A Doorway to the Present

By E. Joy Bowles, BSc ©Dementia Care International

Memories of past events can be triggered by smells and certain essential oils can be used to evoke memories of past hobbies and passions in people with dementia. For example, the smell of eucalyptus oil can remind people of experiences in the bush; mandarin oil can evoke strong memories of summer fruits; and oils from spices used in cooking, like cinnamon and cloves, can conjure up memories of family Christmases.

Very often the memories triggered by odours also have a strong emotional tone to them, whether happy or unpleasant. This is because the brain cells that respond to the incoming messages about odours send messages to many parts of the brain, including that part that is associated with the instant assessment of whether a smell is ‘nice’ or ‘nasty’. This is known as the ‘hedonic’ response to an odour, and it causes a response as involuntary as the knee-jerk in the doctor’s office – if a smell appeals to a person, they will usually turn their head towards the source of the odour, smile and open their nostrils, perhaps with a sniffing action. If the smell disgusts someone, they are likely to wrinkle up their nose and face and turn their head away.
It often seems as though people with dementia are either living in the very present moment, at the whim of their physical sensations and emotions, or they live in their own little world with seemingly very little reference to so-called ‘reality’. It seems unkind to break them out of their world but sometimes it is important to be able to interrupt the flow and bring them back to the present, especially if they are distressed or in danger. People with dementia often take quite a bit of ‘redirecting’ or distracting.

If their sense of smell still works properly, different odours can be used to encourage people back to the present moment. The ability to pay attention to more than one thing at a time seems to decrease, particularly in Alzheimer’s disease and dementia, so an unexpected smell can very often interrupt a person’s pattern of behaviour or train of thought. Essential oils that might work well as ‘distracters’ fall into two different groups: firstly, the pungent oils, secondly the pleasant oils.

The pungent oils include basil, eucalyptus and peppermint that have very strong aromas. Part of the reason they appear to be so strong is that they affect the pain-sensitive nerves in the nose as well as the odour-receptors. This is the same principle that the olden-day ‘smelling salts’ worked on. A spray bottle with water and a few drops of either oil is a handy way of being able to get the aroma near enough to someone to distract them without having to go too close, and without them having to actually take an active sniff.

The pleasant oils are also likely to distract people, particularly if they are agitated. However, care needs to be taken that the same oil is not used every time someone is agitated, or they may come to associate the smell with feeling agitated! Allowing people to pick their own favourite smells is also a fun interaction. Otherwise, talking to family members can provide clues as to which smells the person liked in the past. Sweet-smelling oils like geranium, bergamot and lavender can be used safely, either a few drops in a spray bottle, or on a tissue, which you can ask the person to smell.