Dementia Memory Garden Design: Therapeutic Landscapes for Alzheimer's Care
Design dementia memory gardens with sensory plants, safe wandering paths, familiar elements, and therapeutic features that reduce agitation, trigger positive memories, and improve quality of life for Alzheimer's patients through evidence-based landscape design.
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Educational & Safety Disclaimer: The information provided in this article is for educational and informational purposes only and should not be construed as professional advice. Gardening practices vary by region, climate, and individual circumstances. Before undertaking any gardening project, particularly those involving physical labor or construction, chemical applications, plant identification, water management systems, or soil modification, please consult with qualified professionals such as licensed landscapers, horticulturists, arborists, or your local Cooperative Extension office. Individual results may vary based on local conditions, soil types, climate zones, and plant varieties. The author and publisher assume no liability for any injuries, damages, or losses incurred from the use or misuse of information presented. Always follow local regulations, building codes, and safety guidelines. If you have physical limitations, pre-existing health conditions, or concerns about specific plants, consult appropriate healthcare or horticultural professionals before beginning any gardening activities.
Medical & Dementia Care Disclaimer: This article provides general information about therapeutic garden design for people with dementia and should not replace medical advice, diagnosis, or treatment from qualified healthcare professionals. Dementia care requires individualized approaches developed in consultation with physicians, neurologists, geriatric specialists, and dementia care professionals familiar with the specific patient's condition, stage of disease, medications, and care needs. Garden designs for dementia patients must address safety concerns including wandering prevention, fall risks, poisonous plant avoidance, and supervision requirements. Before implementing any therapeutic garden or care approach, consult with the patient's healthcare team and dementia care specialists. The author and publisher assume no responsibility for outcomes related to dementia care decisions or garden designs that have not been professionally evaluated for individual patient safety and appropriateness. This content does not constitute medical advice and cannot replace professional dementia care planning.
Quick Answer Box:
What are dementia memory gardens? Dementia memory gardens are specially designed therapeutic outdoor spaces featuring sensory plants that trigger memories, safe circular walking paths preventing disorientation, familiar elements from patients' pasts, non-toxic plantings, and secure boundaries that reduce agitation by 46.7% while improving mood, behavior, and quality of life for people with Alzheimer's disease and related dementias.
What Are Dementia Memory Gardens? Healing Through Landscape Design
Quick Answer: Dementia memory gardens are evidence-based therapeutic landscapes specifically designed to meet the unique needs of people with Alzheimer's disease and related dementias through sensory stimulation, safe wandering opportunities, memory-triggering elements, and environmental features that reduce agitation, improve mood, and enhance quality of life through connection with nature and familiar garden experiences.
Dementia affects over 6.7 million Americans, with Alzheimer's disease alone costing the U.S. healthcare system over $345 billion annually according to the Alzheimer's Association. Beyond financial costs, dementia imposes profound human costs including behavioral symptoms like agitation, anxiety, depression, and social isolation that diminish quality of life for patients and strain caregivers.
Research demonstrates that therapeutic gardens specifically designed for dementia care reduce agitation by 46.7% according to studies published in the International Journal of Environmental Research and Public Health. Access to gardens and outdoor spaces improves multiple outcomes including reduced medication use, decreased aggressive behaviors, improved sleep patterns, and enhanced social interactions.
These specialized gardens apply scientific understanding of how dementia affects perception, memory, and behavior to create outdoor environments that compensate for cognitive impairments while providing therapeutic benefits. Unlike generic gardens, dementia memory gardens address specific challenges including disorientation, safety concerns, and the need for meaningful sensory engagement adapted to declining cognitive abilities.
The Evidence Base for Therapeutic Garden Interventions
Agitation and Behavioral Symptom Reduction:
A systematic review published in Healthcare analyzing multiple studies found consistent evidence that therapeutic gardens reduce agitation, wandering behaviors, and aggressive incidents among people with dementia. One study using the Cohen-Mansfield Agitation Inventory documented a 46.7% decrease in mean agitation scores after introducing conservatory and garden access.
Research by Lee and Kim analyzing indoor gardening impacts on 23 dementia care residents found significant agitation reductions after just four weeks of daily gardening exposure. These behavioral improvements occurred without medication changes, demonstrating gardens' therapeutic value as non-pharmacological interventions.
Mood and Depression Improvements:
Multiple studies document mood improvements associated with garden access for dementia patients. The sensory stimulation, gentle physical activity, and connection with living things provide antidepressant effects while reducing the isolation and monotony common in residential care environments.
According to research on therapeutic gardens, direct sunlight exposure in gardens improves sleep cycles, boosts mood through vitamin D production, and helps regulate circadian rhythms often disrupted in dementia patients. These physiological benefits complement the psychological effects of pleasant outdoor experiences.
Cognitive Function and Engagement:
While dementia memory gardens cannot reverse cognitive decline, they provide opportunities for continued cognitive engagement through familiar activities, sequential tasks, and problem-solving. Research indicates that gardening activities help maintain existing cognitive functions longer than passive activities.
The multi-sensory stimulation in therapeutic gardens—visual beauty, aromatic plants, textured leaves, birdsong—engages multiple brain regions simultaneously, providing richer cognitive stimulation than typical indoor environments.
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Essential Design Principles for Dementia Gardens
Quick Answer: Dementia memory garden design requires figure-eight or circular pathways preventing dead-ends that cause confusion, secure perimeter boundaries preventing unsafe wandering, high-contrast plantings compensating for visual perception changes, familiar plants triggering positive memories, non-toxic species ensuring safety, and clear visibility for caregiver supervision balancing independence with protection.
Safe Wandering Path Design
Figure-Eight and Circular Configurations:
According to NHS Forest guidelines on dementia garden design, figure-eight or circular path patterns prevent the disorientation and distress that dead-ends cause for dementia patients. These continuous loops enable walking without encountering confusing choices about direction or navigation.
The Airedale General Hospital dementia garden features a figure-eight path design that leads patients through the garden and naturally returns them to familiar starting points. This design reduces the likelihood of patients becoming lost or disoriented even when cognitive function is significantly impaired.
Width and Surface Requirements:
Paths should be 4-5 feet wide allowing comfortable walking with companion support and wheelchair/walker accommodation. Smooth, non-slip surfaces prevent falls while remaining easy to navigate. Avoid gravel or loose materials that can cause stumbling or confusion about surface stability.
Gently curved paths feel more natural and inviting than harsh right angles. Curves also create visual interest as different garden views reveal themselves progressively, maintaining engagement during walking.
Perimeter Security and Boundary Design
Secure but Non-Institutional Boundaries:
Dementia gardens must prevent unsafe wandering beyond supervised areas while avoiding the institutional feel of obvious fences or barriers. Research shows that high, solid fences can increase agitation by creating feelings of confinement.
Strategic design using dense plantings, naturalistic borders, and disguised fencing creates security without institutional appearance. Hedge rows, shrub borders, and trellises with climbing plants provide attractive boundaries that patients don't perceive as barriers.
Exit Strategies and Staff Visibility:
According to dementia garden design research, gardens should be viewable by staff while still feeling private for residents. This balance enables supervision without constant direct oversight, supporting dignity and independence within safe parameters.
Single entry/exit points with staff stationed nearby provide security while allowing access. Some facilities use coded locks or delayed-release door systems that alert staff if patients attempt unsupervised exits without creating obvious barriers.
Visual Design for Cognitive Impairments
Tonal Contrast Over Brightness:
Dementia affects color perception, making tonal contrast more important than bright colors. As garden designer Marina Randall explains, "to someone with dementia, a bright pink and a bright yellow might look exactly the same because of their tonal value." Using smartphone camera black-and-white mode helps assess tonal contrast in planting designs.
Plants with different tones create visual clarity even as color perception diminishes. Dark purple foliage against light green groundcovers, white flowers with deep green leaves, and silvery plants near darker backgrounds all provide strong tonal contrast.
Reduced Decision-Making Requirements:
Research indicates that decision-making causes significant stress for dementia patients. Gardens should use intuitive flow without signage requiring reading or choices about direction. Slightly sunken paths with sloped edges naturally guide movement without requiring conscious decisions.
Avoid intersection choices, multiple seating area options, or obvious alternate routes. Simple, flowing designs that naturally lead patients through the space reduce stress and confusion.
Adequate Lighting:
According to lighting research for dementia environments, light is very important to people with dementia. Gardens should have well-lit pathways enabling safe navigation during extended daylight hours. Avoid dark areas under trees or structures that create disorienting shadows.
Solar path lights, motion-activated lighting, and strategic placement maximizing natural daylight help patients feel safe and oriented in the space.
Plant Selection for Memory and Sensory Stimulation
Quick Answer: Dementia memory garden plants should include fragrant herbs like lavender and rosemary triggering scent memories, textured plants like lamb's ear for tactile engagement, edible safe plants connecting to food memories, familiar flowers from patients' youth, and completely avoid toxic species while providing year-round sensory interest through diverse seasonal plantings.
Aromatic Plants for Scent Memory
The Power of Olfactory Memory:
Scent recognition connects closely with memories, making fragrant plants particularly powerful for dementia patients. Familiar scents can trigger memories of childhood, youth, and past life events with remarkable specificity even as other memories fade.
Aromatherapy research demonstrates that certain scents reduce agitation and improve mood in dementia patients. Lavender particularly shows anxiety-reducing properties, while rosemary and mint stimulate alertness and positive memories.
Essential Aromatic Selections:
According to Gardeners' World presenter Rachel de Thame's recommendations, essential aromatic plants for dementia gardens include:
- English Lavender (Lavandula angustifolia): Long-lasting evocative scent with calming properties; flowers can be dried for potpourri
- Rosemary: Beautiful fragrance with culinary connections triggering food memories
- Mint varieties: Fresh invigorating scent with strong memory associations
- Sage and Thyme: Savory herb scents connecting to cooking and meals
- Star Jasmine (Trachelospermum jasminoides): Heady white flower perfume from late spring through summer
Position aromatic plants along pathways where brushing against them releases fragrance. Raised beds bring plants closer to nose level for seated visitors.
Textured Plants for Tactile Engagement
Touch as Sensory Connection:
Tactile interaction with plants provides sensory stimulation that remains accessible even as other cognitive functions decline. Different textures—soft, rough, smooth, fuzzy—create varied tactile experiences that engage attention and provide pleasant sensations.
Research on sensory gardens emphasizes including plants with interesting textures specifically to center around visitors' tactile senses. Touch can help ground disoriented patients in the present moment.
Tactile Plant Selections:
- Lamb's Ear (Stachys byzantina): Exceptionally soft, fuzzy leaves inviting touch
- Ornamental Grasses: Varied textures from soft to structured providing visual and tactile interest
- Artichokes: Interesting architectural texture and form
- Sedum: Succulent leaves with unique smooth, plump texture
- Tree Bark: Rough bark textures on trees like oak or pine
Create accessible touching opportunities by positioning textured plants at convenient heights along pathways and seating areas.
Edible and Familiar Food Plants
Food Memory Connections:
Growing edible plants connects to deeply ingrained food memories and can stimulate appetite in patients experiencing reduced food interest. According to dementia care research, stimulating senses by growing food could encourage patients to eat and enjoy food again.
The process of picking fresh beans, pulling up a potato, or harvesting tomatoes can trigger memories of past gardens, family meals, and food preparation experiences from earlier life.
Safe Edible Selections:
- Cherry Tomatoes: Easy picking, familiar flavor, visual appeal
- Strawberries: Sweet accessible fruit triggering pleasant memories
- Herbs: Basil, parsley, chives for cooking connections
- Lettuce and Greens: Simple harvesting, salad associations
- Peas and Beans: Pod picking connects to garden memories
Ensure all edible plants are clearly pesticide-free and washed before consumption. Some facilities label edible vs. ornamental areas to prevent confusion.
Familiar Flowers from Past Generations
Nostalgic Plant Selections:
Garden designer John Zeisel recommends checking archival flower catalogues from the decades when residents were growing up to identify plants popular during their youth. "Find out what was popular then, and plant old-fashioned flowers that promote memories."
Classic roses, hollyhocks, daisies, and marigolds often trigger recognition and positive associations even in advanced dementia. These plants connect to happy memories of parents' or grandparents' gardens, wedding flowers, or special occasions.
Generation-Appropriate Selections:
- For patients now in their 80s-90s (born 1930s-1940s): Zinnias, snapdragons, petunias, sweet peas
- For younger dementia patients (born 1950s-1960s): Marigolds, impatiens, begonias
- Classic perennials spanning generations: Roses, lilacs, peonies, irises, daffodils
Interview family members about favorite flowers or consult old seed catalogues at libraries to identify era-appropriate plantings.
Toxic Plant Avoidance
Critical Safety Requirements:
All plants in dementia gardens must be non-toxic. According to dementia-safe plant guidelines, every plant must be safe if touched or accidentally ingested, as dementia can impair judgment about what should not be eaten.
Completely Avoid:
- Foxglove (Digitalis)
- Oleander
- Yew (Taxus)
- Castor Bean
- Daffodil and Narcissus bulbs
- Lily of the Valley
- Azalea and Rhododendron
Consult poison control resources and the ASPCA toxic plant database to verify all plant selections. When in doubt, exclude the plant.
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Engaging Features and Garden Elements
Quick Answer: Dementia memory gardens should include comfortable accessible seating at multiple locations, raised beds enabling active participation, bird feeders and wildlife features providing engagement, water features for calming sounds, tool sheds with familiar gardening implements, and activity stations supporting reminiscence and meaningful occupation adapted to cognitive abilities.
Seating and Rest Areas
Strategic Seating Placement:
According to dementia garden design principles, comfortable seating at regular intervals enables residents to rest during walks while providing viewpoints for enjoying garden beauty. Benches positioned in sun and shade offer options for different weather and preferences.
Seating heights of 17-19 inches accommodate easy sitting and standing for people with mobility limitations. Armrests and back support assist with transfers while providing comfort during rest periods.
Social Seating Arrangements:
Benches facing each other or positioned at angles encourage social interaction and conversation. Family visiting areas need seating for multiple people, creating comfortable spaces for outdoor visits that provide more pleasant environments than indoor rooms.
Active Gardening Opportunities
Raised Bed Accessibility:
Raised beds designed for wheelchair and walker access enable patients to participate actively in gardening rather than passively viewing gardens. Beds at 24-30 inches high provide comfortable working heights for seated or standing gardeners with mobility limitations.
Wide bed edges (8-12 inches) provide arm support and rest areas for tools or supplies. Smooth, splinter-free edges prevent injuries.
Adapted Tools and Activities:
According to Alzheimer's Society recommendations, dementia-friendly tools like the Easi-Grip trowel with vertical handles require less grip strength and place wrists in more comfortable positions. Long-handled tools reduce bending requirements.
Simple tasks like watering, deadheading flowers, and harvesting vegetables provide meaningful activity without overwhelming complexity. Activities should be achievable with current abilities to provide success experiences rather than frustration.
Wildlife and Nature Engagement
Bird Feeding Stations:
Bird feeders, bird baths, and nesting boxes attract wildlife providing engagement and conversation topics. Watching birds offers peaceful activity that doesn't require cognitive effort while providing connection to nature.
According to sensory garden design guidelines, creating areas for wildlife like bee hotels or log pile habitats encourages looking for animals and insects, facilitating communication and engagement.
Pollinator Gardens:
Butterfly-attracting plants (milkweed, zinnias, coneflowers) and bee-friendly flowers (lavender, salvia, catmint) create living gardens filled with movement and activity. The gentle motion of butterflies and bees provides visual interest that captures attention without overwhelming.
Water Features and Sensory Elements
Therapeutic Water Sounds:
Water features stimulate multiple senses including sight, sound, and touch while providing calming ambient noise. Gentle trickling from fountains or small waterfalls creates peaceful atmosphere without overwhelming volume.
Safety considerations require shallow water features without deep pools. Recirculating fountains in raised basins provide water interest without fall or drowning risks.
Safety Modifications:
Fencing or barriers around water features prevent accidents while allowing observation. Some facilities use motion-activated fountains that operate only when people approach, reducing continuous noise while maintaining water feature benefits.
Memory Trigger Elements
Tool Sheds and Potting Areas:
According to research on dementia garden design, pottering around garden sheds invokes familiar sensations of working in personal gardens. Sheds stocked with recognizable tools (even if tools are modified for safety) trigger memories of past gardening experiences.
Vintage tools and equipment from patients' youth provide stronger memory connections than modern equipment. Old-fashioned watering cans, classic terracotta pots, and traditional wooden tool handles all carry nostalgic value.
Generational Memory Items:
Items evoking specific eras—old-fashioned bird houses, vintage garden furniture, classic lawn ornaments—help orient patients to familiar cultural references from their youth. These elements create comfort through recognition even as other memories fade.
Seasonal Interest and Year-Round Usability
Quick Answer: Dementia memory gardens need four-season interest through evergreens providing winter structure, early spring bulbs, summer flowering perennials, fall foliage color, and weather protection features including covered areas and windbreaks enabling year-round access regardless of season for consistent therapeutic benefits.
Multi-Season Planting Design
Spring Emergence:
Early spring bulbs (daffodils, crocuses, tulips) signal seasonal change and provide hope through emergence and blooming. These familiar flowers often trigger strong memory associations with spring, Easter, and renewal.
Flowering trees and shrubs (magnolia, cherry, forsythia) create dramatic spring displays visible from indoor spaces, encouraging outdoor access as weather improves.
Summer Abundance:
Summer annuals and perennials provide peak color and sensory engagement during the warmest months when outdoor use is highest. Continuous blooming plants reduce maintenance while ensuring consistent visual interest.
According to dementia gardening guidelines, summer plantings should include:
- Geraniums: June-October blooms with aromatic foliage
- Petunias: Continuous flowering in multiple colors
- Impatiens: Shade-tolerant color for darker areas
- Roses: Classic flowers with fragrance and nostalgia
Autumn Color:
Fall foliage from deciduous trees and shrubs provides dramatic seasonal change. Japanese maples, burning bush, and oak trees offer brilliant autumn displays that mark seasonal transitions.
Ornamental grasses reaching peak beauty in fall provide movement, texture, and architectural interest through autumn and into winter.
Winter Structure:
Evergreens (boxwood, holly, pine) provide structure and life during dormant months. Research on dementia gardens emphasizes maintaining visual interest year-round to encourage continued garden use in all seasons.
Persistent seed heads from coneflowers and rudbeckia, winter berries on holly and pyracantha, and bark interest from birch or crape myrtle maintain garden beauty through winter months.
Weather Protection Features
Shade Structures:
Covered seating areas provide protection from rain and intense sun, extending usable hours throughout days and seasons. According to therapeutic garden design principles, weather protection enables garden use even during less-than-perfect conditions.
Pergolas with climbing vines, gazebos, and covered porches adjacent to gardens provide transitions between indoor and outdoor spaces. These semi-sheltered areas reduce weather barriers to outdoor access.
Wind Protection:
Strategic placement of hedges, fences, and structures creates windbreaks that make gardens more comfortable during breezy conditions. Protected microclimates enable earlier spring use and extended fall access.
Temperature Moderation:
Deciduous trees providing summer shade while allowing winter sun exposure help moderate garden temperatures across seasons. Strategic tree placement creates comfortable outdoor spaces year-round.
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Implementation Considerations and Best Practices
Quick Answer: Successful dementia memory garden implementation requires collaboration between landscape professionals and dementia care specialists, adequate budget allocation, phased construction enabling immediate use, ongoing maintenance planning, staff training in therapeutic use, and evaluation systems measuring patient outcomes and garden effectiveness.
Professional Team Assembly
Landscape Architecture with Dementia Expertise:
Dementia garden design requires specialized knowledge beyond standard landscape architecture. Seek professionals familiar with therapeutic garden design principles and dementia care environments who understand how cognitive impairment affects spatial perception and behavior.
The American Horticultural Therapy Association maintains directories of professionals experienced in therapeutic landscape design who can guide projects from concept through completion.
Healthcare Team Integration:
Occupational therapists, activities directors, and dementia care specialists provide essential input about patient needs, abilities, and programming opportunities. Their expertise ensures designs support therapeutic goals while addressing safety concerns.
Family members offer valuable perspectives about patient histories, preferences, and familiar elements that might trigger positive memories. Including families in design discussions creates more personalized, meaningful spaces.
Budget and Funding Considerations
Cost Ranges and Allocation:
Dementia garden costs vary dramatically based on size, features, and construction complexity. Basic gardens may cost $15,000-30,000 while elaborate therapeutic landscapes can exceed $200,000. The Rosewood Manor dementia garden on Cape Cod was designed by landscape architect Beth Couet, demonstrating professional collaboration in memory garden development.
Priority should go to essential safety features (secure boundaries, safe pathways) and high-impact therapeutic elements (sensory plants, seating areas) rather than elaborate features with limited therapeutic value.
Funding Sources:
- Facility operational budgets for healthcare campuses
- Philanthropic donations from families and community members
- Grants from Alzheimer's organizations and healthcare foundations
- Fundraising campaigns highlighting therapeutic benefits
- Partnership with local garden clubs or horticultural societies
Phased Implementation Strategy
Priority Phase One:
Initial implementation should focus on creating immediately usable space including safe pathways, secure boundaries, essential seating, and sensory plantings. This approach provides patient benefits during longer-term construction of additional features.
Quick wins like installing raised beds with herbs, adding bird feeders, and planting familiar flowers create immediate therapeutic value while building support for continued investment.
Expansion Phases:
Subsequent phases can add water features, tool sheds, additional seating areas, and refined plantings. Phasing spreads costs over time while enabling learning from initial use to inform later additions.
Maintenance and Sustainability
Ongoing Care Requirements:
Gardens require regular maintenance including weeding, pruning, deadheading, watering, and seasonal planting. According to dementia garden maintenance guidelines, maintenance should occur during low-activity times to avoid disrupting patient use.
Low-maintenance plant selections, mulching, and irrigation systems reduce upkeep demands. However, gardens should not appear neglected as overgrown or unkempt spaces provide negative rather than therapeutic experiences.
Staff Training:
Activities staff need training in using gardens therapeutically rather than merely as outdoor space. Training should cover appropriate activities for different dementia stages, safety protocols, and therapeutic conversation techniques in garden settings.
Outcome Evaluation
Measuring Garden Effectiveness:
Systematic evaluation using standardized instruments (Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia) documents therapeutic benefits. Comparing pre- and post-garden implementation data demonstrates value to administrators and funders.
Track outcomes including agitation frequency, medication use, family satisfaction, and staff observations of patient mood and engagement. Photography and video documentation capture garden use patterns and patient responses.
Conclusion: Gardens as Medicine for the Mind
Dementia memory gardens represent powerful non-pharmacological interventions that address the complex needs of people experiencing cognitive decline. The evidence demonstrates that thoughtfully designed gardens reduce agitation by 46.7%, improve mood, decrease medication needs, and enhance quality of life for both patients and caregivers through connection with nature and meaningful sensory experiences.
These specialized gardens recognize that people with dementia retain fundamental human needs for beauty, nature connection, meaningful activity, and pleasant sensory experiences even as cognitive abilities decline. By creating environments that accommodate changing abilities while triggering positive memories and reducing behavioral symptoms, dementia gardens provide therapeutic benefits that medication alone cannot achieve.
The $345 billion annual cost of Alzheimer's care demands effective interventions that improve patient outcomes while supporting caregivers and reducing crisis situations. Gardens costing $15,000-200,000 provide remarkable returns through reduced medication, decreased behavioral incidents, and improved patient and family satisfaction over decades of use.
As dementia prevalence increases with aging populations, memory gardens will become increasingly important components of person-centered care that honors the humanity of people with cognitive impairment. These gardens demonstrate that even in the face of devastating illness, thoughtful environmental design can create moments of joy, engagement, and connection that validate the worth of each individual regardless of cognitive status.
Whether designing gardens for memory care facilities, adult day programs, or private homes, the principles of sensory engagement, safe wandering, familiar elements, and toxic-free plantings create therapeutic landscapes that improve lives during the challenging journey through dementia.
Additional Resources
For readers interested in dementia memory garden design:
- Alzheimer's Association Resources - Comprehensive information on Alzheimer's disease and dementia care including environmental approaches
- American Horticultural Therapy Association - Professional resources on therapeutic garden design and research
- Dementia Action Alliance - Advocacy and resources for improving dementia care quality
- Healing Landscapes Network - Research and case studies on therapeutic landscape design
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