INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY
Int J Geriatr Psychiatry 2002; 17: 305–308.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.593
Lavender oil as a treatment for agitated behaviour
in severe dementia: a placebo controlled study
Clive Holmes*, Vivienne Hopkins, Christine Hensford, Vanessa MacLaughlin,
David Wilkinson, Henry Rosenvinge
University of Southampton, School of Medicine, Community Clinical Sciences Research Division,
Memory Assessment and Research Unit, Moorgreen Hospital, Southampton, UK
SUMMARY
Objective To determine whether aromatherapy with lavender oil is effective in the treatment of agitated behaviour in
patients with severe dementia.
Design A placebo controlled trial with blinded observer rater.
Setting A long-stay psychogeriatric ward.
Patients Fifteen patients meeting ICD-10 diagnostic criteria for severe dementia and suffering from agitated behaviour
defined as a minimum score of three points on the Pittsburgh Agitation Scale (PAS).
Intervention A 2% lavender oil aromatherapy stream was administered on the ward for a two hour period alternated with
placebo (water) every other day for a total of ten treatment sessions.
Assessments For each subject 10 total PAS scores were obtained. Five during treatment and five during placebo periods.
Results Nine patients (60%) showed an improvement, five (33%) showed no change and one patient (7%) showed a wor-
sening of agitated behaviour during aromatherapy compared with placebo. A comparison of the group median PAS scores
during aromatherapy showed a significant improvement in agitated behaviour during aromatherapy compared with placebo
(median PAS scores 3 c.f. 4; Wilcoxon Signed-Ranks test p¼ 0.016 (one-tailed)).
Conclusions Lavender oil administered in an aroma stream shows modest efficacy in the treatment of agitated behaviour
in patients with severe dementia. Copyright # 2002 John Wiley & Sons, Ltd.
key words— dementia; aromatherapy; lavender oil; behavioural and psychological symptoms of dementia
INTRODUCTION
Five per cent of people over 65 years and 20% of
those over 80 years have dementia, with 700,000 suf-
ferers in the UK alone. Between 18–65% of people
with dementia experience agitated behaviour (Mirea
and Cummings, 2000). Agitated behaviour is distres-
sing for patients (Gilley et al., 1991), problematic for
carers (Rabins et al., 1982) and is frequently the trig-
ger for placement in residential or nursing home care
(Steele et al., 1990). Pharmacological treatment with
neuroleptic agents is often the first line treatment for
this disorder, despite evidence of modest efficacy
(Schneider et al., 1990), problematic side effects
(Ballard et al., 1999) and, in some instances, severe
neuroleptic sensitivity reactions (McKeith et al.,
1992). Alternative treatments with few side effects
are desperately needed.
Lavender (Lavendula angustifolia) is used in aro-
matherapy as a relaxant. Its sedative nature, on inhala-
tion, has been shown in both animal and human studies
(Buchbauer et al., 1991; Diego et al., 1998; Lis-
Balchin and Hart, 1999). It has a wide range of clinical
applications and has been shown to be effective for the
use of depression and anxiety in cancer patients (Kite
et al., 1998). The use of lavender or other aromather-
apy oils for the treatment of agitation in subjects with
dementia is largely unexplored with a small number of
single case studies (MacMahon and Kermode, 1998;
Brooker et al., 1997) suggesting efficacy but no
Received 22 May 2001
Copyright # 2002 John Wiley & Sons, Ltd. Accepted 16 August 2001
*Correspondence to: C. Holmes, University of Southampton,
School of Medicine, Community Clinical Sciences Research
Division, Memory Assessment and Research Unit, Moorgreen
Hospital, Botley Rd, West End, Southampton, SO30 3JB, UK. Tel:
þ 44(0)23 8047 5216. Fax: þ 44(0)23 8046 3022.
E-Mail: ch4@soton.ac.uk

case-control or placebo studies. We hypothesised that
in a group setting lavender oil, in the form of an aroma-
stream, would have a beneficial effect on agitated
behaviour in patients with severe dementia.
METHODS
Patients
Fifteen patients were recruited from a long-term stay
unit for patients with behavioural problems (Alling-
ton Behavioural Center for Dementia, Moorgreen
Hospital). All patients fulfilled ICD-10 diagnostic cri-
teria (WHO, 1992) for severe dementia. Four patients
fulfilled NINCDS-ADRDA criteria for probable
Alzheimer’s Disease (McKhann et al., 1984), seven
fulfilled NINDS-AIREN criteria for probable Vascu-
lar dementia (Roman et al., 1993), three fulfilled con-
sensus criteria for probable Dementia with Lewy
Bodies (McKeith et al., 1996) and one fulfilled diag-
nostic criteria for Fronto-Temporal Dementia (Brun et
al., 1994). All had evidence of agitated behaviour
defined as scoring greater than three points on the
Pittsburgh Agitation Scale (PAS) (Rosen et al.,
1994) at some point during each day over a period
of one week. The PAS is a 16-point observer rated
scale comprising four domains (aberrant vocalisation,
motor agitation, aggression and resistance to care)
each rated 0 to 4 points. A high score denotes high
levels of agitation. Ethical approval for the study
was granted by the Southampton and South West
Hants Local Research Ethics Committee.
Intervention and study design
The communal area of the unit was diffused with
either standard concentration of lavender oil (2%) or
water, on alternate days, using three aroma-streams
for a period of two hours between the period 4 pm
to 6 pm. All procedures and measurements were the
same when using lavender oil or water. In the final
hour of this two-hour period an experienced indepen-
dent blinded (using nose callipers prior to entry onto
the ward) rater, unaware of the study design, assessed
the individual behaviour of the patients over a one-
hour period using the PAS. A total of five treatments
and five placebo trials were carried out for each
patient over a period of two-weeks.
An alternate-day design was adopted in order to
minimise the effects of any changes in the patients
environment during the course of the study (e.g. as
might occur if there was the admission of a disruptive
patient). Aroma streams were used because they use a
stream of air which allows the diffusion of lavender
oil without the need for hot rings or naked flames
and are hence suitable for use in a dementia care set-
ting. Concomitant drug therapy was allowed through-
out the trial but no changes were made to medication
regimen during the trial period.
Analysis
For each subject 10 total PAS scores were obtained. 5
occurring during treatment and 5 during placebo per-
iods. A median PAS score during treatment and pla-
cebo was calculated which represented the average
level of agitation for that subject during the five treat-
ment or placebo phases. A comparison of these med-
ian PAS scores for all 15 individuals whilst on
treatment was then compared with the median PAS
scores for the same group whilst on placebo using
the Wilcoxon Signed Ranks Test.
RESULTS
The mean age of the group was 79.0 (s.d. 6.3) years of
whom nine (60%) were women. Nine patients (60%)
showed an improvement, five (33%) showed no
change and one patient (7%) showed a worsening of
agitated behaviour during aromatherapy compared
with placebo (Table 1). The group median PAS score
during aromatherapy was 3 points (range 1 to 7) com-
pared to 4 points (range 3 to 7) on placebo; Wilcoxon
Signed-Ranks test p¼ 0.016 (one-tailed).
The distribution of changes on the PAS, according
to diagnoses, are reported in Table 2. Of the four
Table 1. Median PAS scores derived from five separate hourly
sessions with either lavender oil or placebo
Patient Number Median PAS score
Placebo Lavender oil
1 4 4
2 4 3
3 4 2
4 4 1
5 3 1
6 4 4
7 6 5
8 3 5
9 7 5
10 3 3
11 4 3
12 7 7
13 4 2
14 3 2
15 4 4
306 c. holmes et al.
Copyright # 2002 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2002; 17: 305–308.