1. 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

2. 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

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

4. 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

5. 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

6. 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 –
Begin to die – 25

7. 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

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

9. 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

10. 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

11. 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

12. 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.

13. 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

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

15. 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 sq ft
Diffusers w/ max output of 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 $24/ btl

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

17. Restlessness/Wandering
Results – secondary
Age
Restlessness/Wandering
Anxiousness
Angry
Agitation p=
p= 1.0 p=
p= *
Gender p= p=
p= 0.503

18. 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]

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

20. 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