Aromatherapy and My Experience with Hospice Patients

by Jade Shutes

Written by: Robin Kessler

Graduate of our French Aromatherapy Certification Course

Introduction:

Five years ago I became an aromatherapist. I was always interested in alternative medicine and how it could help when conventional medicine failed or was too invasive or debilitating. I felt the earth had more to give us than the use of manufactured synthetic products. I made sure my family ate well and emphasized natural foods so they would grow up healthy and wise. I tried to follow my convictions but unfortunately I became sick with a blood disease and found I had to take prescription drugs as there was no other way to help me. Although I had no choice but to take the drugs, I did have a choice on how I was going to approach the pain I was having. I researched many methods before I came across the properties and potential of essential oils. I found by using the oils it greatly helped me with pain and with the stress I experienced. I learned how to use them correctly and safely and wanted to share that with friends and family. I decided I needed more and went to a renowned school in the field and became certified. Now mind you, I was 60 years old when I decided to go back to school. Never did I dream I could study again, let alone delve into the sciences; chemistry and physics but I got through it. I have taken many courses since getting my certification and I am now enrolled in several advanced training courses.

I worked with many people but I felt there was missing something. I saw an ad on line from the Stein Hospice Group in NJ looking for a trained Aromatherapist. I applied for and was awarded the position. I had to go through additional training as I was working with the terminally ill. This organization is extremely caring and decided to try Aromatherapy with their clients to help them and their families get through this difficult time of their lives. I am so glad they chose me to help them and I enjoy working with their team. They all have hearts of gold and really care about their clients.

People that need hospice are going down the last trail of life. Many have fears and anxiety of what is going to happen next. Many have Alzheimer’s disease or Dementia and cannot take care of themselves anymore. It is not just for those who are passing on. Aromatherapy is an excellent alternative as long as it is done safely. I learned that many of these organizations do not know how to use Essential Oils correctly. While their intent is to help patients, improper use can actually make it worse. This lack of adequate training has manifested itself in the use of the oils neat (undiluted) on people whose skin is very thin and cannot handle the intensity. Others are using Oils in diffusers but with the wrong dilution (too many drops). I have the ability and have chosen to help this hospice organization use the Oils correctly so as to provide the most effective care to these very special patients

How was I going to accomplish this?

I needed some direction and insight into this special client group. I went to my good friend and colleague Madeleine Kerkhof. Madeleine is a former nurse, an expert in the field, an educator in complementary nursing (aromatherapy, aquacare, massage, relaxation), especially in palliative care and care for the elderly and people with dementia. She has written an amazing reference book which I frequently refer to called “Complementary Nursing in End of Life Care, Integrative Care in Palliative Care”. The book is all about the usage of Essential Oils, CO2s and Carrier oils for those in Palliative Care and beyond. She describes how to use each oil and the methods of application. She is a caring wonderful person, who gives her all to everyone around her. I have developed a deep admiration for all she does.

Because I was going to work with many who do have Alzheimer’s disease, I needed to research which essential oils are better or not for this disease. I turned to Robert Tisserand, a leader in Essential Oil Research, for some of my answers. On his website (1) he found research that claims sniffing the Rosemary (Rosmarinus officinalis) herb can increase memory by 75%.

Researchers have found for the first time that essential oil from the herb when sniffed in advance enables people to remember to do things. The studies have shown that it increases alertness and enhances long term memory. On another one of his papers (2), English herbalist Nicolas Culpeper in 1652 wrote that rosemary “Helps a week memory and quickens the senses.” Researcher Mark Moss and Lorraine Oliver show how blood levels of 1,8 cineole correlates with improved cognitive performances. This research gave me more insight on the oils I was going to use to possibly help these patients.

What to expect:

Some patients with Alzheimer’s disease talk to themselves about their past experiences or find themselves living in the past and it can be quite frightening.

Prior to seeing residents, the Hospice sends me an intake form that gives me medical info, allergies they may have, likes and dislikes. This helps me evaluate what is needed and also helps me to decide what oils can be used safely. It is not easy trying to figure out what is needed for each individual. I first have to check to make sure that the selected oils will not negatively interact with or counter the effects of the medicines they are taking. I have to query the family members to determine if there is a smell they like or dislike. I have to be sure they are not allergic to any specific plant.

Case studies of a few of those I have worked with client (real name withheld for privacy): I was introduced to one such individual who I will call Lillie to protect her anonymity.

Lillie lived in Poland as a child. She lived near an orange farm and loved to sit in the fields to eat and smell the oranges. Unfortunately her family was taken away by the Nazis and put into a concentration camp. She was one captive away from being killed when the camp was liberated. She lost most of her family and immigrated to the USA. Later in life she developed cancer, and Alzheimer ’s disease and was placed in a nursing home and put in the care of Hospice by her family. The problem was that because of her disease she repeatedly regressed to the unhappy place in the far reaches of her memory. She had to be restrained for fear she would hurt herself and she constantly screamed and yelled about what happened to her when she was in the camp. Her hands were closely fisted and her face had a terrified look all the time. The cancer was taking over her body and she did not have much time left to live.

I wanted to find a way to refocus her so she could find the happy place in her memory allowing her to move on in peace. The blend I made contained Sweet Orange essential oil (Citrus sinensis) and Petigrain (Citrus aurantium var. amara) which was put into a diffuser. I made a stock blend in a 5ml bottle of half and half to fill the bottle using the drop by drop method. Citrus sinensis is a Monterpenes high in d-limonene. Its calming properties help settle anxiety.

I wanted to stimulate her senses and bring her back to the happy time in her life which hopefully would make her calmer and allow her to relax and let go to her final destination.. I researched sweet orange more and found studies (3) on Effect of sweet orange aroma on experimental anxiety in humans. 40 males were use in the study to see how tranquil it made them. In conclusion, it did help but more studies need to be made.

In another study, (4) sweet orange was diffused in a dental office. Studies show that it decreased anxiety and the mood of the patients while the sweet orange was diffused. Since this was an excellent choice and she loved the smell of oranges, it became part of this blend. Citrus aurantium var. amara which is rich in esters (linalyl acetate) and monoterpene alcohols (linalol) supported by monoterpenes.

As per the Referential Chart (based upon the work of Pierre Franchome and Daniel Penoel) it is calming, grounding and relaxing and lots of yin.

 

A study was performed (5) with 42 administrative university workers. They were put into different groups, seated in a room in front of a computer. They were given a specific task and petitgrain was diffused in the room while this was being done. The AG performed the web site task faster than the CG group. In conclusion it showed petitgrain may improve performances in the workplace by an autonomic balance on the sympathetic/parasympathetic system through a combined action of the petigrain main components (linalyl acetae, linalool and myrcene.) It also showed the combination of reducing the stress level in the participants.

After reading these studies I felt I had something that might just work for her. I put 3 drops of the blend into the diffuser and turned it on. I instructed the caregiver to put this on for a half hour- then turn it off for an hour. Due to the fact that as there is not always someone there, I recommended they do it as much as possible. I went back to the nursing home a few days later and found things did change. The nurses told me she stopped screaming and yelling and stopped lashing out. I asked if I could call in a few days and check to see how she was doing. Three days later I was told she stopped clinching her hands and relaxed them out and was actually smiling. 3 days later she passed, but I was informed it was quietly and in her sleep and very peacefully.

For those in private rooms I can use a diffuser like I did with Lilly but I give instructions to the caregiver on how and when to use it. Inhalers are great but most cannot hold it themselves and it is very hard to get the caregiver to get them to use it and many are not coherent enough to even try. A spray bottle works great because the caregiver can spray a pillow, linens and blankets.

Red is a male resident with Dementia who used to be a Barber. He is constantly agitated and confused. I talked to the family after I received his intake form to find out what smells he enjoyed. He really loved his work. He was a very polished man in his younger years. His nails were polished clear. His hair always combed properly and he loved masculine smells and wore a lot of masculine cologne. Even now, he has a bottle of Old Spice sitting on his dresser, his nails are always manicured properly and his hair brushed.

I also researched what smells are likely to be in a barber shop thinking if I made something close to what he enjoyed he might be less agitated and maybe a bit less confused. I used Vetiver (Vetiveria zizanioides) Cedar (Juniperus virginiana), Rosemary ct. verbenone (Rosmarinus officinalis) and Sweet Marjoram (Origanum marjorana L.).

Vetiveria zizanioides is used in a lot of aftershave lotions used when a man’s beard is shaved. In Ayurvedic medicine, (6) the incense and essential oil are used to cool the mind and improve concentration. The comforting, deep, woody, earthy and distinct aroma of this oil has made it a strict masculine fragrance in the perfume industry. Vetiver oil was recommended even for patients suffering from Yin deficiency, often ended up in a dissociative state of depression.

Vetiver is made up mostly of Sesquiterpenols, Sesquiterpenes and Ketones but very small percentage of Aldehydes and based on the Referential Chart is a combo of Yin, Relaxing, calming and grounding. Its therapeutic properties are CNS sedative, Anxiety, and depression and became an excellent choice for my blend.

Juniperus virginiana is made up of mostly sesquiterpenes and sesquiterpene alcohols with a very minor amount of monoterpenes in a-pinene. Virginian Cedar is often used as a reference for woody scents. Its aroma is mild, dry, light and fresh, with resinous, balsamic and earthy notes.

I looked up a GC/MS report and based on the ternary concept being that they are very calming and balancing I felt this would make a good mix to the blend.

Rosemary ct verbenone is rich in monoterpene, very high in a-pinene, a bit high in monoterpene alcohols, esters of bornyl acetate and ketones  (verbenone) and camphor with a small amount of oxides of 1,8 cineole. In the Ternary concept they are all over the place. It seems to be it has the Yin and the Yang, so it is warming, stimulating, relaxing and cooling. Rosemary verbenone is a softer, gentler version of the more common and pungent cineole variety. It has less camphor than Rosemary ct camphor or Rosemary ct 1,8 cineole. It is said to clear the mind transmits spiritual clarity and inner force which basically shows this on the Referential chart. Because of his age (way over 65) I wanted to give him some clarity but did not want the high Camphor the other two chemo types have. I checked a few places on the web and took some of the info from the Aromaweb site. (7)

Sweet Marjoram (Origanum marjorana L ) is rich in monoterpenes and. Monoterpene alcohols, a bit of sesquiterpenes and esters. It is used for the nervous system, stress, anxiety and irritability. It has mostly Yang and very electropositive effects which has a harmonizing action which would overall make the total blend fit together. I also wanted to make something more manly, with the therapeutic properties of this oil and after smelling it, it smelled not only woodsy but it had a spicy smell, which would even out the tones in the oils.

I put it together in a 5ml bottle 5 drops Vetiver, 10 drops Cedarwood, 4 drops Rosemary ct verbenone, 8 drops Sweet Marjoram using the drop by drop method until I liked the smell. I then instructed the caregiver to put 4 drops into his diffuser. I did not want to make a large amount just in case it did not work and this would give me the chance to change the formula or add more to the bottle. I left instructions to run it 30 min on 1 hour off, for a few hours a day and to please have a family member call me if there was any change or not.

Two days after doing this consistently, I received a phone call from his daughter that there was a change. He was much calmer. He began to talk instead of mumbling like he was doing before. He was again eating. He actually enjoyed the smell and inhaled deeply smiling when it was on. He began talking about his days in the barber shop. He began to smile every time the diffuser was turned on. I had to see for myself so I went and paid him a visit. When I first saw him, he was totally incoherent with a terrible grin on his face. He was constantly lashing about and would not open his eyes. When I went into his room it was almost like a new person was there. No more lashing and at times actually held a conversation with me. I asked him “How come they call you Red?” He said “because I have red hair can’t you see that!” His hair is white now, but his daughter did tell me it used to be flaming red. This tells me at least the oils are helping him a bit. No they will not cure him but at least they are easing some of the stress and anxiety he was experiencing and is putting him in a better place.


Hydrosols:

Sid has dementia and cancer. He stopped eating and became very lethargic. The family did not want to put a feeding tube in him and asked Hospice what could be done. They turned to me. Problem was Sid was on oxygen. I could not use essential oils for him because they are highly flammable. I was told he had it on and off and I did not want to take a chance that someone was spraying it on him or his bedding when it was present. So I turned to the hydrosols. I decided to use Lemon Verbena (Lippia citriodora), Rosemary ct verbenone and Peppermint (Mentha x piperita). And put it in a spray bottle of 2 oz. I used equal parts of each hydrosol.

I picked Lemon Verbena (8) because powerful mental relaxant and stress buster. It is also highly energetic. It is distinctly lemon but not citrusy. It is a revitalizing and balancing spray for all skin types. On long trips it can be sprayed on the face to stimulate the driver and keep the driver alert.

Peppermint is most famous for its digestive, anti-inflammatory, and mind-stimulating properties. Although the essential oil must be used only in low doses, the hydrosol is problem-free, since it is ok for younger children, it is ok for the elderly. It is much lower in menthol then the essential oil and lower in 1,8 cineole.

Rosemary ct verbenone (8) is a worry-free ketone, making it highly useful and safe for all ages. The first note is a sweet, soft green, which is then followed by the classic sharp rosemary odor but with less intensity. Since it clarifies and brightens all complexions, I was hoping it would work like its essential oil and clarify the mind too since it does have 1,8 cineole in it as much lower percentages, among the other chemical components.

The combination of all 3 hydrosols would hopefully make Sid more alert, enough to wake up and eat and not sleep so much. I gave specific instructions to spray it lightly in the morning about half hour before breakfast around his pillow and blanket. They can spray it again prior to lunch and dinner. The first day of spraying nothing happened. The second day it was sprayed before breakfast he woke up and said he was hungry. They fed him. Lunch was the same and so was dinner. He actually started eating. I then found out they took him off the oxygen because he was eating solid food. This blend actually seemed to help.

It is extremely hard to convince the medical profession that aromatherapy is a good alternative despite that shows it can work in some cases when nothing else does. In Lilli’s situation she was being put on prescription drugs to dull the anxiety she was having, but it was not helping. When Stein Hospice explained to the family there might be a better way without using the drug, they opted to try it. The same goes for Red and Sid. I am not allowed to give residents anything internally and topically is a fighting chance. For topically, I have to get full permission from their doctors. In some cases I have made shea butter or tamanu salves and lotions for dry crackling aching hands and feet, that they allowed but add an essential oil to it that is another story entirely. Since most do not believe in essential oils (even though I give full documentation on each oil) it can be extremely frustrating.

I give free seminars on the Safety of Aromatherapy at Libraries and Senior Centers across New Jersey and explain what Aromatherapy can do for the body and mind. I did one a few weeks ago and there happened to be a doctor in the audience who works with patients at a local nursing home. He seemed to like my presentation. It turns out he was coughing. I asked him if he had a cold. He told me he was getting over one but he constantly had this tickle in his throat. Interesting I thought. I happened to have the Aromatic Cough drops I made from our course with me because when I speak my throat gets very dry and found these cough drops really help. Mine was made with Lemon (Citrus limon) essential oil, (30 drops) Frankincense serrate resin infused in water (20mls), and your recipe for cough drops of ginger root shavings, sugar, and honey. This is a picture below of what I made, drying and finished product.

I used Lemon Essential oil which is rich in monoterpenes. It is Analgesic: The main component, d-limonene, has significant antinociceptive properties, it is anti-inflammatory. Limonene is often found in oils with strong antimicrobial actions. It also has a bit of aldehydes which in the ternary concept is good for phlegm and the lungs which makes sense as she he was getting over a cold.

I felt it was safe as it did not have enough oil in it to be phototoxic at basically about 1 drop per cough drops.

I asked him if he wanted one and explained what was in it. He was hesitant at first but he saw I was still alive so he took it. As we walked out to the parking lot he said it really took away the tickle and made his throat feel better. This was actually a turning point for him. He asked me to send him my resume. Hopefully he will call me for my services.


Closing

I am hoping through the seminars I give and my work at these nursing homes, more will open up to the potential of essential oils, hydrosols and how Aromatherapy can help them or those they love or care for.

It touches my heart that aromatherapy can work for both the elderly and those who are waiting to move on. I will continue to help those in need, despite the difficult paths I must follow.


References:

(1) http://roberttisserand.com/2013/04/new-rosemary-memory-research/
(2) http://roberttisserand.com/2012/03/rosemary-boosts-brain-power/
3) https://www.ncbi.nlm.nih.gov/pubmed/22849536
(4) https://www.ncbi.nlm.nih.gov/pubmed/16095639
(5) https://www.ncbi.nlm.nih.gov/pubmed/27763785
(6) http://ayurvedicoils.com/tag/vetiver-oil-in-ayurveda
(7) http://www.aromaweb.com/essential-oils/rosemary-oil.asp
(8) Catty, Suzanne. Hydrosols: The Next Aromatherapy (Kindle Location 3036). Inner Traditions/Bear & Company. Kindle Edition.


To learn more about Robin, please visit her website here.
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