A Qualitative Therapeutic Design Approach for Sensory Garden Design for People with Dementia

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Civil Engineering and Architecture 11(4): 2110-2122, 2023 http://www.hrpub.org
DOI: 10.13189/cea.2023.110431
A Qualitative Therapeutic Design Approach for Sensory
Garden Design for People with Dementia
Manar Elsayed Mohamed Elbasyoni1,*, Sherin Ali Gammaz2
1Department of Architecture, Faculty of Engineering, Modern University for Technology and Information, Cairo, Egypt
2Department of Architecture, Faculty of Engineering, Cairo University, Giza, Egypt
Received January 7, 2023; Revised February 27, 2023; Accepted March 19, 2023
Cite This Paper in the Following Citation Styles
(a): [1] Manar Elsayed Mohamed Elbasyoni, Sherin Ali Gammaz , "A Qualitative Therapeutic Design Approach for
Sensory Garden Design for People with Dementia," Civil Engineering and Architecture, Vol. 11, No. 4, pp. 2110 - 2122,
2023. DOI: 10.13189/cea.2023.110431.
(b): Manar Elsayed Mohamed Elbasyoni, Sherin Ali Gammaz (2023). A Qualitative Therapeutic Design Approach for
Sensory Garden Design for People with Dementia. Civil Engineering and Architecture, 11(4), 2110 - 2122. DOI:
10.13189/cea.2023.110431.
Copyright©2023 by authors, all rights reserved. Authors agree that this article remains permanently open access under the
terms of the Creative Commons Attribution License 4.0 International License
Abstract Many gardens have been established in
daily-care institutions serving people with dementia
however, individuals with dementia experience disabilities
to be engaged in pleasant and useful activities in their
physical outdoor environments which could unexpectedly
have a negative impact on their behavior and cognitive
functioning. People with dementia need to be involved in
activities that stimulate the senses and environments that
deal with their sensory disorder challenges and provide a
multisensory experience through active and passive
activities. Therefore, the research addresses the
interrelationship between the therapeutic goals of dementia
and the design qualities of outdoor sensory spaces used by
them by analyzing the behavior of people with dementia
due to sensory challenges facing them in their physical
environment, followed by the analysis of selected
international case studies of gardens designed specifically
for dementia patients. To reach successful relationships
between therapeutic goals and sensory garden qualities,
dementia specialists and caregivers were engaged to link
these goals and qualities through interview form and three
phases of analytical studies, the research formulated a
design model for appropriate landscape therapeutic
sensory features and elements that can be applied in
gardens serving dementia patients.
Keywords Dementia, Sensory Disorder Challenges,
Therapeutic Goals, Design Qualities, Sensory Garden
1. Introduction
In the case of dementia, memory impairment causes
deficits in sensory functioning, especially in late-stage
dementia [ 1]. Sensory impairment increases cognitive
problems and leads individuals to isolate due to their
disability to communicate with their surroundings, and is
reflected in their behavior in their indoor and outdoor
physical environment [ 2]. Since the gardens represent the
human outdoor environmental content, the design qualities
of the gardens’ landscape elements have an impact on
human performance, cognitive and sensory functioning,
and physical and social interaction [ 3], therefore the
outdoor environment should help individuals with
dementia and their caregivers to overcome the challenges
that face them in the surrounding environment and carry
out their activities in an effective and safe context.
Despite the growing theoretical and practical studies in
the fields of dementia-friendly outdoor environments,
requirements and measurements related to their needs and
disabilities. However, it is possible to observe a clear
disconnect between dementia therapeutic goals set by
dementia specialists and the design qualities of sensory
gardens concerning dementia patients’ sensory needs and
design aspects of dementia outdoor spaces.
Accordingly, this research aims to study the relationship
between the design qualities of landscape elements in
dementia gardens and the therapeutic goals of dementia. To
reach a full understanding of these relations the research
examines dementia characteristics, challenges, and needs

Civil Engineering and Architecture 11(4): 2110-2122, 2023 2111
that affect the behavior of people with dementia in their
built environment, then determines the therapeutic goals
and design qualities of garden elements through theoretical
and practical analysis, then finally dementia specialists,
caregivers, and family members have been engaged
practically to extrapolate the interrelationship between
therapeutic goals of dementia people and design qualities
of sensory gardens in a way that allows formulating an
appropriate design model of landscape features in gardens
that serve people with dementia.
1.1. Dementia: Definitions, Symptoms, and Types
Dementia is a syndrome; it describes different diseases
that affect the brain and usually are progressive effects that
cause deterioration in cognitive functioning. Dementia is
accompanied by symptoms and signs such as memory
problems, difficulties in communication, concentration,
judgment, organizing and planning daily issues, and also
behavior and mood changes [
4]. Dementia has a different
effect on each person, and this depends on some factors
and the personality of each one before the illness and how
the disease affects the brain [
5]. Dementia can occur in
approximately 100 types of diseases. The most common
form of dementia is Alzheimer's disease with an estimated
rate of 60% to 80% of cases worldwide [
6]. Vascular
dementia is the second most cause of dementia after
Alzheimer’s disease. Dementia with Lewy bodies is the 3rd
most common type of dementia, about 10% of the cases
[
7].
1.2. Sensory Disorder Challenges Facing Individuals
with Dementia in Their Physical Environment
In the case of dementia, memory impairment causes
deficits in sensory functioning. Individuals with dementia,
especially in late-stage dementia, experience a reduction in
the acuity of basic senses; seeing, hearing, touch, taste and
smell, and hidden senses; proprioception and vestibular,
and in some cases suffer from sensory hallucinations, this
reduction might lead to sensory deprivation [
8]. Sensory
impairment increases cognitive problems and leads
individuals to isolate due to their disability to communicate
with their surroundings, and also causes discomfort and
agitation, and deficits in their daily activities and affects
social interaction, and is reflected in their behavior in their
physical environment [
9] as shown in Fig. 1. Environments
that provide appropriate sensory stimuli to people with
dementia encourage them to be engaged to social and
routine activities and enable a person to interact with his
surroundings, multisensory physical environment enable
individuals with dementia to live a stress-free, enabling and
positive experience [
10].
Figure 1. The impact of dementia on human sensory memory, based on [8-10]

2112 A Qualitative Therapeutic Design Approach for Sensory Garden Design for People with Dementia
In case of sight loss or visual impairment in dementia,
individuals act differently, as they experience some
difficulties and disabilities in the interpretation and
perception of the brain to what they see, which affect the
person’s visual perception (visual perception difficulties)
and spatial awareness and cause misidentification, blurring,
depth perception difficulties, changes in color perception,
visual disorientation and confusion in the determination of
space and distance, difficulties in mobility and moving
around, visual hallucinations, and impairment in the
biological body clock [
11].
The most common impact of hearing problems on
people with dementia is that they experience
hypersensitivity to sounds and certain tones and become
unable to interpret what they hear clearly. They may
become very sensitive to noise levels which a normal
person can accept. Noise is a very stressful and distracting
feature in their daily life and sometimes background noises
make it so difficult to have a conversation with others,
noise may cause illusions, disorientation, frustration and
anxiety, difficulties in mobility and moving around, and
Auditory hallucinations. The acoustic environment has a
significant impact on the behavior of a person with
dementia that experiences hearing impairment [
12].
People with dementia experience changes in their sense
of touch due to memory impairment and deficits in brain
functioning. Which may cause over-sensitivity or less
sensitivity to touch and it is necessary for a person to be
able to interact with his environment and objects by
physical touching, these problems in touch sensation lead a
person with dementia to lose connection and prefer to be
isolated from others and his familiar environment [
13].
Smell sense is often affected by dementia, causing
olfactory dysfunction which leads to changes in the way a
person experiences his daily activities and surroundings.
Sense of smell is responsible for identifying pleasant odors
and the smell of favorite food it is also the detector that
alerts people to dangerous smells like spoiled food, the
smoke of fires, and the leak of gases, which can cause
distress and danger to individuals with dementia. Taste
sense is related to the smell sense and they work together in
experiencing objects, places, and food in daily activities.
The impairment in taste sense can make food and drinks
taste different [
14].
2. Methodology
The research methodology is presented in Fig. 2 which
illustrates the methodology through three consecutive
phases which depend on different tools and methods in
each phase to achieve the research objective.
The research utilized multi-method qualitative research
tools that included analysis of dementia theories and
interviews with dementia specialists and caregivers, and
comparative analysis of international case studies of
dementia gardens.
Figure 2. Phases of the proposed design approach of therapeutic sensory gardens for dementia patients.

Civil Engineering and Architecture 11(4): 2110-2122, 2023 2113
2.1. First Phase: Determination of the Therapeutic
Goals for Dementia Patients
This paper provides a methodical review of the literature
and scientific theories related to dementia that conducted
qualitative research to explore the therapeutic goals for
dementia patients from the perspective of dementia
specialists and caregivers and patients in early staged
dementia. Accordingly, these goals were analyzed and
categorized into five main therapeutic goals which are:
1. Cognitive functioning therapeutic goals which are
based on functional independence, cognitive
stimulation, reality orientation, communication,
address memory, and interaction [ 15].
2. Psychological and emotional therapeutic goals are
based on managing stress, self-confidence,
self-esteem, ownership, sense of belonging, and
reminiscence [ 16].
3. Physical health therapeutic goals are based on
supporting mobility, relaxation, safety and security,
supporting abilities, and promoting exercise [ 17].
4. Behavioral management therapeutic goals are based
on improving mood, pleasant activities, support
hobbies [ 18].
5. Communication and interaction therapeutic goals are
based on social support, participation, and support
activities [ 19].
2.2. Second Phase: Determination of the Design
Qualities of Landscape Elements in Dementia
Gardens a Comparative Analysis of International
Case Studies
The research in this part analyzed three case studies of
gardens serving dementia patients that applied design
qualities of landscape elements of gardens by using
different methods in applying these qualities and different
design aspects. Accordingly, these case studies were
chosen, namely: Resthaven Paradise-Aged Care institution
in Australia, Magnolia House for the elderly in the United
Kingdom, and Fontenuovo Elderly Care Facility and
Residence in Italy. Then the research set a comparative
analysis between the case studies according to different
therapeutic goals and the design qualities of landscape
elements used in each garden in an attempt to reach a
design approach for these qualities concerning therapeutic
goals.
2.2.1. First Case Study: Resthaven Paradise-Aged Care
Institution, Australia
The Resthaven paradise aged care institution was
constructed in 2011 in paradise city in South Australia.
This institution provides a specially designed garden for
dementia accessible through a dementia building as shown
in Fig. 3.
Figure 3. Resthaven Paradise Aged Care institution garden plan [
20]

2114 A Qualitative Therapeutic Design Approach for Sensory Garden Design for People with Dementia
The Dementia-Enabling Garden is designed with
qualities that help and attract patients to explore the
outdoor environment and interact with the surroundings
through passive and active engagements.
The garden offers an accessible looped pathway that
starts at the building door and ends at the same place. this
pathway passes through different spaces in the garden,
these spaces provide meaningful activities, physical
engagement opportunities, elements and activities that
stimulate the senses, a secure and safe environment, private
seating areas, gardening and horticultural activities,
wildlife attraction elements, elements that promote
reminiscence [
20].
2.2.2. Second Case Study: Magnolia House for the Elderly,
United Kingdom
Starrett Lodge on the NSW Central Coast conducted a
comprehensive literature assessment in 2009 and used the
findings to design a therapeutic, interactive, sensory
wandering garden and an accompanying atrium/sunroom.
The atrium has a view of the rest of the garden and may
be partially opened to let in fresh air, fragrances, and
sunlight. Features for reminiscence, a mural of the nearby
land, an old vehicle, an observation platform overlooking
the wildlife, a finch aviary, a woodpile, a quiet place with
a water element, and raised planting beds where people
may dig and harvest vegetables are all included in the
garden's design. The garden environment was created to
improve the quality of life for people in the dementia units
in Magnolia House, in addition to improving the staff
members' outdoor experience [
21] as shown in Fig. 4.
The garden's design aimed to fulfill the following
qualities: provide a safe and secure environment, promote
independence in using the garden, provide a sensory
stimulating environment, elements, and features that
support orientation, attract wildlife, provide walking paths,
provide seating choices, supports teamwork, provides,
give the opportunities for meaningful activities, provides
maintenance and gardening activities, supports social
interaction between residents and staff members and
family visitors [
21].
Figure 4. Magnolia House Garden plan [
21]

Civil Engineering and Architecture 11(4): 2110-2122, 2023 2115
2.2.3. Third Case Study: Fontenuovo Elderly Care Facility
and Residence, Italy
The Fontenuovo Residence opened a ten-bed unit for
dementia patients with moderate to severe behavior issues
in January 2016. Patients take part in a particular therapy
program that makes use of sensory rehabilitation methods,
such as group or individual healing activities in the healing
garden, where the combination of lights, colors, scents,
essences, noises, objects, and pictures aids in the reduction
of abnormal behavior and the stimulation of memory recall
as shown in Fig. 5. This aims to enhance patients' behavior
as well as their overall mental and physical health.
The Fontenuovo Healing Garden is easily accessible
from the activity hall, allowing a seamless transition
between indoors and out to minimize confusion [
22].
There are various rest places along the main walk, each
with chairs surrounded by fragrant plant varieties to make
the halt even more pleasant and stimulating. There are
also solitary seats available, which provide a personal,
private place, as well as a tiny wooden gazebo to stimulate
social interaction [
22].
2.2.4. The Design Qualities of Landscape Elements in
Dementia Gardens
As a result of the previous analysis of the three cases
studies of dementia gardens, the most important design
qualities of dementia gardens were determined in an intend
to find the interrelationship between these qualities and
dementia therapeutic goals in the third phase of the
research methodology, and these qualities are promoting
independence, sensory stimulation, decision making,
familiar characters, mental mapping, personal identity,
communication, address memory, privacy, ownership,
sense of belonging, self-confidence, promote reminiscence,
safe and secure environment, support mobility, relaxation,
microclimate adaptation, promoting physical exercise,
provide walkable walking paths, shelter and shade,
sustainability, promoting physical activities, accessibility,
support range of abilities, improve mood, pleasant
activities, support hobbies, spatial orientation, horticultural
activity, meaningful activity, familiar tasks, integrate
indoor and outdoor, wildlife attraction, participation and
interaction, support activities, support socialization,
seating choices, and encourage team work.
Figure 5. Fontenuovo Elderly Care Facility Garden plan [
22]

2116 A Qualitative Therapeutic Design Approach for Sensory Garden Design for People with Dementia
2.3. Third Phase: Evaluate and Analyze the
Interrelationship between the Design Qualities of
Sensory Gardens and the Therapeutic Goals of
Dementia
This part of the research presents the interrelationship
between the design qualities of therapeutic sensory gardens
found in each case study and the dementia therapeutic
goals that were previously set and their impact on the
landscape elements this relationship was done by two
methods and these methods were as follows:
2.3.1. Data collection
In this part, data were collected through the past two
phases and set in an interview form which determines a set
of relationships between therapeutic goals and design
qualities according to different design aspects. The
interviews were conducted and accomplished by the
researcher and the participants through institutional visits
and online interviews which were previously determined.
The interview participants were a sample of 20 dementia
specialists and 30 caregivers in different dementia daycare
institutions to determine the relationship between design
qualities and therapeutic goals.
The interviews questions categorized the design
qualities according to the main therapeutic goals through
five topics; 5% of questions about gender, age, garden
visiting rate, and user group if a dementia specialist,
provider, or a family caregiver, 30% for the qualities that
enhance cognitive functioning and psychological
therapeutic goals and, 30% for qualities that supports
Physical health and manage Behavioral therapeutic goals,
20% for qualities that enhance communication and
interaction therapeutic goals, 15% about designing the
outdoor spaces for dementia patients. The interview
questions were on a rating scale on how relevant are the
design qualities to the therapeutic goals and participants
were asked to rate the relationship between Dementia
therapeutic goals (Cognitive functioning, psychological,
physical, behavioral, and interaction) and garden design
qualities.
2.3.2. Data Analysis
The interview data were analyzed and evaluated by the
researcher, and the data analysis is presented in five
categories of design qualities in the shown bar charts in Fig.
6. The final results of the interrelationship between design
qualities and therapeutic goals are shown in Fig. 7.
2.3.3. Comparative Analysis of the Design Qualities of the
International Case Studies Related to Different
Therapeutic Goals
This part of the research presents a comparative
analysis of the design qualities achieved in the selected
case studies concerning therapeutic goals, and the degree
of achievement of these qualities that vary from good (●),
average (■), poor (○), and not applicable as shown in
Table 1.
Figure 6. Data analysis of the interview results of the design qualities related to therapeutic goals [The Researcher]

Civil Engineering and Architecture 11(4): 2110-2122, 2023 2117
Figure 7. Design qualities related to different therapeutic goals [The Researcher]
Table 1. A comparative analysis of the design qualities of the selected case studies related to therapeutic goals
Design Qualities Resthaven, Australia Magnolia House, UK. Fontenuovo, Italy
Cognitive functioning
Promote independence N.A There are fixed seats with arms
to promote independence ■A circular pathway to
minimize confusion ■
Sensory stimulation There are a sensory green wall
and a water fountain ●There is a multi-sensory
stimulating environment ●
There are sensory tanks, and
a rest area surrounded by
stimulating features
●
Decision making Looped pathways with a
non-confusing starting point ●N.A Seating choices and
non-confusing pathways ■
Familiar characters A rotunda with heritage style,
bird bath, and fountain ■An aviary and a fountain along
the pathway ●N.A
Mental Mapping The use of small landmarks
along the garden ○N.A The use of distinct objects all
around the pathway ■
Personal identity N.A Surrounding elements enhance
personal identity ○Surrounding elements
enhance personal identity ●
Communication Enhances communication with
the surrounding environment ○N.A N.A
Address memory N.A Sunroom that overlooks the
garden ○N.A
Psychological
Privacy Provides private spaces for
relaxation ■Provides private zones for
relaxation ■ ■
Ownership N.A N.A Enhances the sense of
ownership ○
Sense of belonging There is a rotunda with heritage
style ○
A memory box and an
observation platform and an old
car
●N.A
Self-confidence N.A Provides a looped pathway ○
Provides a circular path that
passes through all garden
elements
○
Promote Reminiscence Provides a heritage-style
rotunda ■Provides memory boxes, an old
car, and a mural of nearby land ●There is an old tree ■

2118 A Qualitative Therapeutic Design Approach for Sensory Garden Design for People with Dementia
Table 1 continued
Physical Health
Safe and secure
environment
Provides a safe environment by
using paved with non-slip,
material
■Provides a safe environment by
using paved with non-slip,
material
■Pathway with no sharp angles
or junctions and paved with
non-slip, anti-freeze,
non-glare material
●
Support mobility Supports mobility through the
garden
○N.A Support mobility by
providing pathways paved
with non-slip, anti-freeze,
non-glare material
●
Relaxation A rotunda for relaxation ●Private zones for relaxation ●Rest area surrounded by
stimulating features
●
Microclimate Shaded seating area for
multi-use activities
N.A An old big tree in the seating
area for shade
●
Encourage Physical
Exercise
Encourage Physical Exercise ○N.A Encourage Physical Exercise ■
Provide walking paths Looped pathways throughout
the garden
●Provides looped walking paths ●Provides circular walking
paths
●
Shelter and Shade A shaded seating area and
sheltered seats are located on
the pathway
■Provides Shelter and Shade ■Provides Shelter and Shade ●
Sustainability N.A Uses sustainable garden
elements that need low
maintenance
■N.A
Physical activities Provides physical engagement
opportunities
■N.A Supports Physical activities ○
Behavioral Management
Accessibility The garden is accessible
through the dementia building
●The Garden is accessible
through the dementia building
■The Garden is accessible
from the activity hall
●
Support a range of
abilities
Regards and Supports the
Range of abilities
○N.A Regards and Supports the
Range of abilities
■
Improve mood N.A The Birds’ aviary in the garden
helps to improve the mood
■There are multi features that
Improve mood
Pleasant activities N.A The garden provides places for
pleasant activities
■The garden provides places
for pleasant activities
■
Support hobbies N.A There is a woodpile to support
hobbies
○N.A
Spatial orientation Supports orientation by
providing a looped pathway
■Supports orientation by
providing a looped pathway
■Supports orientation by
providing a circular pathway
■
Horticultural activity Raised beds for the
horticultural activity zone
●provides Maintenance and
Gardening Activities
●Raised beds for horticultural
activity
■
Meaningful activity Provides Meaningful activity ●Provides Meaningful activity ○Provides Meaningful activity ■
Familiar tasks Provides Familiar tasks ○N.A Provides Familiar tasks ■
Interaction and communication
Integrate indoor and
outdoor
Integrates indoor spaces with
outdoor through wide building
openings
■Provides an observation
platform and an accompanying
sunroom
■There is a seamless transition
between indoors and
outdoors
●
Wildlife Provides elements that attract
wildlife
●There is an aviary with birds in
it
●Provides an aviary and a
small fountain to attract birds
■
Participation and
Interaction
Supports Interaction through a
rotunda located near the bird
bath and water fountain
■Gathering spaces for interaction
with others
■Supports Interaction with the
surroundings
●
Support activities N.A Support activities in the garden ○N.A
Support Socialization Supports social interaction ■Supports social interaction ■Supports social interaction ■
Seating choices Provides Seating choices along
the pathway
■Provides Seating choices along
the pathway
●Provides Seating choices
along the pathway
■
Teamwork N.A ○Provides spaces that support
teamwork
○Provides spaces that support
teamwork
○

Civil Engineering and Architecture 11(4): 2110-2122, 2023 2119
Figure 8. The most effective design qualities related to different therapeutic goals as a result of comparative analysis of case studies [The Researcher]
3. Results
Based on the previous analytical review of the
therapeutic goals of dementia and the design qualities of
sensory gardens, it has been clear that there is a reciprocal
relationship between these goals and the design qualities of
dementia gardens based on sensory challenges.
The most effective design qualities of each therapeutic
goal in each case study have been determined as shown in
Fig. 8.
These design qualities are related to therapeutic goals
and characterize the garden elements and realize the
different needs of dementia users and they should be
realized in the garden design process considering the
different therapeutic goals of dementia patients.
3.1. Design Qualities and Considerations of Landscape
Elements for Dementia Sensory Garden
Gardens should provide certain qualities to enhance the
quality of life for people with dementia and assist in the
therapeutic process. Therefore, garden should fulfill the
following qualities:
1. Provide a controlled and balanced stimulating
environment
Effective and qualified sensory gardens for dementia
people should provide an environment that includes
controlled and balanced stimulating features, so as not to
over-stimulate users or give a feeling of boredom. This can
be achieved by:
• Noise reduction, as it acts as a negative stimulant and
has the greatest and most harmful effect on people
with dementia, noise is produced by the surrounding
people, traffic, urban noise, entertainment tools, and
operational equipment used for work. Noise can be
reduced by the selection of a quiet site location for the
garden, and the use of materials and elements that
absorb or eliminate noise.
• Take into account the effect of landscape features and
their morphological characteristics that stimulate
sight and touch senses like colors, light, texture,
contrast, movement, size, and form and other
characteristics that stimulate hearing, smell, and taste
senses like sound and aroma, to improve the
interaction of all five senses with the surrounding
environment.
2. Provide non-annoying safety and security
Mobility and moving around are very important for a
person with dementia, as they need to move freely and
easily in a balanced, safe, and secure environment that is
not restrictive or controlling the user, with fewer
threatening and unobtrusive obstacles. These needs can be
achieved through Innovative design approaches.
This feeling can be achieved through:
• The use of suitable lighting features that do not hinder
the movement and are suitable for its function.
• The use of shrubs or planted walls with suitable
height or vines' screens to define pathways and zones,
which give a sense of control and freedom at the same
time instead of high fences that Impose obtrusive
control.
• The use of non-restricting technology that fulfills
safety for the user like detecting and monitoring tools.
3. Use elements and features that support orientation
People with dementia experience their surrounding
environment with a great feeling of disorientation that they
need to be assisted to be safely oriented in their living
spaces and outdoor areas: this supported orientation can be
achieved through:
• By using colors, contrast, and texture in the garden's
design features to support the identification of
elements, pathways, and floors.
• Use garden features that indicate the function of the
used space.
• Avoid the use of shiny floors and features that can
cause glare and be mistaken by users or misidentified
and use features and treatments that reduce glare.

2120 A Qualitative Therapeutic Design Approach for Sensory Garden Design for People with Dementia
• Use garden signages and signs to support orientation
and ensure entrances and exits to garden spaces and
indoor spaces
• Use features and characteristics that are familiar to
the user.
4. Support participation and involvement in daily
activities
A person with dementia needs to practice his daily
activities at his level of abilities garden design can be
designed to encourage utilizing a person’s interests and
skills
• Design spaces that encourage and support outdoor
therapeutic activities such as horticultural therapy,
reminiscence therapy, pet therapy, and gardening.
• Design space for music activities with a controlled
noise level.
• Design gathering spaces with familiar and domestic
characteristics and elements, supported with certain
sounds or odors.
• Encourage the practice of outdoor physical activities
by designing safe and accessible spaces and
non-slippery pathways for secured walking and
strolling.
5. Promote and enhance self-confidence and self-esteem
A person with dementia needs to reach an optimum level
of self-confidence in his daily tasks and activities and
support his skills and therefore reaches his self-esteem and
respect; gardens can maximize this feeling by providing
appropriate landscape design of:
• Clear paths and routes between the indoor and
outdoor nodes.
• Avoid unclear pathways and unsafe spaces or
elements.
• Supporting social interaction with others and
encouraging activities and skills.
6. Support social interaction and relation with family
and caregivers
A person with Dementia needs to keep regularly
communicated and connected to considerable family
members and caregivers, so gardens must provide:
• Proper spaces for private family visits with suitable
features
• A wider space is prepared for a larger group of family
members to easily communicate
• Provide an intimate personal space to be used by the
person with dementia easily alone
• Provide a workable space or activity space to
encourage interaction with family members in a safe
way.
• To maximize the quality of life of a person with
dementia, his cultural background must be
experienced and enclosed in the design considerations
4. Discussion and Conclusion
This research addresses the interrelationship between
the therapeutic goals of dementia and the qualities of
different design aspects. The research first reviewed the
definitions, symptoms, and types of dementia and the
impact of the sensory disorder on the behavior of people
with dementia in their physical environment. It elaborated
on the therapeutic goals of dementia from the perspective
of dementia experts and caregivers to be used in the second
part of the research, which presented the design qualities of
dementia sensory gardens concerning different design
aspects. Finally, the research presents a set of design
qualities and considerations for each type of sensory
challenge as a therapeutic sensory design approach for
gardens used by people with dementia to enable users to
overcome their sensory challenges and achieve therapeutic
goals.
Declarations
Ethics Approval and Consent to Participate
The research included an interview-based survey. All
respondents are professional dementia specialists and
dementia caregivers (above 20 years old) and agreed to
participate in the interview as a part of this research. This
survey has no participation of any dementia patient and
there were no medical trials set on patients and no medical
or human data was shared in this survey. The researcher
provided the participants with all the data they need to
know about the study to make an “informed” decision
about participating in this research and they all gave their
permission to be part of the study and they make an
“informed” consent to participate.
Consent for Publication
The manuscript does not contain any personal data in
any form (including individual details, images, or videos).
Further, all participants are professional dementia
specialists and dementia caregivers (above 20 years old)
and agree to publish the results of the interview.
Availability of Data and Material
All data generated or analyzed during this study are
included in this manuscript.
Competing Interests
The authors declare that there are no competing
interests.

Civil Engineering and Architecture 11(4): 2110-2122, 2023 2121
Funding
This study received no funding from any resource.
Authors' Contributions
All authors contributed to the manuscript and have read
and approved the final version. All authors put the outline
of the study idea, completed the literature review, planned
the methodology, conducted the interview form and its
analysis, and are responsible for writing the manuscript
details, figures, and revisions.
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