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Proceedings of International Scientific Conference “Post COVID-19 Tourism”
Veliko Tarnovo/Sofia, Bulgaria, 3-4 October 2024
29
ACCESSIBLE TOURISM FOR PEOPLE WITH DEMENTIA:
AN EVIDENCE-BASED DESIGN APPROACH TO SENSORY
GARDENS IN URBAN AREAS
Ciro Albuquerque
1
*, Zilsa Santiago
2
Universidade Federal do Ceará (UFC), Brazil
ABSTRACT: It is estimated that approximately 55 million people worldwide live with dementia, and this
number is projected to triple by 2050. In Brazil and Latin America, cases are expected to increase by 200%,
making dementia the seventh leading cause of death globally. Accessible Tourism (AT) for people with dementia,
especially through the creation of sensory gardens in urban areas, emerges as a promising strategy to significantly
improve the quality of life of these people, while promoting social inclusion, collective well-being and the
sustainable development of tourism. Dementia causes cognitive and sensory impairment, resulting in difficulties
in perceiving stimuli, disorientation and increased anxiety. In view of this, the aim is to investigate the most recent
scientific evidence that, combined with the concept of accessible tourism in urban areas, can guide urban planning
managers to promote improvements in city infrastructure and adapt public policies aimed at serving people with
dementia. This exploratory research is based on an integrative literature review, including publications between
2020 and 2024, on the themes of "dementia", "tourism", "evidence-based design" and "accessibility in urban
areas". As a result, seven elements were considered promising in urban design: (i) controlled stimulation of the
senses; (ii) familiarizing and safe environments; (iii) integration of memories and narratives; (iv) variety of
accessible routes; (v) incorporation of restorative nature; (vi) appropriate colors and materials; and (vii)
connectivity and access to urban transport modes. These elements prove to be effective both accessible and
sustainable tourism, promoting inclusive, healthy and economically viable environments.
KEYWORDS: dementia, tourism, evidence-based design, accessibility, urban areas.
INTRODUCTION
The Alzheimer's Disease International (ADI) 2024 report highlighted that more than 55
million people worldwide live with dementia, and someone is diagnosed with the condition
every 3 seconds. The global prevalence is estimated to reach 153 million by 2050, a significant
increase, particularly in Latin America, where cases are expected to grow by 200% by then, in
contrast to the 100% expected in the United States (AID, 2024). Dementia, already the seventh
leading cause of death globally and the leading cause in some countries, represents an annual
1
Ciro Férrer Herbster Albuquerque, Master's student in Architecture, Urbanism and Design in the Postgraduate
Program of the Department of Architecture, Urbanism and Design (PPGAUD) of the Federal University of Ceará
(UFC). Architect and Urbanist, consultant and academic researcher in Neuroscience and Aging applied to built
spaces. Brazil, ciro.ferrer@hotmail.com, ORCID ID: https://orcid.org/0000-0002-7462-6941
* Corresponding author
2
Zilsa Maria Pinto Santiago, Professor and PhD in Education from the Federal University of Ceará (UFC),
Professor and advisor of the Postgraduate Program in Architecture, Urbanism and Design (PPGAUD) at the
Federal University of Ceará (UFC). Architect and Urbanist, consultant and academic researcher in Accessibility
of the built environment. Brazil, zilsa@arquitetura.ufc.br, ORCID: https://orcid.org/0000-0001-9980-4954.
Proceedings of International Scientific Conference “Post COVID-19 Tourism”
Veliko Tarnovo/Sofia, Bulgaria, 3-4 October 2024
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economic burden of US$1.3 trillion, a figure that is expected to more than double by 2030. The
responsibility for addressing this challenge lies with governments, which must promote
awareness, diagnosis and detection, in line with the goals of the WHO Global Action Plan on
Dementia. Currently, only around 50 countries have implemented National Dementia Plans,
despite more than 21% of governments having committed to developing them in 2017,
reflecting the urgency of a more effective response (AID, 2024).
This set of symptoms that significantly affect the ability to carry out daily activities,
predominantly associated with aging, causes symptoms such as memory loss, confusion,
depression, apathy and mood swings, in addition to impacting their families, caregivers and
society in general. Given the prevalence and severity of this condition, academics have
investigated ways to create dementia-friendly communities and provide care for these people
(AID, 2024). Studies highlight the importance of providing social comfort, health interactions
that preserve the dignity of patients, music-based therapies as a treatment, challenges faced by
caregivers and factors that influence the acceptance of psychosocial interventions by patients
(Alzheimer's Association, 2024).
According to Buckley (2022), tourism activities have demonstrated benefits for the
well-being and mental health of the general population. Despite the potential of tourism to
benefit people with dementia and other stakeholders, such as formal and informal caregivers
and medical specialists, the topic is still little explored (Waby, 2023). However, tourism has
been proposed as a non-pharmacological intervention for individuals in the early stages of
dementia (Wen et al., 2022). With dementia still incurable and attempts at new drugs for
Alzheimer's Disease (AD) having a failure rate of 99.6% between 2002 and 2012, innovations
and cost-effective interventions are becoming increasingly necessary. Accessible Tourism (AT)
has the potential to offer experiences that stimulate confidence, memories and independence
for these patients (Cummings et al., 2021).
Experts in geriatric care note that most tourism destinations still do not accommodate
the unique needs of visitors with dementia. This scenario is slowly changing in countries such
as Australia, Canada, the United Kingdom and the United States, where dementia-friendly
travel guides are being developed and dementia-specific attractions are being designed,
including dedicated cafes, sensory trails and art workshops (Wen et al., 2022). With regard to
sensory enrichment, the emerging field of study of Accessible Tourism (AT) presents itself as
a promising possibility to be developed, given the character of creating environments that allow
all people, regardless of their physical, sensory or cognitive abilities, to fully participate in
Proceedings of International Scientific Conference “Post COVID-19 Tourism”
Veliko Tarnovo/Sofia, Bulgaria, 3-4 October 2024
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tourism activities (Escuderos, Andreu and Ros, 2021).
The World Travel & Tourism Council (WTTC) report estimates that the accessible
tourism market could reach more than 8 trillion dollars annually (WTTC, 2023). According to
the European Network for Accessible Tourism (ENAT), tourists with physical or cognitive
limitations, such as people with dementia, tend to travel more frequently and stay for longer
periods compared to the average tourist. They often travel with family members or carers,
increasing the total number of travelers in a group and therefore increasing direct spending on
accommodation, food and activities (ENAT, 2023). Furthermore, the study carried out by
VisitEngland in 2018 found that tourists with disabilities or reduced mobility, including those
with marked cognitive decline, spent approximately £15.3 billion in the UK during the year.
This study emphasizes that tourists who require more specific support have a significant
economic impact, especially in sectors such as hospitality and services, and that investment in
accessible infrastructure can further attract this audience (Wen et al., 2023).
From this perspective, taking into account the proposal of Accessible Tourism (AT),
this study aims to investigate the bibliographic production focused on the applicability of
sensory garden projects in urban areas, taking into account: the accessibility of the project; the
tourist activity as a proposal for health and well-being for the public with dementia, caregivers,
family members and health professionals; evidence-based design (EBD); and the integration of
this therapeutic area with the city design. It is expected that the findings of the study can guide
urban planning managers to promote improvements in the infrastructure of cities and to adapt
public policies aimed at serving people with dementia.
METHODOLOGY
As this is exploratory research, an integrative literature review was used as a method
between 2020 and 2024. The research focuses on the theme of “Accessible Tourism of Sensory
Gardens for people with dementia in urban areas”, guided by the question “How can accessible
tourism in sensory gardens benefit people with dementia, caregivers and family members in the
urban environment?”. The keywords “"dementia", "sensory garden", "tourism", "evidence-
based design", and "accessibility in urban areas" were defined. The Boolean operator selected
was “AND”. In this way, it was possible to arrive at the groups: “dementia” AND “sensory
gardens”; “evidence-based design” AND “accessibility in urban areas”; “dementia AND
“tourism” AND “sensory garden”; “accessibility in urban areas” AND “tourism” AND
“sensory garden”; “dementia” AND “evidence-based design”.
Proceedings of International Scientific Conference “Post COVID-19 Tourism”
Veliko Tarnovo/Sofia, Bulgaria, 3-4 October 2024
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The searches were carried out between June and September 2024, in the CAPES
Periodicals repository. The inclusion criterion adopted was articles whose theme involved the
biopsychosocial and therapeutic benefits of sensory gardens for the public with dementia,
family members and caregivers. As an exclusion criterion, articles that did not meet the
requirements were eliminated: a) language: English; b) search for articles; c) period: last four
years (2020-2024); d) filtered by peers; e) exclusion of repeated publications. Of the 534 studies
searched, only 12 met the proposal linked to the initial research question. As results, seven
promising elements stand out for the design of sensory gardens that are essentially accessible
and capable of providing well-being, sensory stimulation and mental health to users, whether
they are diagnosed with dementia or not: (i) controlled stimulation of the senses; (ii) familiar
and safe environments; (iii) integration of memories and narratives; (iv) variety of accessible
routes; (v) incorporation of restorative nature; (vi) appropriate colors and materials; and (vii)
connectivity and access to urban transport modes.
RESULTS
As a result of the method adopted, sensory gardens are spaces intentionally designed to
engage the five human senses — sight, hearing, smell, touch, and taste — through essentially
natural elements. These gardens play a significant role in sensory stimulation, especially for
individuals facing cognitive and sensory declines due to neurodegenerative conditions, in
addition to providing inclusion and socialization for older people who find themselves isolated
in their homes most of the time, deprived of multiple senses essential for healthy aging (Hung
et al., 2023). These environments promote positive responses in the brain, helping to improve
cognition, memory, and mood. In the context of individuals with dementia, sensory stimulation
through contact with textures, aromas, sounds and colors can evoke past memories and provide
emotional comfort, alleviating symptoms such as anxiety and agitation (Moszkowicz,
Moszkowicz and Porada, 2023).
Studies have shown that integrating these therapeutic environments into urban areas
represents a crucial opportunity to improve the quality of life of people with dementia, while
transforming these spaces into accessible and inclusive destinations (Fleming, Bennett and
Zeisel, 2022; Elbasyoni and Gammaz, 2023). One of the main approaches is to create places
that can be easily accessed, ensuring that the urban route to the garden is intuitive and safe (Lak
et al., 2021). This can be achieved through fluid connections with public transport and adjacent
streets, as well as adequate signage to guide people with cognitive impairments. The Dementia-
Proceedings of International Scientific Conference “Post COVID-19 Tourism”
Veliko Tarnovo/Sofia, Bulgaria, 3-4 October 2024
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inclusive Planning and Design Guideline is the first document of its kind to compile strategies
and actions for the design of the built environment at the neighborhood scale (Happy Cities,
2023). Even though it does not prioritize sensory garden design, the document presented
significant advances in this area of study of urban planning and dementia.
Sensory gardens, when designed for Environmental Enrichment (EE)
1
, play a crucial
role in stimulating several brain areas, promoting neuroplasticity
2
and strengthening cognitive
reserve
3
, especially in individuals with dementia and neurodegenerative diseases (Murroni et
al., 2021). Neuroscience has shown that exposure to environments rich in sensory stimuli can
activate adaptive processes in the brain, mitigating dysfunctional behaviors and slowing
synaptic degeneration (Lai et al., 2023). With a view to guiding urban planning managers to
promote improvements in city infrastructure and to adapt public policies aimed at accessibility,
inclusion and dignity of people with dementia, seven EBD-oriented guidelines were proposed
for sensory garden projects, as shown in Table 1.
Table 1. Proposal Sensory Garden Projects for the Accessible Tourism in urban areas.
(i) Controlled Stimulation of the Senses
Sensory gardens should balance
sensory stimulation without causing
overload. According to Attention
Restoration Theory (ART), natural
environments promote cognitive
recovery by reducing the need for
directed attention (Olszewska-
Guizzo, 2023).
. Aromatic plants such as sage (Salvia officinalis),
lavender (Lavandula angustifolia) and rosemary (Salvia
rosmarinus) have demonstrated anxiolytic, anti-
inflammatory, antioxidant and neuroprotective effects.
They have also demonstrated potential in the treatment
of common neurological disorders, including
Alzheimer's disease, Parkinson's disease, migraines and
cognitive impairments. They are able to stimulate
olfactory memory without overloading the sensory
system (Faridzadeh et al., 2022).
. Natural sound elements, such as running water, which
create a relaxing ambient sound and help reduce
agitation (Cheng and Sabran, 2022).
. Varying tactile surfaces, such as different floor
textures and plants, which encourage touch and promote
reconnection with the environment, improving mood.
1
Refers to environments that offer a wide variety of sensory, cognitive, motor and social stimuli that can promote
brain development and mental well-being. These environments are characterized by the presence of varied visual,
auditory and tactile stimuli, opportunities for problem-solving, cognitive challenges and the practice of physical
activities (Murroni et al., 2021).
2
The brain's ability to reorganize itself and adapt to changes throughout life. This includes the formation of new
neuronal connections (synapses), the modification of the strength of these connections and, in some cases, even
the generation of new neurons (neurogenesis). This process occurs in response to new experiences, environmental
stimuli, injuries or changes in functional demands (Murroni et al., 2021).
3
It refers to the brain's ability to resist neuropathological damage and maintain cognitive function in the face of
injury or aging (Lai et al., 2023).
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Veliko Tarnovo/Sofia, Bulgaria, 3-4 October 2024
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(ii) Familiar and Safe Environments
For people with dementia, familiar
and predictable environments are
essential to reduce disorientation
and anxiety. Studies show that
accessible urban design should
minimize physical and cognitive
barriers (Fleming, Bennett and
Zeisel, 2022).
. Well-defined and legible spaces, without confusing
passages or unnecessary forks, using visual reference
points such as characteristic trees or sculptures.
. Clear signage with simple, large icons, aiding spatial
orientation and reducing the risk of disorientation.
. Soft, uniform lighting, avoiding harsh shadows that
could confuse or cause fear. Adequate night lighting also
ensures safety.
(iii) Integration of Memories and Narratives
Sensory garden designs should be
able to activate positive memories
and promote personal narratives.
Studies on affective memory
suggest that environmental stimuli
can trigger old memories,
improving self-esteem and
emotional well-being in people with
dementia (Fleming, Bennett and
Zeisel, 2022).
. Create themed areas inspired by cultural or
regional memories, such as gardens of local plants,
which refer to familiar activities.
. Incorporate social spaces that facilitate interaction
and social reconnection, with comfortable and accessible
furniture for rest.
(iv) Variety of Accessible Routes
People with dementia and their
caregivers have different levels of
mobility and endurance. Inclusive
pathways should meet a variety of
needs, based on the concept of
universal design (Fleming, Bennett
and Zeisel, 2022).
. Routes with accessible, flat and non-slip pavements,
which allow wheelchair mobility and prevent falls.
. Short and long route options, allowing users to
choose their own route according to their level of
comfort and need.
(v) Incorporation of Restorative Nature
Green environments have a proven
restorative function in scientific
literature. The presence of
vegetation improves air quality and
provides calming effects
(Olszewska-Guizzo, 2023).
. Compact urban forests or sensory groves, where the
visitor is enveloped in tall vegetation, creating a sense of
refuge and privacy.
. Water features, such as small ponds or fountains,
which not only contribute to the relaxing soundscape,
but also serve as visual focal points that anchor the
space.
(vi) Suitable Colors and Materials
The perception of colors and
contrasts is altered in people with
dementia, and inappropriate use of
colors can increase confusion. Soft
colors and well-distributed contrasts
. Soft, natural colors for main areas, avoiding bright
or complex tones that can generate anxiety.
. Natural materials, such as wood and stone, create a
pleasant tactile connection and do not cause artificial
sensations or discomfort to the touch.
Proceedings of International Scientific Conference “Post COVID-19 Tourism”
Veliko Tarnovo/Sofia, Bulgaria, 3-4 October 2024
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help with spatial perception,
contributing to walkability and the
performance of daily activities
(Wiener and Pazzaglia, 2021).
(vii) Connectivity and Access to Urban Transport Modes
Sensory gardens should not be
isolated enclaves; they should be
connected to the city, favoring
accessibility and shared use by the
entire population. The theory of the
walkable city argues that accessible
and well-connected environments
encourage everyday use of these
spaces (Olszewska-Guizzo, 2023).
. Central location or in areas easily accessible by public
transport, increasing accessibility and frequent use by
people with reduced mobility.
. Smooth transitions between urban areas and the
garden, such as green squares that gradually introduce
the visitor to sensory immersion.
DISCUSSION
Gradually, partnerships between universities and urban planners have been
incorporating sensory garden practices in strategic locations in urban centers, considering
people with dementia, residents of the region and, consequently, encouraging tourist visits by
the public interested in mental health and cognitively beneficial stimuli for human aging. A
practical example of this integration is the Dementia-Friendly Community Gardens in
Singapore, where sensory gardens were incorporated into densely populated neighborhoods.
The planning of these gardens aims to create environments that promote social interaction and
engagement with nature, with specific areas dedicated to horticultural activities, sensory
stimulation and relaxation (Alzheimer’s Association, 2024). In France, the University of
Sorbonne carried out practical applications of sensory gardens mediated by the principles of
EE, finding promising improvements in the behavioral and attentional state of elderly people
with mild and moderate dementia (Bourdon and Belmin, 2021).
In Australia, more than 20 venues host events in memory cafes where people with
dementia socialize over morning tea. Similarly, the Museum of Contemporary Art Australia in
Sydney offers workshops where educators guide participants through the interpretation of
artworks, followed by creative activities to do at home, providing beneficial behavioral stimuli
while also making tourism accessible to new participants (Wen et al., 2022). A particularly
notable initiative is Australia’s first dementia-friendly sensory trail, which opened in 2021 in
Woowookarung Regional Park, near Melbourne. Designed by the Victorian State Government
with input from people with dementia and their caregivers, the nearly one-kilometer trail winds
through lush forest inhabited by kangaroos and wallabies. The trail is accessible to wheelchair
Proceedings of International Scientific Conference “Post COVID-19 Tourism”
Veliko Tarnovo/Sofia, Bulgaria, 3-4 October 2024
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users and assistance dogs, with nine designated stops, including community meeting spaces
where visitors can listen to music and share their impressions of the natural landscape (Wen et
al., 2022).
In the United Kingdom, a Guide to Dementia-Friendly Tourism, published by
government agencies Visit England and Visit Scotland, outlines strategies for improving
services for travelers with dementia. Recommendations include accessible toilets, clear signage,
discounts for carers and directories of local attractions suitable for this group. In addition, a
growing number of tourist attractions in these countries are implementing dementia-friendly
initiatives. The Museum of Modern Art in New York, for example, is developing art
appreciation programmes specifically for visitors with dementia. In the United States, more
than a dozen museums, galleries, and nature centers in states including Minnesota, Michigan,
Tennessee, and others participate in the Spark! cultural program, which offers creative
workshops for individuals with dementia. Similarly, the National Museums of Liverpool in
England offers a variety of services, including guided tours called memory walks through the
city’s historic sites, group reminiscence sessions, and intergenerational activities for children
and their grandparents (Alzheimer’s Association, 2024).
These examples highlight the growing recognition of the need for tourism that caters to
people with dementia. While there is still much to be done to expand accessibility, the
development of dementia-friendly travel experiences shows promising potential not only to
improve the well-being of people affected, but also to create inclusive and enriching
experiences that benefit travelers, their caregivers and the community at large. Finally, despite
their recognized importance in academic and practical terms in some regions of the world, there
is still a lack of studies investigating the implementation and dynamics of sensory gardens in
macromobility
1
and micromobility
2
of urban modes in order to add data and evidence-based
design to urban planners in cities.
1
Refers to transportation systems that allow travel over longer distances, often intercity or interstate, with greater
passenger and/or cargo capacity. These modes are designed to connect large urban areas or even different
regions, states or countries, offering medium to long-distance travel (Olabi et al., 2023).
2
It involves transportation modes aimed at short distances, typically within urban or metropolitan areas. These
means are generally individual or have limited capacity, focused on fast and affordable trips for short distances,
such as the last kilometer between public transport and the final destination (Olabi et al., 2023).
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CONCLUSIONS
Integrating the concepts of reason, emotion, behavior, and memory into the design of
sensory gardens in urban areas not only mitigates the negative impacts of dementia, but also
transforms these spaces into tourist attractions with therapeutic benefits. The design principles
for sensory garden projects, based on neuroscientific evidence and linked to the purposes of
Accessible Tourism, support the emotional and cognitive well-being of people with dementia,
creating restorative environments that benefit both patients and their caregivers and family
members. In addition, such spaces can stand out as innovative tourist destinations by providing
multisensory experiences that encourage relaxation and connection with nature, attracting
tourists in search of regenerative and healthy experiences. In addition to welcoming people with
dementia, sensory gardens offer other visitors an opportunity to enjoy a space designed to evoke
calm, stimulate the senses, and promote emotional recovery. In this way, these environments
not only meet the needs of a specific group, but also consolidate themselves as places of
reconnection with the natural environment in the midst of urban areas, contributing to the
development of inclusive and sustainable tourism, while reinforcing the role of cities as
promoters of health and well-being.
ACKNOWLEDGEMENT
This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de
Nível Superior – Brasil (CAPES) – Finance Code 001.
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