• Better Practice National Conference

Sensory Towels

Jo Bozin explains how a simple award-winning aromatherapy program has improved the mealtime experience for residents and staff in one Melbourne residential facility

While working mornings and early afternoons at Bupa Thomastown in February 2011, I noticed a lot of uneaten food returning to the kitchen after lunchtimes. Eating is an integral part of everyone’s lives and ensuring adequate nutrition is vitally important for people living with dementia, who often have decreased appetite which can lead to health problems or exacerbate existing conditions. Inspiration from my training as an aromatherapist led to the introduction of a ‘sensory towels’ program for residents. This simple initiative has made a significant difference to the lives of those living with dementia, or who, for one reason or another, have lost interest or the desire to eat at lunchtime.

Credit: Alexander Hardin

Aromatherapy

The average person can identify between 4,000 to 10,000 different smells, ranging from hamburgers on the barbecue to different types of fresh flowers. Each of these aromas stimulates the brain in different ways. They may relax or excite the nervous system by chemical means or scents which can have a psychological effect, prompting memories and emotions (good or bad) and causing physiological effects based on subjective responses.

I am an aromatherapist, whose inspiration for the sensory towels program came from attending a massage clinic during my aromatherapy and massage training. As students, we spent 10 weeks practising with clients from the general community. We had a selection of 20 essential oils from which to select for their therapeutic properties. Citrus sinensis (sweet orange) was often a popular choice due to its uplifting quality and fresh, familiar aroma. If we selected Citrus sinensis, we were advised to explain to the client that they may leave feeling quite hungry after their massage. Thus, the seed was firmly planted for later use in my work in aged care.

Creating and using sensory towels

Anyone is able to offer this initiative, as no special skill set or qualification is required.

To make sensory towels, all you need are:

  • One face washer (per participant)

  • Essential oil of Citrus sinensis (sweet orange). Must be 100% pure.

  • Access to a sink for hot water

  • Microwave

Method:

  • Place all washers into a sink of hot water (not boiling, just hot tap water).

  • Squeeze them out and lay flat on sink/bench.

  • Add 2 x drops of Citrus sinensis essential oil to each washer, and roll up as if making a sausage roll.
  • Place on a microwave safe bowl or plate and heat in the microwave on high for the required length of time. We put 20 washers into a microwave for about 3.5 minutes. (As microwave strengths vary, please check the wattage).

You may have to shake some of the heat from the first few washers before offering it to someone, to prevent burning or frightening them, but neither do you want the last participants to receive a cold washer.

Before they begin their meal, encourage each person to take a deep breath and then help them, if required, to cleanse and refresh their face and hands. This small ritual and the stimulation of the sweet orange oil will help improve appetite and will very likely result in more food disappearing off the plate.

Results, reception and risks

Bupa Thomastown began this initiative with eight residents, all of whom had low appetite and who had experienced a decline in their health. We believed these people would benefit from the therapeutic action of Citrus sinensis. Daily progress notes were made for the eight residents, who were also weighed weekly. During the first month, residents who had previously been losing weight began to maintain their weight and others had slight to significant weight gain.

Eighteen months later, we now have 39 out of 45 residents requesting a sensory towel at lunchtime, and the numbers increase with each new admission. All residents are invited to participate, but personal choice is always respected.

Opportunity for conversation is also created at this time due to the familiarity of the aroma and the one-to-one interaction it creates between clients, staff, volunteers and family members. Family members who are visiting at lunchtime are very interested in this natural intervention and look forward to assisting their loved ones in the pre-mealtime ritual, often asking if there is a spare towel for themselves as well. Families have said it is refreshing that the facility staff are open to using alternative therapies. It is evident to staff and families that there is less food returning to the kitchen due to increased appetites.

The use of sensory towels also led to an unexpected outcome in the laundry. After laundering the essential oil-infused washers each day, the laundry environment is fresher and the machines always smell beautifully clean and fresh. However, the laundry staff are not too pleased about their increased appetites!

There are no known serious risks associated with the use of Citrus sinensis. It can, however, make us more susceptible to the sun’s ultra-violet rays if used in creams and massage oils or lotions. This risk does not apply to inhaling the diluted scent from a towel. As just two drops are applied to each washer, there is no danger of phototoxicity at this level of dilution.

Conclusion

Since receiving an Aged Care Standards and Accreditation Agency Better Practice Award for the program in September 2012, we have been asked by other residential aged care facilities in Australia and New Zealand to supply information about this initiative.

To date, we know of more than 40 care homes that are now using sensory towels as part of their daily routine, equating to over 4,000 residents. I believe there may be many more that we are not aware of through ‘word of mouth’.

The sensory towels program proves that you don’t have to spend a fortune to improve the lives of the people in your care, and that you don’t require a degree to drive it, either. The costs are minimal and residents, their families and staff all benefit from the uplifting aromas delivered throughout the care home each day. Apart from an initial weight gain of a kilo or two amongst the staff, there has not been a downside to this initiative. The environment is fresh and clean, the residents are eating well and families, staff and the allied health professionals all notice and enjoy the uplifting aroma throughout the care home.

Jo Bozin is a diversional therapist at Bupa Thomastown in Melbourne, Victoria and has worked in the field of disability and aged care for over 35 years. For more information, contact her at: Jo.Bozin@bupacare.com.au

Editor’s note

Numerous small studies have shown that aromatherapy is effective for short-term alleviation of anxiety or poor mood, that it can assist with motivation, and it can be used as an effective complementary therapy in helping people with agitation. Full investigation of the evidence is beyond the scope of this article, but Clive Holmes and Clive Ballard give a detailed overview of research on the subject in Aromatherapy in dementia, published in 2004 in Advances in psychiatric treatment (10).

– James Baldwin, Contributing Editor

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