Shifting the paradigm of digital design for older people
An insight report by Studiomade, a creative agency specialising in design solutions for healthcare, finance and non-profit organisations
To better serve older people, we want to rethink how we design for them. Age is not always the sole indicator of what a person wants from a digital experience
The proportion of older people in the population is increasing ever faster. There are 15.5 million people in the UK aged 60 and over. In England and Wales, a quarter of us are 60-plus. In the ten years to 2021, the number of over-65s in England and Wales increased by almost two million, to 11 million. Globally, by 2030, older people will outnumber young people. The UK’s economic success will be increasingly tied to older workers and a healthy, economically active older population.
With the health issues that arise as we age, this demographic shift has increased the pressure on the NHS. A major new 2023 report from Age UK shows how our health and care system is struggling, and often failing, to meet the needs of our growing older population. The proportion of older people living alone is also increasing, and that has a detrimental effect on health.
These factors have created an opportunity for well-designed digital products and services to take pressure off the NHS and support older people. This group has the most potential to benefit from them, both in managing health conditions and in preventative care, through wellbeing and monitoring products.
The opportunity is not only about product creation, the economy and the financial bottom line; it’s about societal good and a higher purpose, wanting to look after our elders better and help take pressure off the NHS.
Digital tools are now shaping the future of health, with 350k+ on the market. The right products can enable older people to get the advice or treatment they need, and access it when they want to. Care can shift, where feasible, from the in-person model to remote and at home. Healthcare professionals are supported (e.g. by detecting falls or tracking health data). People themselves as well as families and carers can all be part of managing the health of an ageing population.
Ada Health, for example, uses AI to help users assess symptoms, track health conditions and get personalised recommendations. It has 13 million users, 50+ in-house medical experts and has completed 13 million symptom assessments.
myGP, which connects with GP practices’ booking systems, has helped to reduce the number of people booking a doctor’s appointment by nearly 26%, through in-app triage, signposting, self-care advice and asynchronous chat between patients and practices. It has had 1.5m downloads, and a 50% increase in use this year.
The NHS’s own app has had 30 million downloads. In 2022, 1.7 million GP appointments were booked through it and 22 million repeat prescriptions were ordered, up from nine million the previous year.
Globally, part of the World Health Organization’s strategic vision is for digital healthcare to support equitable and universal access to quality health services, make health systems more efficient and sustainable, and enable them to deliver good quality, affordable and equitable care.
WHO’s Regional Director for Europe, Dr Hans Henri P Kluge, recently said: “It is abundantly clear that digital health is the present and future of our health systems, so we must ensure that there are no winners or losers, that everyone benefits, and no one is left behind.”
Around two in five over-65s have used a health app (mostly for health tracking) but usage is lower than it is among younger age groups. One survey found that the main reason, among half of respondents, was lack of interest. A third had never thought about it and 20% didn’t know if it would help them. Another study found that there is lack of awareness of products, perceived lack of technical ability, and trust and privacy concerns.
Yet more than half of older people are willing to use apps, particularly higher earners, people in good health and people with a higher level of education. The level of technology use among older people has increased notably over the past decade and will continue to as middle-aged people, already used to technology, enter the older age group.
Despite this, healthcare professionals are not recommending digital tools to older people. A UK survey in 2023 found that a third of people aged 18 to 24 had been recommended a health app by a healthcare professional, but only 3.9% of over-65s had.
What if we could design digital products that overcome these barriers to use? Products that older people are interested in using and think would help them, and that healthcare professionals are confident to recommend? Current accessibility guidelines for older people are a great place to start, to make products that function well.
But we believe even more can be done by thinking beyond just usability and shifting the design paradigm to give older people a well-designed, enjoyable digital experience, tailored to them, that they trust and want to use; one that becomes an essential part of their healthcare.
The big five tech companies have all invested in health-tech, the biggest investor by far being Alphabet (Google’s parent company). It has invested billions of dollars in healthcare research and development and into health-tech companies. In 2022, it spent $1.7+ billion exploring future health ideas. Verily, its life sciences business, raised $1 billion last year to expand its data-driven healthcare products for the end user.
There are multiple routes for new ideas and ventures to get support, funding and grants. For example:
Startup Health supports ambitious founders (nearly 1,000 so far) with moonshot ideas, through its innovation ecosystem and training programme. Global Tech Advocates connects and mentors healthtech innovators, investors, life sciences and medtech companies and healthcare providers worldwide.
Digital Health London’s Accelerator is a 12-month programme for digital health companies whose products or services have a high potential to meet NHS and social care (usually products that have been piloted in the NHS and are ready to scale). It is supported by NHS England and helps innovators navigate the UK health environment.
The Design Age Institute, through various programmes, facilitates and provides initial funding for products and services that support healthy ageing, in areas such as mobility, health, social connection and the home.
Best practice baseline
Established accessibility guidelines are a solid foundation for creating inclusive and user-friendly products for older age groups. We want to highlight two broad areas, based on our own testing:
Reduce the cognitive load
Our testing has shown that this group wants to read and navigate at their own pace — but this doesn’t mean they don’t understand the content or instructions. Make your product easy to use and understand (especially when it’s complex and rich in information), something good design should do anyway. Some ways to do this:
- Interfaces that are clear, uncluttered and intuitive, presenting information and options in a straightforward way.
- Images and iconography combined with text, to easily and quickly identify elements and information.
- Concise signposting, and a logical information hierarchy that’s easy to follow and doesn’t overload the user.
- Give people time. Put them in control: give them the choice to view, confirm, cancel, move to the next thing and so on. Don’t confuse or distract them with pop-ups.
- Onboarding and guidance showing what the product does and how to use it. Younger people tend to click something without knowing where it goes, to see what happens; older people are more likely to worry about breaking it.
- Language that’s straightforward, consistent and uses familiar words and phrases. This helps people know exactly what to do and to trust the product. It can reassure users who find using digital products stressful. They also notice when it’s not consistent.
Test it on your audience
User testing with older people is paramount, to give you essential information that you shouldn’t build without.
- Test assumptions. User testing validates (or not) what you thought about your audience’s preferences, behaviour and expectations, so you can design what they need and not what you thought.
- Assess usability. Many websites and apps meet accessibility criteria but fail usability tests. See how people use your product. Is it as clear as you thought? What annoys them? User testing identifies potential pain points to work on.
- Evaluate features. Do people use your product features as intended? Do they miss elements you thought they’d use? This shows you what you need to refine.
- Assess navigation. By seeing how people navigate your product, you can refine the interface and user journey, for a more user-centric design.
For detailed accessibility guidelines, The Helen Hamlyn Centre for Design at the Royal College of Art sets out useful principles in Age-Inclusive Digital Platforms.
The NHS design principles, for people designing and building digital services for the NHS, are publicly available and useful guidance for all people-first products and services. We especially like:
- Design for the outcome. What will good look like? What are the health, wellbeing or other measurable outcomes that your work will impact? Your work should improve lives, either directly or indirectly.
- Do the hard work to make it simple. Healthcare journeys can be complex. Take the time to understand what you are trying to solve. Do not push complexity on to the people using it.
Shifting the design paradigm
Age is not always the sole indicator of what a person wants from a product. However, it is crucial to consider it in all decisions about your design and how someone will use your product, right down to the micro level. Product and service design should consider age, but not make assumptions about capabilities. It should — like all good design — put the person and the problem you’re solving first.
Following accessibility guidelines will make a product functional and inclusive, but why stop there? Combining creativity with functionality can create a product that delights the user, gives a better user experience and makes them want to come back to it.
To better serve older people, we want to rethink how we design for this group and go above and beyond generic accessibility to a deeper understanding of their experiences, preferences and challenges.
As a design studio, we know that most designers want to create a sense of design aspiration and aesthetic. We also believe that most people want this, whatever their age or health. Why wouldn’t someone older want to use something that’s highly functional and does what it should but is also beautiful? Stay creative!
One important way is to acknowledge differences across the 60+, 70+ and 80+ age groups in terms of stage of life, employment or retirement, and likely health issues — in the same way that there are differences among younger age groups. We would probably think first before we grouped 20-year-olds with 40-year-olds.
Care is needed if you’re targeting an age range of two or three decades. For example, if you’re talking to people in their 60s, don’t use photos of people in their 80s; that’s their parents.
One of the key differences across older age groups is technical literacy. One indicator for this might be what a person’s profession is or was. Someone could be 60, have a job that doesn’t involve technology and hate using apps; someone else could be 67 and just retired from heading up a global tech team.
Tim Berners Lee (invented the internet) is 68. Geoffrey Hinton (a founder of AI) is 75. Don Norman (pioneer in UX design) is 87. While they are clearly exceptional in their professional achievements, it’s older people who created the digital revolution that happened in the 1980s and 90s and made technology a large part of our lives, unlike anything humans had experienced before.
Digital natives may not appreciate how radical it was and underestimate an older person’s tech literacy and their capacity to adapt.
We must acknowledge digital differences and appreciate that some people are very experienced with technology, some are not at all, and there’s every level in between. Someone’s eyesight or dexterity may have deteriorated with age and they need bigger buttons on an app; that doesn’t mean they can’t find their way around it or follow directions. Don’t assume that everyone doesn’t know.
Avoid shocks: we’ve seen in our research that some older users don’t like elements of surprise (e.g. pop-ups, inconsistencies, being taken somewhere they didn’t want to go or having to do or learn something new or unexpected).
Maintain a simple, intuitive design, even when (especially when) your product is complex e.g. it’s data rich, contains a large medical knowledge base or includes diagnostic tools. It not only makes it usable but can also give users a sense of accomplishment as they master it.
Simple doesn’t have to mean basic. Simple can mean sophisticated. It takes skill to design. Look at Apple.
Design in moments of delight. This is about making your product a pleasure to use — for example, a beautiful interface, relatable and humanised narrative and personalised interactions — so that they want to keep coming back to it because they enjoy using it, and it becomes a meaningful part of their life.
Use storytelling to build empathy, create a positive environment, support the person and help them feel empowered.
When we designed and built a prototype online hearing test for Kennedy Woods (who had a grant from the Design Age Institute), they wanted it to be radically different to existing, abrasive hearing tests. Their idea was to humanise it by using the sounds of birdsong. We added a forest soundscape, beautiful illustrations, simple user journey and a narrative that gives moments of delight, taking the user through different scenarios on a walk through the forest as they progress through the test.
Our approach meant that we met the guidelines on designing for older people and made something we think is a pleasure for them to use but that also appeals to a wider audience: everyone who wants to test their hearing. Hearing Birdsong was exhibited in the Design Museum’s Future of Ageing exhibition in 2022.
Create aesthetic inclusivity. As businesses and product designers, let’s create inclusive digital environments that don’t compromise on visual sophistication, using design principles that match aesthetic appeal with functional accessibility.
This way, we may even design products that are so good — designed not solely for age but for the problems they’re solving — that other groups want to use them too.
People-first design and personalisation
The convention for good digital design is to keep interfaces simple, clear, consistent and easy to use. We aim to do this in everything we design, whoever it’s for. For older audiences, where some people may need further simplification but some may not, this presents an opportunity for personalisation — going beyond light/dark mode and text sizing options.
Is your product an opportunity to do something innovative and evolve beyond that, into design that anticipates individual needs? What about integrating assistive features?
We’re increasingly seeing on projects the importance of assistive features and being reminded how relatively small changes in UI and UX design can make a big difference for the user, removing friction from various points in their journey.
For example, for our client Send it to Alex, we are working on a workplace wellbeing tool for neurodiverse people, which includes a large evaluation questionnaire split into sections. User testing showed us that people like simplicity, want help navigating around the interactive elements, don’t want to feel daunted e.g. by complex questions, and like to see their progress.
So our iterations included putting the focus on one thing per screen, with nothing around it competing for attention; adding simple, clear guidance on exactly what to do and where it will take you; eliminating complex wording and terminology and keeping the tone of voice consistent; and adding a progress bar.
Seeing how much these improved our testers’ experience reminded us that these are always good principles for all people-first design, of all ages, not just for neuro-inclusive design.
These are a few more ideas we’ve been thinking about:
- Guided autonomy: a balance between providing clear user guidance and allowing the product to be used intuitively. This can help people feel empowered, engaged and more confident.
- User-defined value: user-driven customisation options for people to tailor the tool according to their preferences. This makes it feel personally relevant, even like a companion.
- Adaptive learning loops: adaptive learning mechanisms, where the interface evolves with the user’s preferences and habits. This could be especially powerful for tracking and monitoring apps, giving the user a sense of progress and achievement.
- Integrate AI: for example, ChatGPT-type prompts with medically factual, trustworthy answers using data you’ve trained your product on. This removes the friction of irrelevant in-app search results and onerous database browsing, and makes it faster. Users can ask their precise questions and get an instant response. We’re currently working on an app for carers where we are doing just this.
Another people-first principle is design for the problem you’re solving, not (just) the age.
Indoor location apps company Briteyellow won funding from the Design Age Institute to build a train travel app for passengers with access needs and older people. With user testing at every stage, we’re designing a product — like Google maps for train stations — that will help travellers with mobility issues navigate stations but can also be used by anyone who wants to get around quickly and easily.
You can see if there’s step-free access but you can also see if you can buy food, go to the loo and still get to your platform on time.
To create emotional resonance, consider the use of nostalgia. Cognitively, our brains are wired to deeply engage with nostalgic moments. This wouldn’t be right every time and it has to be done carefully, otherwise it can make users dwell on the past or feel negative about their present life, health or issues such as loneliness.
Nostalgia done well, however, can provide comfort through familiarity and evoke happier times, especially if the present is overwhelming or uncomfortable in some way. It can increase the feeling of optimism, including optimism about health. It can create trust and lead to emotional engagement and long-term use among older users.
It has to be used effectively, for example:
- Be coherent. Design and functionality have to match. Plonking a retro element on for the sake of it could be confusing and jarring. It has to make sense for the product and user experience.
- Ask the audience. You’re thinking disco; they’re thinking old school hip hop. Kodak or Nintendo? Bladerunner or The Breakfast Club? What era and emotions are you trying to evoke? It’s highly subjective, so ask!
- Give it a fresh twist. You want to evoke positive feelings from the past but you don’t want to look and feel dated. Reference the past, but in a way that integrates seamlessly into your digital product.
To help to address isolation and give a sense of community and feeling of accountability, think about integrating social elements into your digital healthcare product. Maybe family members could be connected, to involve them in patient care. For tracking and monitoring products, a secure in-app community would allow people to share their progress and cheer each other on.
Nike’s running app is an example that does this well. As well as expert coaching plans, guided runs and performance tracking, it connects users with an active community of fellow runners. Can you design the healthcare equivalent, for elders?
Innovation and the age-experience paradox
As we touched on above, there is an age-experience paradox when it comes to technology and digital products; a situation where people have more life experience and wisdom but are perceived as less experienced or knowledgeable than they are.
However, this assumption that people are less capable because of their age overlooks the extensive experiences and problem-solving skills that they’ve accumulated.
We don’t have to stop innovating when designing health-tech for older people. We need to innovate more, and we have three ideas as a starting point.
Field work. If designers went beyond standard user testing and carried out field work, before the product prototyping stage, this could quash this paradox and fuel innovation as they could:
- Engage directly with older users to understand their unique experience, perspective and needs and design accordingly.
- Uncover hidden pain points and unmet needs at a much earlier stage.
- Co-create solutions with them, humanising your product creation in the best way.
- Address the say/do gap (what consumers say they’ll do vs what they actually do).
- Integrate from the outset any necessary learning curve needed for new technology.
Build a digital legacy. For example, a digital health diary function. The user documents their health journey and insights and passes it down to younger generations, giving them valuable family health knowledge, awareness of potential inherited conditions, and personal narratives about their older relative’s health or illness experience that they can learn from.
Create evolutionary design. This means building products that adapt to evolving needs, designed from your own user research as well as insights from studies such as this one on changing technology usage patterns as people age. A 2018 study showed the importance of integrating older users into all phases of the innovation process. For older people to adopt and use technology, designers and developers have to focus more on their needs, preferences and characteristics.
This requires a participatory strategy that starts with users’ needs and ends post-launch by evaluating the effects of the technology. Partnerships among researchers, designers, developers and older people, throughout the innovation process, are critical.
“That’s what I want to do with [designing] things for the elderly. Make the thing so successful that everybody wants it. OK designers, it’s up to you.”
Don Norman, design professor and author.
We hope this article has got you thinking and inspired you. To talk about anything in it, discuss a project or connect with us, email our Strategic Director, Phil Reid, on phil@studiomade.co or visit https://studiomade.co/expertise/healthcare/
