Design for the Elderly – Getting Started

By Gerd Waloszek, SAP User Experience, SAP AG – December 21, 2010

Design for the elderly has become a prominent topic at UI and design conferences in recent years. On the SAP Design Guild, it has not been covered yet specifically – only in the context of universal usability. This is my very first article about this topic, and therefore I will focus on getting a foothold in the domain. I will look for aspects that define and drive design activities in support of elderly people. Personal references from conference visits and a few personal experiences with old people are included to spice this article up a little.

I plan to add two more articles about design for the elderly to the 10th Anniversary Edition in 2011, one about design challenges (or conflicting goals...), and another one from a more personal perspective.

 

A New Topic for the HCI and Design Community

In recent years, design for the elderly has met an increasing interest at human-computer interaction (HCI) and design conferences. For example, recent CHI conferences offered a considerable number of papers, posters, and student projects on this topic. I also observed this trend at the DIS 2010 conference in Aarhus, Denmark, and will refer below to a few relevant papers that were presented there . Overall, these conferences encompass a wide range of subjects within the broader topic of design for the elderly. Here is a selection of subjects, arranged according to different perspectives and with some overlaps:

  • The Internet ...
    • As an information resource for old people
      Examples: Age-related information (such as about health, accessible homes), general information (easier to access than physical information in various locations)
    • As a means of communication for old people
      Examples: discussion forums about age-related and other topics, e-mail
    • As a service for old people
      Examples: shopping, administration, booking (such as rooms, flights, trains, cars)
  • Living alone and coping with loneliness:
    • Electronic devices that monitor behavior and health functions or remind people to drink, eat, or take pills
    • Electronic devices that allow people to call for help in the case of an accident or health problem
    • Electronic mates, particularly for lonely people
  • Support for ...
    • People with disabilities including old people (this aspect is typically dealt with under the label of accessibility or universal access/design/usability activities)
      Examples: People with dementia or Alzheimer's, old people who can no longer live independently or in their homes (with support personnel)
    • Family members (children, partners, relatives) or friends of old people
    • Personnel in nursing homes

 

Approaching the Topic

For this article, I would like to approach design for the elderly in a special way and, as an introduction, begin with a few anecdotic remarks. Long ago, when I watched the first movie about Molière's life (produced in 1978), the following observation from Molière became engraved in my mind: Old people would still like to do a lot of things, such as dancing, running, or jumping around, but they cannot do them – or cannot do them properly – anymore. A quick look at competitive sport reveals that this progression starts early, and we use a number of metaphors to describe it. Once, I was given a brochure in which this progression was characterized using a door metaphor: Over time, more and more doors close for us, that is, we have fewer and fewer options at our disposal. Despite the wants of which Molière spoke, most people have learned to cope with the diminishing number options that are available to them and adapt their needs and desires accordingly – which is almost painless as long as attractive alternatives exist. Folk wisdom describes the adaptation of our desires to reality as cherries that hang too high for our reach – so we do not long for them (some people call this wisdom). Of course, there are still activities that we regret not being able to do anymore. Whereas Molière talked of the wants that old people still have, we can also observe that our wants themselves wane when we become older (they even may no longer come to existence) – and we have numerous excuses or explanations for why that happens. The waning has numerous causes; the fear of not being able to master new and sometimes even familiar challenges definitely plays a role. And then I had to make the sad observation that old people lose their initiative and also their ability to handle more complex devices. One might describe this state as "the end of all wants beyond the primary needs," but the name does not matter – the phenomenon is a sad reality, not only in nursing homes.

For the following discussion, I would like to rephrase the three aspects that I uncovered in my introduction above as follows:

  • For many people there comes a time when they can no longer do certain things, be they physical or mental activities. Depending on the situation at hand, people can be supported through optical, mechanical, or electronic devices that compensate the deficit to a greater or lesser degree. Design for the elderly, which can also be regarded as part of universal design, addresses exactly this aspect.
  • Then there also comes a time when people no longer want to do certain things. These no longer desired activities typically include using new technology or using technology at all. Such a lack of motivation can become a serious obstacle to supporting old people through devices. Thus, when we address this issue, many more aspects come into play than mere design.
  • And finally, there comes a time when independent use of technology becomes more or less impossible – it looks as if all of our above-mentioned efforts were in vain. For example, old people may no longer be able to use a TV, radio, or clock properly on their own. Even the stove or the washing machine can become mysteries to them or put them in dangerous situations. We have to ask a different question here: Is it possible to design for those old people at all, and if so what are the specific requirements and boundary conditions of such a design?

In my opinion, the three aspects, physical and mental deficits, lack of motivation, and lack of receptiveness for technological interventions, are a means to understanding how old people can be supported through technology. I will briefly look at them one by one.

 

Dealing with Physical and Cognitive Deficits

First, I will look at supporting older people (and ill or disabled people as well) through compensating for physical and cognitive deficits. There are basically two approaches to compensating for deficits:

  • Provide support through people
  • Provide support through technology, either exclusively (the "preferred" way) or in combination with people

As the term human-computer interaction implies, the respective work in the HCI and design domains is largely dominated by work that investigates how old people can be supported through electronic devices, that is, work that follows the second approach. Conference programs reflect this focus and boast of papers devoted to the design of new devices, sometimes including related services. These devices and services are meant to support elderly people in various contexts, for example, in situations that they can no longer deal with on their own – but this article is not the place to go into details.

Care robots for ambient assisted living

Figure 1-2: Care robots for ambient assisted living (left: Care-O-bot, Fraunhofer IPA; right: CASERO transportation system without driver, MLR System GmbH) (from WUD 2010 keynote in Stuttgart, Germany)

As already mentioned, a lot of current work focuses on supporting old people through devices, particularly in the Information and Communications Technology (ICT) domain. But I would like to point to relevant work that has already been done in the past under a different label: universal access/design/usability (and also under the related label accessibility; see also our Highlight Topic "Universal Usability"). For example, considerable work has been invested in the design of homes for elderly people (link to Website). As an example of more recent developments, on the other hand, I would like to mention the direction of "ambient assisted living" (AAL), which was demonstrated in the World Usability Day (WUD) 2010 keynote "Mythos User Experience (The User Experience Myth)" by Franz Koller at the local event in Stuttgart, Germany. The AAL approach might rightly be regarded as the Hi Tech variant of older work, which dealt more with architecture and the use and control of electricity. Mobile and ubiquitous computing will also boost work on the support aspect in the future.

 

Dealing with Lack of Motivation

The second aspect, lack of motivation to engage with (new) technology, points to the fact that old people become less and less motivated to appropriate and use technology, particularly complex electronic devices and services. As I have already noted, this behavioral change interferes with work aimed at supporting old people through technology, and therefore has to be taken seriously. Particularly younger designers are so enthusiastic about their devices and technology as such that they easily forget the barriers that often exist between old people and technology.

Of course, many researchers and designers are aware of this challenge and investigate it more closely. At conferences, I encountered, for example, papers that compared technology adoption of older people with that of younger ones (for example, the paper "Bedienung interaktiver Produkte – eine Frage des Alters?" by Jenny Vayhinger, WUD 2010, Stuttgart Germany), or investigated the motivation of old people in general to engage with technology. Graeme Coleman, for example, presented the paper "Engaging The Disengaged: How Do We Design Technology for Digitally Excluded Older Adults?" at the DIS 2010 conference. He showed that old people often adopt a pragmatic attitude towards technology and carefully look at the cost-benefit ratio of using it. Young people, on the other hand, often buy technology for its own sake, or because it's fun or "hip" to own it.

Audience during Jenny Vayhinger's presentation   Jenny Vayhinger giving her presentation   Graeme Coleman giving his presentation

Figures 3-5: Jenny Vayhinger giving her presentation (left and center); Graeme Coleman giving his presentation (right)

In the past, I met many old people who proudly told me that they did not need not deal with computers and all this "bad" technology (including the "bad" Internet). Others cautiously asked me whether it would be possible for them to avoid having a computer during their life span. They probably had no idea of how much computers have already invaded our lives. Many old people fear the complexity of electronic devices and are anxious about making errors. They may also be anxious not to show to other people that they cannot use them properly – they do not want to look stupid, as Alan Cooper would phrase it.

However, things are changing: A new generation of old people is emerging who are familiar with ICT and will make use of computers, the Internet, and electronic devices. They will do so as long as possible to compensate for their deficiencies and to make their lives richer and more independent of physical as well as cognitive restrictions and barriers. As far as I can see, I can already be counted among this "new generation."

 

Dealing with the "Undealable"

Finally, I would like to touch on the third of the three aspects that I have outlined above: old people who are "beyond" being able to use technology – at least, on their own and of their own will. This aspect seems to be dealt with least at HCI and design conferences. Mark Blythe's study "Age and Experience: Ludic Engagement in a Residential Care Setting" presented at the DIS 2010 conference perhaps comes close: He reported a project in which two painters approached old people in a nursing home and tried to portray them – with more or less success, depending on the ways in which the artists were able to communicate with the old people.

Two portraits by Phil Reynolds photographed from Mark Blythe's slides

Figures 6-7: Two portraits by Phil Reynolds photographed from Mark Blythe's slides

First of all, one has to acknowledge that there are a considerable number of old people who are no longer able to use technology on their own initiative and without assistance. The reasons and causes for this deficit vary. For example, old people who have dementia or Alzheimer's lack short term memory and orientation. They do not remember what the devices are for and how they can help them. They also cannot remember or are unable to find out how to operate the devices because they are too complex. When other people explain the devices to the old people, they will retain the information for a moment, but will ask again a minute or two later.

But I also learned that these issues do not imply that old people in this state do not use or appreciate any technology or devices at all. For example, many of them can still use phones, albeit in a limited fashion only, that is, they use phones only passively: They may pick up the phone when they are called (as long as they hear the bell ring), or use it when the personnel hands it to them. (They may also replace the handset incorrectly after the call, and the phone line can be blocked for hours.) Nevertheless, they still know what phones are used for and have no issues with talking to people who are invisible to them. This familiarity probably results from a life-long exposure to phones. In addition, it should be noted that not only cognitive disabilities may impact the use of phones; bad hearing can also make the use of phones more or less fruitless.

I also found that these old people may nevertheless exhibit an interest in funny gadgets when other people hand them to them or direct their attention to them. My parents-in-law have a lot of fun with a soft plastic toy that flashes lights when it is turned around, and they really enjoy it for a while. However, this works only as long as other people show them the gadget and hand it to them – they do not play with it on their own initiative.

All in all, my own experiences with very old people I can note: They are still able to use some devices in a limited fashion and may enjoy playing around with funny gadgets, but usually they do not take action themselves. Instead, other people have to hand the devices or gadgets to them. They also use them only as long as they are in company with other people and may quickly lose interest in them. The devices may also appear "new" to them each time they pick them up. Definitely, much more research is needed to gain a better understanding of how old people may profit from devices – and also from funny gadgets – apart from having fun, which is an achievement and a valid argument in itself.

 

Final Word

This article was a first and brief encounter with the topic of design for the elderly, which entails many subtopics and stretches various fields and disciplines. There is a lot to learn for me in this respect – I am just at the beginning of my tour. I will continue with my encounter with this new field and plan to contribute two more articles about design for the elderly to the 10th Anniversary Edition of the SAP Design Guild in 2011: As already stated, one will discuss design challenges (or conflicting goals) and another will be written from a more personal point of view.

 

References

SAP Design Guild

Universal Design, Trace Center

Further References

 

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