Guidelines for a Palliative Approach in Residential Aged Care

• CAM therapies may be culturally sensitive for many people, and were beneficial in enhancing
a person’s sense of control;
• For pain management, in addition to using traditional analgesics (including opioids), it may
be useful to combine such treatments with acupuncture, TENS, relaxation and imagery, and
hypnosis; and
• To treat the underlying causes of dyspnoea (for people with moderate to severe
breathing difficulties) and to improve functional capabilities (e.g. walking) it is valuable to use
acupuncture, acupressure, muscle relaxation with rebreathing training, and rebreathing training
combined with coping strategies [246] (Level II).
Aromatherapy
Aromatherapy has been considered as an appropriate treatment for the reduction of behavioural
disturbances in people with severe dementia. Recent studies of the merits of aromatherapy and
aromatherapy massage have been conducted, including some RCTs, which indicate positive
effects of aromatherapy with essential oils [247] (Level II). Ballard, O’Brien, Reichelt, and Perry
(2002) [248] conducted a RCT regarding the use of lemon balm (Melissa Officinalis) versus a
placebo oil (sunflower oil) with 71 residents in aged care with severe dementia. Sixty percent
(n = 21) of those in the lemon balm group were found to have a 30% reduction in levels of
agitation, which was significantly higher than the placebo group (14%). Quality of life scores
also improved significantly for those residents in the lemon balm group compared with the
placebo group; percentage of time spent socially withdrawn; and percentage of time engaged in
constructive activities. No side effects were observed during the trial. These results suggest that
the use of aromatherapy may be beneficial for reducing behavioural disturbances and improving
the quality of life for residents with severe dementia [248] (Level III-1).
An RCT was conducted to determine the merits of using aromatherapy and massage (AM),
conversation and aromatherapy (CA), and massage only (M) with 21 people with severe
dementia [249] (Level II). The only significant difference was a reduction in agitation for those
participants in the AM group during the hours of 3 and 4pm compared with the CA and control
group. No other significant differences were found between groups or at the other three times when
behaviour was observed. Although the sample is small, it does suggest that the use of aromatherapy
with massage may be beneficial for residents with severe dementia, particularly mid-afternoon.
There is also some evidence that massage (with or without essential oils) reduces anxiety in
hospice patients [250] (Level III-1). However, the addition of an essential oil appears to enhance
the effect of massage and to improve physical and psychological symptoms, as well as overall
quality of life.
Music therapy
A systematic review of the literature found that there were no RCTs regarding the use of
music therapy for residents with severe dementia had a positive effect on residents’ levels of
agitation [251] (Level II). However, lower level studies have been undertaken that suggest that
this type of therapy may have benefits. For example, Denney (1997) played background music
during meal times for one week, followed by a week with no music and found that levels of
112 Guidelines for a Palliative Approach in Residential Aged Care