Abstract
Objectives:
To verify the effectiveness of aromatherapy massage on elderly patients under long-term hospitalization.
Design:
Aromatherapy massage was performed twice a week for a total of eight times.
Setting:
Nursing home.
Subjects:
Elderly women under long-term hospitalization.
Interventions:
Questionnaire and measurement of stress marker levels (salivary amylase activity) before and after the first, fifth, and eighth aromatherapy massages.
Outcome measures:
Questionnaire (Face scale, General Health Questionnaire-12 [GHQ-12]), measurement of salivary amylase activity.
Results:
A decrease in stress after aromatherapy massage compared to before each massage was confirmed at all measurement times and with the stress marker. No marked reduction was observed in Face scale or saliva amylase activity as a whole over the long term, although decreasing tendencies were seen. Marked reductions in GHQ-12 were observed over the long term.
Conclusions:
Aroma massage appears likely to prove effective in reducing psychological stress among elderly patients under long-term hospitalization.
Introduction
Materials and Methods
Patients
Subjects were selected at random from among elderly women (mean age, 83 years; range, 66–92 years) under long-term hospitalization (mean duration of hospitalization, 2 years, 9 months; range, 3 months to 4 years, 1 month) in Aoba Medical Clinic (Miyazaki, Miyazaki, Japan). Eleven patients provided informed consent to participate. The agreement to participate in this research was obtained for patients whose condition was stable. However, symptom exacerbation in two patients made continuation of the research difficult, limiting final analysis to nine patients. Underlying conditions for these nine patients included Parkinson's disease, cerebral infarction, cervical spine injury, spondylosis deformans, gonarthrosis, angina, hypertension, hyperlipemia, diabetes, osteoporosis, and insomnia.
This study was conducted in accordance with national guidelines and was approved by the ethics committee of Chikama Hospital (Miyazaki, Miyazaki, Japan).
Materials
Elderly patients under long-term hospitalization will be in a depressed-like state easily. Consequently, essential oil from geranium was used for purposes such as reducing spasm, 4 and essential oil from peppermint was used to reduce sleepiness. 5 Essential oil from geranium [Pelargonium graveolens (Thunb.) L'Hér.], essential oil from peppermint (Mentha×piperita L.), and jojoba oil [Simmondsia chinensis (Link) Schneid.] for the present research were obtained from Green Flask Co. (Meguro-ku, Tokyo, Japan). The aromatherapy massage oil was made with the jojoba oil as a base, with the essential oils (geranium:peppermint=1:3) comprising 2%.
Protocol and measurements
Aromatherapy massage was performed by a physical therapist and a occupational therapist at Aoba Medical Clinic. A standard massage method was determined by agreement of the two therapists. Aromatherapy massage was performed twice a week for eight times in total, for 5 minutes each time. The aromatherapy massage was performed on both legs. Two questionnaires were administered and measurements of salivary amylase activity as a stress marker were performed before and after the first, fifth, and eighth (final) aromatherapy massages.
The Face scale (0–5) 6 and the 12-question General Health Questionnaire (GHQ-12) 7 were used as questionnaires, and salivary amylase activity 8,9 was used as an objective measure of stress. The GHQ method (points scored for negative answers; maximum score, 12 points) was used as a method of evaluating GHQ-12. A salivary amylase monitor (NIPRO; Kita-ku, Osaka, Japan) was used to measure salivary amylase activity, with lower values indicating lower levels of stress. The Face scale and salivary amylase activity were measured as indicators of physical and psychological stress. GHQ-12 was used to measure psychological stress.
Statistical analysis
Statistical differences in means of all results were assessed using one-way analysis of variance with Dunnett's multiple comparison post hoc test using JMP software (SAS Institute Japan, Minato-ku, Tokyo, Japan). Statistical significance was established at the level of p<0.05.
Results and Discussion
Decreases in stress following each aromatherapy massage were confirmed at all measurement times and with salivary amylase activity. Temporary effects in terms of decreased stress from aromatherapy massage were observed (Table 1, no significant differences).
Values represent mean±standard error of the mean (SEM) (n=9).
Significant difference from first pre-aromatherapy massage status (p<0.05).
In addition, to clarify long-term changes, measurements before each aromatherapy massage were compared (Table 1). This comparison revealed no significant reductions in Face scale score or salivary amylase activity over the whole study period, although a decreasing tendency was seen. On the other hand, a clear reduction was observed in GHQ-12 (p<0.05). In addition, the change of GHQ-12 differed from the changes in Face scale scores and salivary amylase activity, showing continued decreases over the course of treatment. Conversely, changes in Face scale and salivary amylase activity were similar. This was attributed to differences between measurement of physical and psychological stress by the Face scale and salivary amylase activity and measurements of psychological stress by GHQ-12. Salivary amylase activity is thought to also be affected by physical stress. 8,9
Major changes in physical condition were not thought to be present with long-term in-patient treatment and habituation to aromatherapy massage.
Conclusion
Although patient conditions and diseases varied widely, the results were largely consistent. Aromatherapy massage is thought to reduce physical stress in the short term, but achieving meaningful reductions in physical stress may not be likely using only 5 minutes of aromatherapy massage just twice a week. However, aromatherapy massage is considered likely to prove effective for reducing psychological stress for elderly patients under long-term hospitalization.
Increases in psychological stress might exert deleterious influences on the development and progression of other pathologies. The results of this clinical study suggest the potential utility of aromatherapy massage for elderly patients under long-term hospitalization.
Footnotes
Author Disclosure Statement
No financial conflicts exist.