MAINTAINING SERENITY IN THE THERAPEUTIC RELATIONSHIP: AROMATHERAPY, INDIVIDUALIZED MUSIC OR BOTH TO PROMOTE ENGAGEMENT AND EMPOWER CHOICE

Abstract

Introduction The use of complementary and integrative methods in the care of older adults is increasingly popular. Elderly persons who suffer from chronic, persistent or severe mental illness are less likely to be offered or encouraged to utilize these interventions. Engagement in treatment is an issue that plagues the mental health system and is associated with better outcomes and less use of costly inpatient hospital stays when involvement and empowerment of patients is integrated into care. Aromatherapy is a popular cultural and spiritual intervention. Many elderly people utilize components of aromatherapy as part of developmental and family rituals with strong historical roots. Individualized music is one of the most powerful forms of complementary interventions being utilized as part of treatment regimes for disorders ranging from acute psychosis to anxiety to dementia. Compliance with medications and treatment regimes is considerably higher when patients are allowed to make choices regarding care. This project describes the use of aromatherapy with and without individualized music to enhance patient engagement in therapeutic sessions and treatment discussions. Methods A convenience sample of older adults being treated in diverse clinical areas: the psychiatric emergency department, a 31-bed acute inpatient unit and an outpatient clinic; each part of a large urban tertiary care hospital were offered options prior to being involved in therapy sessions or clinical interviews. Patients were offered of three essential oils: Lavender (Lavendula angustifolia), Grapefruit (Citrus paradisi) or Peppermint (Mentha piperita) prior to clinical interviews or therapy appointments. Oils were provided on individual wood sticks that were immersed in the oil and given to the patient with instructions to hold under the nose and inhale deeply for at least 3 deep breaths. They were also offered the ability to listen to individual music choices for brief periods of up to 3 minutes in a variety of genres that included classical, jazz, showtunes, latin, soft rock, dance and easy listening. Music was offered via wireless headphones that could be worn over the ear for several minutes in a waiting area. This was offered both separately and in combination with aromatherapy. Rating of satisfaction with the intervention using a 5-point Likert type scale, likelihood of recommending to others and decision to return for further care. Results The aromatherapy was widely accepted with >90% of patients choosing an oil and utilizing the intervention. Average age of the patients was 77 years old with range from 55 years to 95 years. Our sample included patients from very diverse cultural backgrounds that are present in a urban New York City population. The majority were not native English speakers and the population as a whole included those speaking more than 20 different languages. Diagnostic diversity was also quite enriched and included those with Anxiety disorders and issues related to life stress as well as many with Schizophrenia and Bipolar disorder. Most patients made a choice of an oil for aromatherapy (75%) or took a recommendation from the therapist (25%). Impact on acceptability, satisfaction with the intervention and likelihood to recommend to others was rated on a 5-point Likert type FACES scale that allowed patients to identify their response without language barriers. More than 90% of patients reported being Very Satisfied with the aromatherapy. Music was less likely to be chosen as a brief intervention (55%) both with or without aromatherapy. Most patients felt that the brief time period of 5 minutes or less was not long enough for their preference although among those that accepted the intervention, 85% reported being Very Satisfied with the use. No participant reported a negative response or adverse effect from with or both interventions. Conclusions Use of individualized aromatherapy greatly increases sense of engagement and appreciation of care. Our patient sample included a diverse sample of very acute patients many of whom entered the hospital on an involuntary basis, as well as those who were presenting for follow up outpatient visits. The clinical acuity was extremely diverse but also included a Comprehensive Psychiatric Emergency Program (CPEP) where the need for care was urgent. The interventions had widespread acceptability in a variety of clinical services and with patient form very cultural diverse backgrounds. Brief music was not as widely accepted, in part because the use of headphones as a delivery mechanism was not as well received by patients. Use of choice with both interventions was felt to be inherently empowering to patients. Most patients were very satisfied with being more involved in making choices that affected their ability to engage with care and treatment in an open manner. Patients expressed a clear desire to recommend and share these interventions with others. This research was funded by Mount Sinai Beth Israel