Ask an answerable question (PICO)：
Psychological symptoms and behavioral abnormalities are common and prominent characteristics of dementia. It includes symptoms such as anxiety, agitation, and aggression.These symptoms not only affect the quality of life of dementia patients but also increase the caring difficulties and stress of caregivers. Most of the clinical use of drugs improves dementia symptoms, but anxiolytics can worsen the cognitive function of a dementia patient, and antipsychotic drugs may increase mortality. Therefore, the authors are willing to explore the simple and safe acupressure combined with aromatherapy with a sedative effect that can be used to alleviate the emotional agitation of dementia patients.
The Method and Analysis of Literature Review：
The search of the literature using the evidence-based nursing PICO method. The keywords included Patients/problems as “Dementia”, Intervention as “Acupressure; Acupuncture points; Aromatherapy; Odorants”, and Outcome as “psychomotor agitation; aggression; anxiety; hostility; irritable mood”. The search strategies by using the Boolean logic "AND” and “OR" were implemented. The databases of literature were collected from The Cochrane Library, PubMed, CINAHL, and Airiti Library. Publication dates weren't limited, publication type of "Randomized Controlled Trial, Systematic Review", and language as "Chinese, English" were limited. After all, 2 Randomized Controlled Trials articles were included in order to provide the best evidence.
Critical Appraisal：
The RCT Critical Appraisal Sheet was accorded to appraise the quality of literature in the randomized controlled trial respectively. The level of evidence is based on The Oxford 2011 Levels of Evidence from The Centre for Evidence-Based Medicine, and both RCTs are Level 2. The result of the first literature showed that aroma-massage with acupressure + exercise had a significantly different in improving the Chinese Cohen-Mansfield Agitation Inventory "aggressive behaviour" (p = .06), "physically nonaggressive behaviour" (p = .16), and "verbally agitated behaviour" (p = .63). There was no significant difference, but the severity of Behavioral and psychological symptoms of dementia (BPSD) was significantly reduced in patients 3 months after the intervention. The result of the second one showed that the CAMI scale scores decreased significantly (p < 0.01) at three weeks after using aroma acupressure. Consequently, using the aroma acupressure can improve dementia patients' emotional agitation immediately and continuously.
Results, Conclusions and Recommendations：
Aromatherapy combined with acupressure can improve agitation in people with dementia, and it can also improve mania compared with regular treatments. But the acupuncture points, time, and concentration of essential oils used in the two literatures are all different. Therefore, through this evidence search, there is not enough evidence to support which acupoints and essential oil concentrations can most effectively improve agitation in patients with dementia. It is expected that there will be more rigorous systematic review literature and randomized controlled trial literature for empirical review and clinical application and reference in the future.
魏秀靜
