3 tips for designing user experiences for the elderly

From my own research on end-of-life decision-making, as well as working with my design students for the elderly population in Singapore, I have come up with three insights:

1. Talk, talk, talk – Build relationships with the elderly. Consulting with users is the gold-standard of user-centred design, and it is nothing new, but I continue to see designers designing for target groups they don’t understand. Designers tend to design for themselves, and they get away with it most of the time because the technology-consuming audience IS mostly in the same age group. With the elderly, however, failing to understand their unique circumstances can leave a project dead in the water.

Anecdotally, most developers I have met are in the 25- to 35-year-old range. If we define the elderly as anyone over 65, then we are talking about a minimum 30-year age gap, often more. In most of Asia, the past 30 years was a time of rapid developmental change, from villages to cities, from black and white TVs to YouTube. Jargon has changed and horizons have been expanded.

The entire concept of ‘a job’ has evolved, going from field, to factory, to office, to just about anywhere. Change has been so pervasive and radical that most of what developers assume to be ‘normal’ may not be the case at all.

I had a student who wanted to design technology to improve medical adherence. A pressing problem with many elderly is that they forget or refuse to take their medication. This can sometimes have fatal consequences from accidental overdosing when they make up for it or from reduced therapeutic outcomes. Thus, if the elderly can be reminded to take the right medications at the right time, this would be a good thing.

A smartphone app with its portability and programmability seemed to be the logical choice. When my student showed the paper prototype to an elderly couple here in Singapore, their reaction was not positive. They wanted to know why she was complicating the medication process by adding an extra layer of activity between them and the medication. You see, while the utility of the smartphone made sense to us, the extra complication of setting up the reminder systems made no sense to the elderly.

Designers need to understand that the elderly may experience many perceptual difficulties. Vision, fingertip sensitivity and hearing are eroded as we age. Working memory, the ability to remember several thoughts at one go, is affected as well. Prospective memory – the ability to remember what to do next, takes a hit as well.

These changes are not of the same extent, nor universal, but it is sufficiently prevalent in the population as a whole that designers must take these things into account. Furthermore, these perceptual, motor and cognitive difficulties may cause the elderly to experience lower trust and confidence in technology. Therefore, the elderly may experience many unforeseen issues with technology, issues that are easily overlooked or overcome by a younger, more confident population.

Taken together, the internal and external changes lead to sufficient reason for developers to have a conversation with the elderly. Designers will benefit from better input at the pre-design phase, as well as during user testing.

User testing with any population requires the designer to create a safe atmosphere so that the participants do not feel tested or threatened, but instead are confident enough to give honest and critical feedback. Again, against the background of those internal and external changes mentioned earlier, it is easy to understand why many elderly user-testing participants find themselves saying “It’s ok” and “It’s fine” when in reality they do not like the technology but are afraid to say so for fear of looking like they have not understood it. If these are the kinds of answers you are getting when you test with your elderly users, you are either asking the wrong questions or asking the right questions the wrong way.

2. Instead of new products, make existing products elder-friendly – One insight that I have had, after working with the elderly population and talking to medical personnel who work with this population, is that the old don’t feel old. Thus, they don’t want to be reminded they are old, and as far as possible, don’t want to be treated as if they are old. I call this the desire to ‘keep on keeping on’.

As you read this, remember that in 20 to 40 years, you will qualify for the term ‘elderly’. From this perspective, it is easy to understand how, regardless of age, an artist will always stay an artist, and a gamer will stay a gamer. While the official definition of active ageing is someone who is a mentally and physical healthy person contributing to society, it tends to mask certain aspects of ageing. From a designer’s perspective, I find it more productive to realise that bad exercisers will continue to avoid exercise and socially reclusive people will not magically become social butterflies as they ‘age actively’.

So as the silver tsunami arrives, a growing need will not be in NEW products that enhance elderly living, but in adapting existing products to accommodate the changes wrought by time on a person’s body. The point is maintenance, not enhancement. The kinds of adaptions to be undertaken can be categorised into three common areas: Physical, cognitive and social.

• The physical adaptations mostly fall under the guidelines of universal design principles. Examples of these are more obvious help systems, bigger, tactile methods of control, anti-slip systems and wheelchair ramps. These have been exhaustively explored elsewhere and will not be expanded upon here.

• A good example of cognitive elder-friendly adaptations is elder-targeted IT training courses. Many seniors express a desire to be trained to use their smartphones and computers, rather than having someone always help them. These courses are more repetitive, assume less prior knowledge and have a safe environment among other seniors.

Therefore, designers aiming to improve elderly user experience can provide a better out-of-the-box experience, or supply elder-friendly help systems. A positive effect has long been shown to improve performance on cognitive tests. So a happy and confident elderly user is a satisfied and loyal user. We can all do with more of those.

• Finally, social adaptations to improve the elderly user experience are much harder to find. I am often asked what ‘user experience design’ means and how it is different from regular ‘user interface design’. My answer is in the consideration of ‘desire’ and ‘pleasure’. User interface design aims to achieve the critical criteria of usability (easy to learn and use) and usefulness (meets a need). User experience design, however, is aimed at generating a pleasurable experience or a desirable product for the user.

This layer of desirability is of particular relevance when we consider social adaptations for the elderly. Imagine this scenario: Eric, who has always been a gamer, begins to age. As he ages, the atmosphere of a LAN gaming centre, which is noisy and dim, becomes very elder UNfriendly. The noise challenges his ability to filter auditory input, and the dimness makes it hard for him to see where he is going.

Furthermore, it seems to be socially awkward for an elderly gentleman to walk into a gaming centre. But if he foregoes visiting the centre, he also foregoes keeping socially and mentally active with the things that he loves doing.

Active ageing proponents often talk about the need for casual games for the elderly. It would be interesting to see what a casual gaming centre for the elderly would look like.

In sum, elder-friendly products are products that maintain, or even better, enhance existing lifestyles.

3. Consider the needs of the pseudo-secondary users – These are the people around the elderly. Although they have long been considered secondary users of technology for the elderly, this title masks their true influence on how technology enters the life of the elderly. Instead, adding the term pseudo emphasises the fact that although the benefactors of the technology are the elderly, the actual operators may be this secondary audience. I think of pseudo-secondary users as the scaffolders and the caregivers. The scaffolders are the people in daily contact with the elderly. This would include home care personnel (e.g. maids), adult children and grandchildren.

They are the ones who mediate an older person’s experience with technology. By mediate, I mean that they provide the initial push to adopt certain technologies, structure the usage by showing them ‘what it’s for’, and scaffold use by providing tech help and often advance the level of the senior’s engagement with technology by introducing new tools.

As a result, although they are technically not the end-users, they are still key considerations as they completely colour and influence the user experience of the elderly. In fact, most designers are hard pressed to think of an elderly design scenario that does NOT include a scaffolder.

The scaffolders come into play especially when developers are trying to promote an innovative product. As initial adopters they will be the ones who need to be convinced of the value proposition of a particular technology before they will promote this technology with the elderly. In effect, they are the gatekeepers and therefore, the unique selling point of the product should meet with acceptance and approval from their perspective.

Still, this view should be balanced by not overly emphasising the scaffolders’ role to the point that the needs of the primary user is compromised. This is particularly true in home monitoring technology, where it is the family who tends to do the market search and purchasing decisions, while elderly privacy concerns tend to bow to the more pressing needs of safety. Just because it is necessary does not mean that we can forgo designing better products that do a better job of balancing these needs.

The second group of pseudo-secondary users are the caregivers. These are the numerous professional personnel involved in geriatric care – for example, doctors, nurses, therapists, hospital social workers and hospice workers.

They are the people who work with elderly everyday, but are not with the same senior everyday. They see large numbers of the elderly, and technology may be used to make their job easier, more efficient, or save them time so that they can give better care to the elderly. By supporting the caregivers, designers can still meet the goal of supporting the elderly, with frail elderly in particular being the main benefactors.

For example, one student group, when given the task of designing something for the elderly in Singapore, came upon the brilliant idea of designing pocket language translators. In their observations of how nurses work, they found that the linguistic barrier between nurses and the elderly in Singapore is growing. It turns out, that many of Singapore’s nurses come from the rest of Asia, thus they may have unfamiliar accents, or they cannot be assumed to have functional grasp of the many languages and dialects that the elderly in Singapore speak.

In an ideal world, the translator would work both ways, translating on the fly from patient to nurse and back. But for their minimum viable product, the student group only proposed a common-phrase speaker to help with the process of caregiving. Such common-phrases might be “We are going to take your temperature” or “Please sit up”. Nurses that the students showed the prototype to welcomed this design as a good way to build trust with elderly patients, making their jobs easier and the elderly more comfortable.

– Foong Pin Sym lectures on interactive media design and user experience at the National University of Singapore. She also mentors at the NUS Entrepreneurship Centre. (This article is from a talk given by Pin Sym at the UP Singapore Active Ageing Hackathon 2013.) 

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