On a sunny spring day at the Hebrew Home for the Aged at Riverdale in Riverdale, NY, 10 seniors sit around a conference table and press thin white strips of paper to their noses, inhaling deeply. The program leader, Ruth Sutcliffe, paces behind the residents, offering clues about what they're smelling.

"This scent should be familiar," Sutcliffe says, leaning over to give a participant a paper strip. "It's something that you bake, and it's something many of us eat every day."

Slowly, the residents start to respond. "It's woodsy," says one. "It could be bread," volunteers another. Sutcliffe raises her arms in triumph. "It's bread!" she says. "Doesn't it smell great?"

From there, the room starts to buzz. Now everyone has a story about bread: One woman at the end of the table, wearing a bedazzled denim hat and a matching vest, pipes up to share how she grew up near a factory that baked bread and can remember the scent from her childhood. Another woman starts to laugh. "There's only one time when bread doesn't smell good," she says. "And that's when you're fasting for Yom Kippur!" Others smile and nod in agreement.

Smell Stimulation

The residents at the Hebrew Home are participating in a smelling session, which uses scents to elicit memories and conversation. It's not the first time the center has experimented with scents: It recently hosted an olfactory exhibit that featured baseball-related scents. Residents inhaled the aroma of hot dogs, popcorn, and even the sweaty, leathery smell of players' mitts—odors that took them right back to their favorite baseball stadium.

Sutcliffe got the idea of using scents to evoke memories after her mother-in-law was diagnosed with Alzheimer's disease in 2007. When her own mother was diagnosed with dementia three years later and died in 2016, she pursued the idea more seriously.

Drawing on her 25 years of experience as a fragrance developer, Sutcliffe curated 12 evocative scents designed to resonate with an older population, including mint, lilac, coffee, cedar, apple, and bread. Then she assembled a scent kit—Essential Awakenings (thescentgurugroup.com)—that includes rollerballs, paper strips, and cue cards that offer hints about what the smell might be for those whose sense of smell may be impaired or diminished. Today, she travels to different assisted living centers to facilitate smelling sessions for residents.

Memory Triggers

Assisted living and memory care facilities have long used visual and verbal cues in group settings to engage residents in conversation, socialization, and memory recall—a process known as reminiscence therapy. A Cochrane Review of reminiscence therapy published in March 2018 analyzed 22 studies involving nearly 2,000 participants and concluded that the therapy may improve quality of life, cognition, and mood. The review also noted that the evidence is mixed and more randomized controlled trials are needed. In the meantime, facilities like the Hebrew Home are using scent cues to elicit memories as well.

"For people with memory impairment, sensory input is a welcome thing," says Beth Liebowitz, program director at The Greens at Greenwich, a memory care center in Greenwich, CT, who has worked with Sutcliffe. "It doesn't require them to answer 20 questions about their past or frustrate them because they have trouble saying a word. It wakes up their brains in a different way."

"I've noticed our residents are calmer after a smelling session," says Thomas Cookson, senior therapeutic recreation assistant at River House Adult Day Center in Cos Cob, CT, another facility that uses scents to engage residents. "They really enjoy the act of reminiscing. They find it soothing to remember someone or something they love." Even if they can't articulate what they're smelling, they often hum or make facial expressions and seem to enjoy the intellectual exercise of trying to name them, he says.

Brain Activation

When we inhale a scent, it travels through the olfactory bulb and activates the brain's hippocampus and amygdala, says Artin Arshamian, PhD, a postdoctoral student at the Donders Institute for Brain, Cognition, and Behaviour in the Netherlands, who studies how sensory experiences like smelling can impact memory. While the prefrontal cortex triggers the actual memory, such as the time and place the scent was first smelled, the amygdala and hippocampus provide the feelings associated with the memory of that smell, he says.

"Odors can evoke the same kinds of memories that visual pictures can, but the memories you get from smell are more emotional," Dr. Arshamian says. That emotional response helps stimulate conversation, he says.

Scents and Memory

As the Cochrane Review suggests, the evidence for reminiscence therapy is mixed. "Memory has a lot of components, and we don't know yet if scent has a positive effect," says Mark Albers, MD, PhD, assistant professor of neurology at Harvard Medical School. "In order to have a memory, three things need to happen," he says. "First, you need to know when the initial memory occurred. Then, it has to be encoded in your brain by the hippocampus. Then it has to be recalled. If you suffer from memory loss, you can have problems with attention, encoding, and recall." So far, researchers know that scents can trigger memory recall, but only if the other two components—attention and encoding—are present.

Benefits for All

While researchers parse the brain benefits of scent therapy, smelling sessions have other, more tangible rewards. "Memory provides a lot of security, and as memory erodes, you feel less secure. Over time you get agitated. If scents have a positive emotional power and help people tap into positive memories, that could be really comforting for people with dementia," says Cookson, of the River House Adult Day Center.

During the smelling sessions at the Hebrew Home, Sutcliffe sees that same positive emotional effect. As residents inhale the scent of bread, they trade memories, smile, and laugh.

"I'll tell you a funny story," says one resident, pressing her blue cardigan to her shoulders. "I lived above a bakery, and my neighbors would come into my apartment and ask, 'What are you baking?' I would tell them, 'I'm not baking a thing, so don't get excited!' It was the smell of the bagels from the bakery." Around her, everyone chuckles, and the conversation moves to bagels.