Presenter Sue Leger-Krall, ARNP, PhD River Garden Hebrew Home Jacksonville, Florida

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 [lavandulaagustifolia] 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]

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

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 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

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] • Cingulategyrus – [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]

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 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]

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

16. Results – primary

17. Results – secondary

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