Evaluation of the Effectiveness of Diffused Lavender in an Adult Day Care Center Presenter Sue Leger-Krall, ARNP, PhD River Garden Hebrew Home Jacksonville, Florida

Collaborative effort between University of Florida, River Garden Hebrew Home and Baptist Medical Center Robin Moorman Li, PharmD, BCACP, University of Florida, College of Pharmacy Sue Leger - Krall, ARNP, PhD, Director of Home and Community Based Services Anna Orman, MD, Medical Director, River Garden Hebrew Home Brian Gilbert, PharmD candidate, University of Florida, College of Pharmacy

Speaker Disclosures Dr.’s Krall, Li, Orman, and Brian Gilbert have disclosed that they have no relevant financial relationships.

Learning Objectives By the end of the session, participants will be able to: Objective 1 – understand the basics of essential oils Objective 2 – discuss the use of lavender [lavandula agustifolia] essential oil as an intervention modality for behavioral issues seen in clients with dementia Objective 3 – evaluate the effectiveness of using essential oils as alternatives to pharmaceuticals for common behavioral issues seen in clients with dementia

Essential oils – basics Essential oils – the volatile liquids distilled from plants [including seeds, bark, leaves, stems, roots, flowers, fruit, etc] highly dependent on “conditions” – soil, fertilizer use, geographical region, climate, time of harvest, etc Highly dependent on methods of distillation and manufacturing [pure, therapeutic grade according to international standards] Currently no standardization required in US – FDA does not review YL sends oils regularly to Europe [AFNOR / ISO / EC – all correspond to each other AFNOR – Association Francaise de normalization ISO – International Standardization Organization – Switzerland ER – European Commission

Essential oils – basics All oils have chemical constituents [identified by Gas Chromatography] Hydrocarbons – monoterpenes, sesquiterpenes, diterpenes oxygenated compounds – esters, aldehydes, alcohols, phenols, oxides well known “constituents” Monoterpenes: d – limonene [citrus oils] Esters: lavender, chamomile Phenols: peppermint Oxides: eucalyptol Freq – measurable rate of elect energy All things have electrical frequencies from low range to hi – oils, food, human body, XR’s Healthy human brain – 71-90 Healthy human body – 62-68 Sickness – 58- 42 Begin to die – 25

Essential oils – basics each constituent has specific properties Antiseptic – pine, thyme Antibacterial – thyme, cloves Antiviral – melissa, citrus oils Analgesic - wintergreen [99% methyl salicylate-cortisone affect] Expectorant –eucalyptus Sedating – lavender

Essential oils – basics All oils have measurable electromagnetic frequencies [measured in Hz or MHz] that can affect frequencies of human cells Human brain 72-90 MHz Human body 62-68 MHz Cold symptoms 58 MHz Cancer 42 MHz Near death 25 MHz Processed / canned food 0 MHz Fresh produce up to 15 MHz Fresh herbs 20-27 MHz Essential oils 52-320 MHz Bruce Tainio – BioTechnologies – dev equip to measure biofreq of humans/ foods/ oils ORAC - antioxidant score

Essential oils – basics All oils absorbed into cells Topically – through skin [neat or with carrier oil] Aromatic – inhalation* * odor passes through olfactory bulb to olfactory tract to various structures of brain including Amygdala – anticipates pain, perceives threat, stores/ releases emotional trauma Entorhinal cortex – processes stimuli to send to hippocampus [long term memory] Hypothalmus [ANS / hormones] Cingulate gyrus – [B/P, HR, attention] Orally – needs the designation GRAS generally regarded as safe

Essential oils – history Essential oils – mankind’s 1st medicines Ancient texts found in China, Egypt, Arabia and Holy Land record specific oils used in healing [Spice route] long history of use in traditional medicine in Europe even up to modern times [lavender in WW 2] Renewed interest in blending “eastern” modalities with “western” medicine as patients demand wholeness / holistic approach to their care 1998 – National Center for Complimentary/ Alternative Medicine [CAM] Reason for increased interest in CAM - Hi costs of traditional approach Increased “medicalization” of care ie OB Highly educated people able to access online information Increased “issues” w/ mainstream Rx ie antibiotic resistance and super bugs Hippies of ‘60’s “like” natural approach  – yoga, relaxation, natural foods

Essential oils - con’t Most major medical centers have some type of CAM program Cleveland Clinic – Integrative Therapies Program – have trained RN to use aromatherapy with essential oils Scripps Center for Integrative Medicine Center – focus on complimentary medicine including use of essential oils Vanderbilt University Medical Center – 2011 study done in ER using essential oils Cancer Treatment Centers of America

Motivation for the study Dementia related behaviors – can be difficult for families, staff and the person Focus of licensing / accrediting agencies and Feds / CMS – reduction in use of antipsychotic meds Increased use of person centered approaches to manage dementia specific behaviors Lavender recommended in the literature to reduce stress and anxiety.

Purpose and objectives Primary purpose – evaluate the effectiveness of diffused lavender oil to reduce incidences of restlessness/ wandering, anxiousness, agitation and anger. Secondary purpose – to evaluate differences between age groups / gender in regards to reduction in above incidences

Sample 23 Participants – [all enrollees who attended adult day program] 15 female 8 male Age range 73- 98; 60% 73-85 40% 85-98 Race – 22 Caucasian, 1 African American Data collection – 4 month period [2 months pre intervention, 2 months intervention]

Methods Prospective observational study IRB approved [Baptist and University Florida] 60 days observation, then 60 days observation with diffused lavender [M–F] Lavender diffused twice /day for 20 min in each of 3 ADP “sections” of room space 3 sections of room – each approx 900-1200 sq ft Diffusers w/ max output of .75-1.3 ml/15 min of use … 2x.day diffusion =approx 3 cc [2.6 cc] x 5days = 15 and 1 btl =15 cc week Each room – 4 btls / month x 3 rooms =12 btls /month x 2 months – 24 btls [bought 30 btls @ $24/ btl

Results – primary Pre-Intervention Restlessness/Wandering Post-Intervention N = 343 N= 282 p= 0.8438 Anxiousness N= 5 N= 0 p= 1.0 Anger N= 10 N= 5 p= 0.50 Agitation N= 129 N= 25 p= 0.0010 * Stat signif – probability that results are not d/t “chance”

Restlessness/Wandering Results – secondary Age Restlessness/Wandering Anxiousness Angry Agitation p= 0.9301 p= 1.0 p= 0.7510 p= 0.0414 * Gender p= 0.5372 p= 0.7628 p= 0.503

Discussion Use of diffused lavender showed stat diff between agitation incidences pre to post intervention. Also stat diff seen in agitation in younger age group [70-85] No stat diff seen pre/ post intervention for other behaviors [anxiousness, restlessness/ wandering, and anger]

Limitations Small sample size N=23 Observer bias/ subjectivity Client drop out Diffusing intervals

Future Replicate the pilot study with larger sample size ie on Memory Care unit Increase timing of oil diffusions and also intervals Add qualitative component to capture feedback from families and staff