BioMed Research International 1 persons in the present study,as none in either group were Acknowledgments familiar with aromatherapy at the baseline assessment.To introduce them to new nonpharmacological interventions, The authors would like to thank all of the participants.Thanks they were given more exposure and choices for managing are also due to Ms.Maritha Lau,the aromatherapist,for her pain.The fact that the pain management programme was professional advice on aromatherapy. able to empower older persons with knowledge about pain and the necessary skills to manage their health problems is References consistent with the findings of previous studies [8,43].The aromatherapy programme consisted of centre-based sessions [1]Census Statistics Department,Hong Kong Population Pro- and self-administered home-based aromatherapy.Accepting jections 2012-2041,HKSAR:Demographic Statistics Section, and cooperating with the aromatherapy programme,the Census and Statistics Department,2012. older persons in the intervention group benefited from [2]Census Statistics Department,Thematic Report:Older Per- decreased levels of pain,depression,anxiety,and stress sons,HKSAR:2006 Population By-Census Office,Census and after completing the programme.The positive effect of the Statistics Department,2008. programme was also supported by the increased use of [3]B.Brochet,P.Michel,P.Barberger-Gateau,and J.F.Dartigues aromatherapy and aromatic spray by the participants in the "Population-based study of pain in elderly people:a descriptive intervention group after the completion of the programme. survey,"Age and Ageing,vol.27,no.3,pp.279-284,1998. The present study has limitations in that the samples 4]S.T.Brown,M.K.Kirkpatrick,M.S.Swanson,and I.L were recruited by convenience and only older persons were McKenzie,"Pain experience of the elderly,"Pain Management included.The results cannot be applied to other populations. Nursing,vol.12,no.4,pp.190-196,2011. The duration of the sessions may not have been enough [5]M.M.Y.Tse,V.T.C.Wan,and S.S.K.Ho,"Profile of pain to generate a sustained effect in the older persons in the and use of pharmacological and non-pharmacological methods management of their pain.It is recommended that,in future for relieving pain in older persons in nursing homes,Journal of studies,a third group of participants be added as placebo to Pain Management,vol.3,no.3,pp.309-317,2010 prevent the occurrence of the Hawthorn effect. [6]H.Yu,F.Tang,M.Yeh,B.I.Kuo,andS.Yu,"Use,perceived effec- tiveness,and gender differences of pain relief strategies among the community dwelling elderly in Taiwan,"Pain Management 5.Conclusion Nursing,vol.12,no.1,pp.41-49,2011. [7]K.E.J.Ng,S.L.Tsui,and W.S.Chan,"Prevalence of common As the proportion of older persons in the population chronic pain in Hong Kong adults,The Clinical Journal of Pain, increases,pain will undoubtedly become an even greater vol.18,no.5,pp.275-281,2002. problem in the future.Pain is inevitable in the face of age and [8]J.M.Fouladbakhsh,S.Szczesny,E.S.Jenuwine,and A.H. decreased physical functions.Under the total pain concept Vallerand,"Nondrug therapies for pain management among espoused by Saunders [9],pain is multidimensional,affecting rural older adults,"Pain Management Nursing,vol.12,no.2,pp. people in their physical,psychological,social,and spiritual 70-81.2011. aspects.Psychological well-being is also affected when an [9]C.Saunders,"Care of the dying,"Current Medical Abstracts for older person suffers from chronic pain.Pharmacological Practitioners,vol.3,no.2,pp.77-82,1963. and nonpharmacological interventions have been found to [10]D.H.Barlow,"Unraveling the mysteries of anxiety and its dis- be effective in managing chronic pain in older persons. orders from the perspective of emotion theory,"The American Nonpharmacological interventions are considered to have Psychologist,vol.55,no.11,pp.1247-1263,2000. fewer side-effects and tend to be preferred by older persons. [11]F.Cecchi,R.Molino-Lova,A.Di lorio et al,"Measures of According to the total pain concept,there is a close relation- physical performance capture the excess disability associated ship between pain and psychological distress. with hip pain or knee pain in older persons,"Journals of A four-week aromatherapy programme was designed Gerontology A:Biological Sciences and Medical Sciences,vol.64, and implemented as a nonpharmacological intervention for no.12,pp.1316-1324,2009. managing pain in older persons.Depression,anxiety,and [12]L.Gagliese and R.Melzack,"Chronic pain in elderly people, stress levels were significantly reduced in the intervention Pain,vol.70,no.1,pp.3-14,1997. group after the aromatherapy programme,showing that [13]O.H.Mowrer,"On the dual nature of learning:a reinter- aromatherapy can help to maintain the psychological health pretation of“conditioning”and“problem solving,Harvard of community-dwelling older persons. Educational Review,vol.17,pp.102-148,1947. Keeping older persons pain-free and in good psycho- [14]R.C.Shah,A.S.Buchman,P.A.Boyle et al.,"Muscu- logical health is the key to healthy ageing.Educational loskeletal pain is associated with incident mobility disability in programmes can help to promote knowledge about pain and community-dwelling elders,Journals of Gerontology,vol.66A, pain management in older persons. no.1,pp.82-88,201L. [15]Y.Tsai,S.Wei,Y.Lin,and C.Chien,"Depressive symptoms,pain experiences,and pain management strategies among residents Conflict of Interests of Taiwanese public elder care homes,"Journal of Pain and Symptom Management,vol.30,no.1,pp.63-69,2005 The authors declare that there is no conflict of interests [16]M.Tse and J.Au,"The effects of acupressure in older adults with regarding the publication of this paper. chronic knee pain:depression,pain,activities of daily living andBioMed Research International 11 persons in the present study, as none in either group were familiar with aromatherapy at the baseline assessment. To introduce them to new nonpharmacological interventions, they were given more exposure and choices for managing pain. The fact that the pain management programme was able to empower older persons with knowledge about pain and the necessary skills to manage their health problems is consistent with the findings of previous studies [8, 43]. The aromatherapy programme consisted of centre-based sessions and self-administered home-based aromatherapy. Accepting and cooperating with the aromatherapy programme, the older persons in the intervention group benefited from decreased levels of pain, depression, anxiety, and stress after completing the programme. The positive effect of the programme was also supported by the increased use of aromatherapy and aromatic spray by the participants in the intervention group after the completion of the programme. The present study has limitations in that the samples were recruited by convenience and only older persons were included. The results cannot be applied to other populations. The duration of the sessions may not have been enough to generate a sustained effect in the older persons in the management of their pain. It is recommended that, in future studies, a third group of participants be added as placebo to prevent the occurrence of the Hawthorn effect. 5. Conclusion As the proportion of older persons in the population increases, pain will undoubtedly become an even greater problem in the future. Pain is inevitable in the face of age and decreased physical functions. Under the total pain concept espoused by Saunders [9], pain is multidimensional, affecting people in their physical, psychological, social, and spiritual aspects. Psychological well-being is also affected when an older person suffers from chronic pain. Pharmacological and nonpharmacological interventions have been found to be effective in managing chronic pain in older persons. Nonpharmacological interventions are considered to have fewer side-effects and tend to be preferred by older persons. According to the total pain concept, there is a close relation￾ship between pain and psychological distress. A four-week aromatherapy programme was designed and implemented as a nonpharmacological intervention for managing pain in older persons. Depression, anxiety, and stress levels were significantly reduced in the intervention group after the aromatherapy programme, showing that aromatherapy can help to maintain the psychological health of community-dwelling older persons. Keeping older persons pain-free and in good psycho￾logical health is the key to healthy ageing. Educational programmes can help to promote knowledge about pain and pain management in older persons. Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper. Acknowledgments The authors would like to thank all of the participants.Thanks are also due to Ms. Maritha Lau, the aromatherapist, for her professional advice on aromatherapy. References [1] Census & Statistics Department, Hong Kong Population Pro￾jections 2012–2041, HKSAR: Demographic Statistics Section, Census and Statistics Department, 2012. [2] Census & Statistics Department, Thematic Report: Older Per￾sons, HKSAR: 2006 Population By-Census Office, Census and Statistics Department, 2008. [3] B. Brochet, P. Michel, P. Barberger-Gateau, and J. F. Dartigues, “Population-based study of pain in elderly people: a descriptive survey,” Age and Ageing, vol. 27, no. 3, pp. 279–284, 1998. [4] S. T. Brown, M. K. Kirkpatrick, M. S. Swanson, and I. L. McKenzie, “Pain experience of the elderly,” Pain Management Nursing, vol. 12, no. 4, pp. 190–196, 2011. [5] M. M. Y. Tse, V. T. C. Wan, and S. S. K. Ho, “Profile of pain and use of pharmacological and non-pharmacological methods for relieving pain in older persons in nursing homes,” Journal of Pain Management, vol. 3, no. 3, pp. 309–317, 2010. [6] H. Yu, F. Tang, M. Yeh, B. I. Kuo, and S. Yu, “Use, perceived effec￾tiveness, and gender differences of pain relief strategies among the community dwelling elderly in Taiwan,” Pain Management Nursing, vol. 12, no. 1, pp. 41–49, 2011. [7] K. F. J. Ng, S. L. Tsui, and W. S. Chan, “Prevalence of common chronic pain in Hong Kong adults,” The Clinical Journal of Pain, vol. 18, no. 5, pp. 275–281, 2002. [8] J. M. Fouladbakhsh, S. Szczesny, E. S. Jenuwine, and A. H. Vallerand, “Nondrug therapies for pain management among rural older adults,” Pain Management Nursing, vol. 12, no. 2, pp. 70–81, 2011. [9] C. Saunders, “Care of the dying,” Current Medical Abstracts for Practitioners, vol. 3, no. 2, pp. 77–82, 1963. [10] D. H. Barlow, “Unraveling the mysteries of anxiety and its dis￾orders from the perspective of emotion theory,” The American Psychologist, vol. 55, no. 11, pp. 1247–1263, 2000. [11] F. Cecchi, R. Molino-Lova, A. Di Iorio et al., “Measures of physical performance capture the excess disability associated with hip pain or knee pain in older persons,” Journals of Gerontology A: Biological Sciences and Medical Sciences, vol. 64, no. 12, pp. 1316–1324, 2009. [12] L. Gagliese and R. Melzack, “Chronic pain in elderly people,” Pain, vol. 70, no. 1, pp. 3–14, 1997. [13] O. H. Mowrer, “On the dual nature of learning: a reinter￾pretation of “conditioning” and “problem solving”,” Harvard Educational Review, vol. 17, pp. 102–148, 1947. [14] R. C. Shah, A. S. Buchman, P. A. Boyle et al., “Muscu￾loskeletal pain is associated with incident mobility disability in community-dwelling elders,” Journals of Gerontology, vol. 66A, no. 1, pp. 82–88, 2011. [15] Y. Tsai, S.Wei, Y. Lin, and C. Chien, “Depressive symptoms, pain experiences, and pain management strategies among residents of Taiwanese public elder care homes,” Journal of Pain and Symptom Management, vol. 30, no. 1, pp. 63–69, 2005. [16] M. Tse and J. Au, “The effects of acupressure in older adults with chronic knee pain: depression, pain, activities of daily living and