential oil treatment QoL-AD P=0.03 DF34.23 F(1, 5.07) Fc=4.13. Phase III: The majority of nurses (90%) perceived essential oils had been effective in reducing agitation in the residents despite results of the single blind RCT revealing no significant effect. Half the nurses (50%) reported the oils were effective for some residents. This phase of the study also asked nurses to reflect on the process used to conduct this research project. The majority considered research process to be unobtrusive (60%), routinely timed (60%) with effective communication (40%) between researcher and nurses as positively support the research process in RACFs. Conclusion: These findings support a clinically significant opposing effect of the essential oils Lavender when compared to Lemon Balm in residents with dementia and without dementia. These results indicate that Lemon Balm may be effective in reducing agitation in residents without dementia and less effective in reducing irritability in residents with dementia. Further Lavender may be effective in reducing physical non-aggressive behaviours. Despite a reduction in the resident behaviour with treatment there was no clinically significant decline in agitation when Lavender or Lemon Balm was independently compared to placebo. Nurses maintained strong belief throughout the trial in the ability of the essential oils to reduce agitation in some residents. Facilitators of nurse compliance to research were identified as projects that provided research education were unobtrusive in the RACF environment, routinely timed with effective communication between researchers and nurses.
Date of Award | 2017 |
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Original language | English |
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- lemon balm
- lavenders
- essences and essential oils
- therapeutic use
- agitation (psychology)
- older people
- mental health
Lavandula Angustifolia and Melissa Officinalis for agitation management in older adults : a mixed method study
Watson, K. (Author). 2017
Western Sydney University thesis: Doctoral thesis