Effectiveness and Safety of Aromatherapy in Managing Behavioral and Psychological Symptoms of Dementia: A Mixed-Methods Systematic Review

Abstract

<b><i>Introduction:</i></b> Behavioral and psychological symptoms of dementia (BPSD) is the most prominent and distressing manifestation for older persons with dementia (PWD) and caregivers. Aromatherapy has demonstrated its effectiveness in managing BPSD in various studies. However, previous studies and systematic reviews have obtained inconsistent findings, and a review of qualitative studies is yet to be conducted. <b><i>Method:</i></b> A mixed-methods systematic review with a convergent segregated approach was performed to evaluate the effectiveness of aromatherapy in improving the BPSD and quality of life (QoL) of PWD and in relieving the distress and burden of caregivers, as well as its safety for PWD. Both published and unpublished quantitative and qualitative studies written in English and Chinese between January 1996 and December 2020 were retrieved from 28 databases, including MEDLINE, EMBASE, and Web of Science, based on the prespecified criteria. The methodological quality was assessed by using critical appraisal tools from the Joanna Briggs Institute. Quantitative synthesis, qualitative synthesis, and integration of quantitative and qualitative evidence were performed. <b><i>Results:</i></b> A total of 12 randomized controlled trials, 10 quasi-experimental studies, and 2 qualitative studies were included in the review. Some inconsistent findings regarding the effectiveness of aromatherapy in reducing the severity of BPSD were observed. Some studies reported that aromatherapy significantly improved the QoL of PWD and relieved the distress and burden of caregivers, promoted a positive experience among caregivers, and had very low adverse effects on PWD (with aromatherapy inhalation reporting no adverse effects). <b><i>Conclusion:</i></b> Aromatherapy, especially in the inhalation approach, could be a potentially safe and effective strategy for managing BPSD. However, more structuralized and comparable studies with sufficient sample size, adherence monitoring, and sound theoretical basis could be conducted to obtain conclusive findings.

Smellscape as a healing factor in institutional gardens to enhance health and well‐being for older people with dementia: A scoping review

“…This literature review demonstrates that even though knowledge in this area of research is limited, the available knowledge generally presents a promising approach to improving the health and well‐being of older people with dementia. The evidence obtained from many of scholars focusing on aromatherapy as an isolated sensory factor was used as a basis for this study, which predominantly examined individuals' peripheral symptoms, such as agitation and other behavioural symptoms (Fung et al., 2012; Herz, 2009; Li et al., 2021). Therefore, this study of garden smellscapes benefits from and complements the findings of aromatherapy research.…”

The Relationship between Aromatherapy and Mental Wellbeing: A Narrative Review

“…There is a wide range of behavioral and psychological symptoms experienced by patients with severe cognitive impairment (van der Linde et al, 2010;Cerejeira et al, 2012). Some research suggest positive effects of aromatherapy using balm oil with an overall improvement in agitation and quality of life parameters (Ballard et al, 2002;Li et al, 2021). Other research show a cognitive group-specific effect of Lemon Balm's ability to calm anxious behavior (Watson et al, 2019).…”

Need-based care in nursing homes : from evidence to integration in caregivers’ clinical decisionmaking

“…However, while being recommended as first-line treatment, the evidence on nonpharmacological interventions is only slowly surfacing and has a very limited body of knowledge (Woods et al, 2018). Systematic reviews on non-pharmacological treatments show only low to moderate effects on BPSD in people with dementia for music therapy (van der Steen et al, 2017;Moreno-Moralies, 2020), doll therapy (Ng et al, 2017), reminiscence therapy (Woods et al, 2018), aromatherapy (Li et al, 2021), animal-assisted therapy (Lai et al, 2019) and psychotherapy (Cheston & Ivanecka, 2017). Explanations for this limited amount of evidence are mainly inconsistent results, small sample sizes and other biases like selection bias, detection bias, attrition bias, reporting bias, performing bias, availability of training, supervision, manual or protocol and the lack of randomized controlled trials (RCT) with control groups (Woods et al, 2018;Li et al, 2021;Lai et al, 2019).…”