In plain English
Aromatherapy uses plant-derived essential oils, applied to the skin or diffused in the air, to support wellbeing. In dementia, lavender and lemon balm have a modest but consistent evidence base for reducing agitation. Safe use is straightforward.
What aromatherapy is
Aromatherapy uses concentrated plant oils (essential oils) for therapeutic effect. In dementia care, two oils have been most studied: lavender (Lavandula angustifolia) and lemon balm (Melissa officinalis). Both have a calming reputation, and small studies support modest benefit for agitation and anxiety.
The evidence base
Cochrane and other systematic reviews find:
- Modest reduction in agitation, anxiety and behavioural symptoms in moderate to severe dementia;
- Improved sleep in some studies;
- Effects smaller than Cognitive Stimulation Therapy or music therapy, but consistent;
- Few side effects.
The mechanism is not fully understood. Effects may be pharmacological (compounds in the oils absorbed through the skin or inhaled), sensory (calming response to pleasant smells), or relational (the gentle touch and attention that often accompany application).
Practical use
Diffusion
An electric or candle-based diffuser distributes oil vapour through a room. Use 3 to 5 drops in the diffuser water. Effective for ambient calming, particularly in the evening for sundowning, or in care home day areas.
Topical application
Diluted essential oil (3 to 5 drops in 30 mL of carrier oil such as sweet almond) applied to the wrists, neck or back of the hands. Often combined with gentle massage, which itself is calming.
Sleep
A few drops of lavender on a pillow or in a pillow spray can support sleep onset.
Safety
- Essential oils are concentrated; never apply undiluted to skin;
- Patch-test on a small area of skin before broader use;
- Avoid in known plant allergies;
- Keep oils out of reach of confused people who may ingest them;
- Use food-grade oils only if oral use is being considered (uncommon in dementia care);
- Avoid use in known asthma where strong scents trigger symptoms;
- Some oils (citrus) are photosensitising; avoid sun exposure on application sites.
Where it fits in dementia care
Aromatherapy is best used as one element of a non-pharmacological approach, alongside Cognitive Stimulation Therapy, music, social engagement, exercise and routine. It is unlikely to substitute for these but adds usefully, particularly for evening agitation and sleep.
Access
Aromatherapy products are widely available at high-street health stores and online. A qualified aromatherapist (member of the International Federation of Professional Aromatherapists) can advise on individualised programmes. Many dementia day services and care homes include aromatherapy in their programmes.
Frequently asked questions
Does aromatherapy work as well as medication for agitation?
No. Aromatherapy is a useful complement, not a substitute. For severe behavioural symptoms despite a non-pharmacological approach, medication may be needed; see the agitation and aggression page.
Which oil should I try first?
Lavender for general calming and sleep. Lemon balm for daytime agitation. Both have the strongest evidence base in dementia.
Are essential oils safe with medication?
Topical and diffused use is generally safe with prescribed medication. Oral use of essential oils (rare in dementia) requires careful review for interactions.
Can I use a diffuser overnight?
Yes, with an intermittent or low-output diffuser. Avoid continuous high-output diffusion through the night.
Are there any oils to avoid?
Avoid oils known to be neurotoxic in concentrated form (camphor, sage in high doses). Stick to widely used calming oils (lavender, lemon balm, bergamot, sweet orange).
References
- Forrester LT et al. Aromatherapy for dementia. Cochrane Database 2014.
- Ballard CG et al. Aromatherapy as a safe and effective treatment for agitation in severe dementia. J Clin Psychiatry 2002.
- International Federation of Professional Aromatherapists.
- NICE NG97.