Design for the Elderly – Some Tightrope Walks

By Gerd Waloszek, SAP User Experience, SAP AG – March 17, 2011

Designing for the elderly has become a prominent topic at UI and design conferences in recent years, but has not yet been covered accordingly on the SAP Design Guild Website. However, we are now gathering pace. Here is my second article from this domain, in which I would like to discuss a number of dilemmas that designers face when they design for elderly people – I view them as walking tightropes. One might also say that much like Odysseus who had to maneuver his ship safely between Scylla and Charybdis, designers have to navigate their designs through a number of conflicting decisions, directions, and requirements. Please note that although there is some overlap with my first article, this article takes a somewhat different line...



Much like designing for disabled people, designing for elderly people adds severe constraints to the designers' options. In addition to technical and task-related boundary conditions, their regular work also requires them to take humans' physical and cognitive abilities and limitations into account. Knowing about and taking these into consideration sets designers apart from developers and most marketing people and represents an essential contribution to the work of design teams – particularly when the team members come from various disciplines. The additional design constraints arise from extending the prospective user population considerably by including users with further limited physical and cognitive abilities for whom standard design solutions are often no longer appropriate.

However, designing for elderly people is not only about people's limited abilities: Cultural, social, and ethical issues are also involved. There are no easy answers to many of these issues, and the design profession is still in a learning state. Last, but not least, economic factors determine and often constrain design decisions further. As an example of the latter, we can observe that many design proposals targeted at elderly people focus on replacing human support through technical solutions – because human care is simply too costly in terms of time and money.


Walking Tightrope No. 1: Stigmatizing or Satisfying the Needs and Wants of Older People?

Old people are seen as a growing consumer market in Western countries such as Germany, which is expected to have the world's oldest population by 2035. In 2007, the then German Minister for Family Affairs, Ursula von der Leyen, urged German industry to take advantage of this growing market and to develop dedicated products for older people. Whether older people will actually buy these products is another matter. They will be advertised and easily recognized as having been developed for older people, and thus bear the risk of stigmatizing their buyers and owners. In his book Design Meets Disability (review), Graham Pullin writes that disabled people do not want to be stigmatized by society, whereby stigmatization includes the tools, devices, and aids that they use. The same is likely to be true of older people too.

In Germany, we have read reports of a mobile phone with a large display, large buttons, and simplified functionality that was advertised as a phone for senior citizens by its manufacturer (whose name is usually not disclosed). The phone was a commercial flop. However, another company (also usually undisclosed) offered a similar mobile phone without the label "for citizens." This phone is reported to have become a success story. Thus, it is not only the look of a device, but how it is labeled that also determines whether elderly people will feel stigmatized by using it or not.

Pullin reports interesting differences between aids for the elderly: Glasses are worn like fashion accessories these days, while hearing aids are typically still designed to be as invisible as possible. He also discusses prosthetics and presents the example of a young woman who regards her prosthetics as fashion accessories and treats them as such: She switches them according to her mood or the event she is going to visit. Such behavior is, however, still the exception. All in all, whether people feel stigmatized or not by using a certain device seems to be related to cultural traditions: Whereas glasses have lost their "stigmatizing" status, hearing aids are still burdened with it.

In a recently published study, German usability company UID investigated older people's attitudes toward technology and their technical abilities and compared the results with those of younger people. While the researchers found differences between the age groups, they were not as large and dramatic as the researchers had expected. They concluded, contradicting Ursula von der Leyen, that there is no need for specific products for senior citizens on the market. While the needs of older people should be taken into account, aesthetics should not be neglected. In our current consumers' world, aesthetics seem to constitute an important prerequisite for users, be they "normal", older, or disabled, in accepting products. Pullin confirms this finding in his book. Moreover, and as with products for disabled people, all kinds of users profit from products that cater to the needs and limitations of older people.

To sum up, designing for the elderly requires with consideration, attention to the needs of older people, and an eye for design aesthetics. It is by no means a straightforward task for designers.


Walking Tightrope No. 2: Are Older People in Favor of or Against Technology?

In the past, I have had frequent discussions with older people about computers. Many of them proudly told me that they did not use or need them. A few others fearfully asked whether they would be able to do without all this technology during their life span. Usually I confirmed this, not telling them that they were already surrounded by computers. Thus, one might be tempted to say that the current generation of elderly people consists to a large degree of people who try to avoid modern technology or even fear it. It looks as if my personal experiences are already outdated...

Jenny Vayhinger   Graeme Coleman   Franz Koller

Figures 1-3: Jenny Vayhinger at WUD 2010 (left); Graeme Coleman at DIS 2010 (center); Franz Koller at WUD 2010 (right)

Many papers investigate the attitude of older people towards technology and their ability to take advantage of it. I already mentioned a German study on this topic, which was also presented at the local WUD 2010 event in Stuttgart, Germany (see figure 1). At the DIS 2010 conference in Aarhus, Denmark, I attended a paper presentation by Graeme Coleman entitled "Engaging the Disengaged: How do we design technology for digitally excluded older adults?" (see figure 2; see also my first article.) Although this title sounds less optimistic, Graeme pointed out that for older people, successful technology acceptance is related to perceived value (which I understand all too well...). They ask questions like:

  • Is it worth spending the time learning how to use it?
  • Is there a practical purpose for it?
  • Is it better than the "traditional" means?

Collectively, these studies taught me the following:

  • Motivation: There are differences between younger and older people with respect to their willingness to use technology, but these are not as large as some people would expect. Older people also follow an economic approach and ask whether is the technology is useful enough for them to justify the effort of learning how to use it.
  • Abilities: The cognitive, perceptual physical, and learning abilities of older people decrease over time; as a result operating speed decreases as well. Many older people nowadays use technology to compensate for their deficiencies (glasses, hearing aids, computers, dedicated electronic devices). They also use it for finding information about health and other age-related issues and for staying connected with relatives, friends, and others – sometimes world-wide (for example, through discussion forums for specific topics).

There are also rumors about a rising new generation of technology-savvy elderly people, which comes as no real surprise to me. People who, like me, are in their early sixties grew up with computers and electronic devices. Unlike in the past, when older people were often proud of not needing to deal with information technologies (ICT), a new generation of older people is emerging that is familiar with ICT and that uses the Internet and other technologies in manifold ways.

Finally, however, and as I wrote in my first article, there will come a day for many older people when they are no longer able to use technology on their own intent and in an active fashion. But this is another (sad) story and its outlook is still open – maybe we can even find ways of engaging these people...


Walking Tightrope No. 3: Direct Design Toward Technological Solutions or Human Support?

When I have looked at design studies targeted at supporting the elderly at conferences, including student projects, I have been amazed at how often designers present technological solutions for problems which I thought would be better solved by human care. In some cases, I even had the impression that the preference for technical solutions had run riot with the design teams. I did not see any point in the proposals made, and would also question whether old people would accept and use them.

As an example, many student projects at CHI presented electronic buddies for elderly people, serving as a replacement for human contact and performing certain tasks such as offering pills. A further example in this vein, which I already mentioned in my first article, is the "Care-O-bot®" interactive butler developed by Fraunhofer IPA. It was presented under the label of "Ambient Assisted Living" (AAL) by Franz Koller in his keynote for the local WUD 2010 event in Stuttgart, Germany (see figure 3). This robot (see figures 4-5) drives along the floors of a nursing home, enters rooms, and offers water to the inhabitants of the home, depending on their water consumption. It is a well known fact that old people tend to drink far too little – so far, so good. But wouldn't human care solve this issue more easily? The respective Website states that "as an interactive butler, Care-O-bot® 3 is able to move safely among humans, to detect and grasp typical household objects, and to safely exchange them with humans." However, my trust in artificial intelligence solutions is too low to expect a robot of this kind to work flawlessly – I imagine robots crashing into each other (if there is more than one at a nursing home) or running into people in corridors... However, these are my personal feelings – I would have preferred a human-based approach. The development team at Fraunhofer IPA probably thinks very differently about its project.

Care-O-bot     Care-O-bot

Figure 4-5: Care-O-bot® (from Fraunhofer IPA)

Thinking about the justification for such projects – apart from being a technological exercise or demonstration, which may be a justification in itself – brings me directly to the second aspect of this issue: Technology is often used to replace human support for economic reasons. People are too costly and there are too few of them who want to work in nursing homes, bearing in mind the low wages and the immense work and mental pressure put on them. Thus, we have to live with this unsatisfactory situation at the moment and, looking at the growth of an aging population, for some time to come. Nevertheless, we need to take a careful look at technological solutions and always ask whether a "human support" solution would be a viable alternative.


Walking Tightrope No. 4: Do We Need Older Designers for More Empathy with and Knowledge of Older People?

My father-in-law often stated that we were unable to imagine the problems of old people and what being old means because we were too young (relatively…). Was this a valid or just a "killer" argument? Probably both. On the one hand, it allowed him to downplay any criticism of his behavior. On the other hand, there is also a lot of truth in what he said, as I have learned myself over the years. When you are young, you are simply not aware of the fact that, for example, your sight and hearing will deteriorate in later life and this can make everyday living cumbersome.

This leads me to the question of how designers can take better account of the needs of older people. The following approaches come to my mind:

  • Include older designers to play the role of advocates for older people in your design team
  • Let prospective users, in this case older people, participate in the design process
  • Put yourself in an older person's shoes

Of, course, all of these approaches can and, in an ideal world, should be combined. Perhaps the third item needs a brief explanation, though. In 2002, I attended an accessibility workshop, led by Gregg Vanderheiden and Shawn Lawton Henry, at the CHI conference in Minneapolis. In one of the exercises, we tried to open bags and remove sweets without the ability to grasp, operate a computer keyboard with a mouthstick, recognize buttons on a device that was hidden in a bag, or purchase a ticket on a kiosk system with labels that were unreadable. These exercises gave us a vague impression of what disabled users experience. However, this approach is primarily suited to simulating physical deficits: Cognitive deficits are much harder, if not impossible, to simulate.

Do we really need older designers to help design the environment for older people? I would definitely say "yes." But how can we include them in design teams? In our current society, people retire between the ages of 60 and 65, or even earlier. There is no generally accepted approach to making fruitful use of older people's knowledge. Our society needs to rethink how we can profit from older people without blocking the future of young people. In this special case, I would, just as a small mosaic stone, propose offering retired designers part-time jobs in design projects for older people.

There are also huge "cultural" differences between design directions. Usability people typically demand an empirical approach. Their mantra is: "Ask the user." Other design fields, including product design, still favor the model of the "genius designer," who asks his genius instead of the users. I believe that design for older people requires a more empirical approach than design for ordinary users. There is still insufficient knowledge of the abilities and needs of older people – only real users can provide us with the right answers. On the other hand, if a genius designer is at work, he is hopefully already in his 50s or even older...

To sum up, most of today's designers are young and technology-savvy and are therefore likely to have difficulties in imagining the problems that older people face with technology. Simulations are only of limited value, and there is no place for older designers. Participatory (or user-centered) design seems to be the best answer at the moment...


Walking Tightrope No. 5: Between Active and Passive Life

This item has less to do with UI design itself, and more with how we design the environment in which we live. For many older people, this environment is a nursing home. After living in their own flats or houses, they often have no option but to move into a home because they can no longer care for themselves: Even external support is no longer sufficient to ensure their well-being.

Nursing homes relieve old people of a multitude of responsibilities, such as preparing meals, washing their clothes, cleaning their rooms, or even washing themselves. However, there is a big issue with relieving older people of their responsibilities: They become, to a greater a lesser degree, condemned to a mostly passive life.

On the one hand, support is necessary for old people who are no longer able to perform certain everyday activities on their own. On the other hand, it is well established that being active is the secret to leading a long, satisfying life. Thus, we need to think about how we can design homes for the elderly in ways that the elderly can be included in the daily routine of the nursing home and feel that they are still needed and valuable. You could argue that such involvement would actually increase the work load for the nursing home personnel. This may indeed be the case in today's homes. New ideas are needed for the nursing home of the future, in which old people can contribute their existing abilities and thus lead a satisfying and fulfilling life for as long as possible.

As most people age gradually, their motivation to actively engage with technology and to be active generally decreases over the years. Their physical and cognitive abilities deteriorate as well. This limits their ability to lead an active life. We face the challenge of striking the right balance between active and passive elements and involving older people in activities for as long as possible.


Walking Tightrope No. 6: Between Supporting Independence and Surveillance...

I have attended numerous paper sessions at HCI conferences that presented prototypes of monitoring systems for elderly people. Some of them monitored health parameters – such as blood pressure, pulse, or blood sugar levels. Others monitored people’s whereabouts and behavioral patterns, such as restroom usage. Originally, these devices were intended to prevent health-related and other disasters. But the data patterns that they collected could also be used for other purposes. For example, they could be used for assigning people to specific care levels and transferring them from their homes – where they had lived independently – to nursing homes with more care and thus less independence.

Here we face a situation in which design solutions that are meant to support the independence of old people can also be used in ways that effect exactly the opposite, namely by controlling the behavior of old people in ways that undermine their independence. I clearly remember a researcher stating that he was intimidated by the idea of the approaches he had presented being used in such a control fashion when he was old.

All in all, this example demonstrates that a pure "design" view often falls short and that social and ethical decisions are often involved as well. This one seems to be the toughest of all the tightrope walks presented in my article, and I do not see an easy solution appearing on the horizon...


Final Word

This article presents the dilemmas that designers face when they work on solutions for elderly people. I have come across them mostly through paper and project presentations at conferences and other HCI-related events. Although, they are not based on my own design experience, I nevertheless hope that the thoughts presented here are useful for designers who create solutions for older people and for those who are considering entering this challenging field.



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