Bryce Rutter, Metaphase
MEDdesign

Designing Medical Devices for Dignity

By Bryce Rutter, Ph.D
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Bryce Rutter, Metaphase

Aging is not for the faint of heart.

For some people, as early as in their late 40s, the human body begins to feel the wear and tear of the initial one-third of life and begins to show signs of aging. For men, it is the eyes that age first. Glare and contrast become problematic and small print becomes increasingly difficult to read. For women, the loss of strength, especially in the hands, is the first noticeable trait of aging. Like men, women experience decrements in vision.

Aging manifests predominantly in mobility, vision, cognition and hand function—all fundamental factors for living life in full. With age, people move and think more slowly, and hand function decays. These are the skills necessary to interact successfully with our ever-expanding digital world, and as they diminish, life becomes extraordinarily more challenging.

Unlike product design for a “skill homogenous” group of Millennials or Gen Z, product design for Boomers or Grays is significantly more complex because no two people age in the same way. While some people experience decrements in vision in their late 40s or early 50s, others may retain 20/20 vision but live with the onset of arthritis or degenerative joint and neural diseases that erode their haptics and dexterity. These impairments prohibit people from performing the simplest of daily tasks, such as opening a container or pressing a button. Designing for Boomers and Grays requires a tactical design focus that studies aging across all sensory modalities and considers the multiple combinations of aging traits emerging along a life continuum.

I can’t do that anymore!

It’s a shock when an individual discovers for the first time that he struggles to lift the 40-pound bag of dog food, or she can’t lift her two-year-old grandchild. It is the loss of strength that delivers this handicap. Whether it’s pushing a lawn mower or lifting supersized bottles of mouthwash at the club store, the market presses brands to lower costs with club-store oversized packaging that creates both barriers to usability for Boomers and Grays as well as a new in-home storage problem. One-handed containers have grown into five-to-ten-pound two-handed containers that are difficult to handle and hard to manage to dose or dispense. With age, flexibility, range of joint motion, strength and general motor ability fades. What was once an easy stoop, carry or reach cannot be done, or can be accomplished only at the cost of some level of discomfort, pain or exertion. By way of illustration, through natural aging, women in their 60s and beyond can experience a 40% to 60% loss of strength in their hands.

Compounding the challenge to design for an aging population is that as age increases so does the prevalence of age-related diseases. Arthritis affects one in every five Americans. Twenty-four million Americans, or 8% of the population have diabetes, which commonly presents as fingertip neuropathies. Again, no two people age in the same way, so these common diseases add layers of complexity through reductions in vision, dexterity, feedback and comfort. These motor, strength and sensory barriers are exacerbated by the vision issues of aging eyes.

I can’t read this!

Age changes eyes and eyesight. Perhaps they’re called the “Golden Years” because of the increased sensitivity to glare! Sharp contrast turns to blurs and typical print size is challenging to read at arm’s length or with glasses and high lighting levels. A common and critical complaint is legible type on labels, with pharmaceutical products as a notorious offender. The “real estate” battle among label size, logos, brand considerations and FDA mandated copy have resulted in labels that are virtually unreadable.

Readability deficits extend beyond packaging to include all on-product iconography. Good iconography design leverages human familiarity with legacy product experiences. It distills the physical design to fundamental elements that show what happens when the product function is engaged. From everyone’s everyday experience, the PRINT icon—the recognizable little printer—as well as the FORWARD and REPLY circular arrow icons are excellent examples of good design. The small floppy disk SAVE icon, however, challenges legacy experiences because the floppy disk from the late 1970s is virtually unrecognizable to most of today’s users, who have never seen one or don’t remember ever using one.

Effective labels, functional type size and intuitive and explicit icons can easily be tested. Iterative usability testing, referred to in medical product development as formative and summative testing, is essential to identify and confirm design elements that contribute to intuitive and unequivocal communication.

I don’t understand how it works!

The intersection of iSOFT healthcare software, wireless devices, wearables, apps for everything, smart phones and tablets has created a culture where everyone is always on call and available. This technology nexus defines a deep chasm between Boomers, who spent the first third-to-half of their lives with zero digital products, and younger generations who grew up connected and are total digital natives. The differences between these cohorts are significant, with individual legacy experiences driving expectations of what digital technology is, what it should deliver, and how you expect it to work. The impact of these distinct experiences extends from home to the workplace and the marketplace. For example, young surgeons who grew up in their parents’ basements playing video games immediately embrace robotic surgical systems with virtual reality interfaces, whereas Boomer surgeons, still in their prime, do not have that digital native advantage.

Cars are the perfect design storm for Boomers and Grays. Speed, decision-making and interacting with the car’s electronics combined with aging vision, motor skills and reaction times are a formula for accidents. Frequent Boomer and Gray complaints include changing/choosing from multiple audio sources, figuring out how to use the navigation system and the eye-hand coordination required for a touchpad or cursor device while hurtling down the highway at 60+ mph. Old-fashioned physical knobs and buttons that are located with a glance and adjusted blindly are replaced by touch interfaces that require direct visual feedback for targeting and control. All combine to take aging eyes and attention off the road more frequently and for more time.

Voice-activated devices like Siri, Alexa and Google Now effectively enable those with mobility problems, but present serious operation set-up challenges for Boomers. The marketing for these, and for simplified cell phones as another example, acknowledges that barrier, but seems to come in two “Oh those wacky old people” flavors: 1. Elders endearingly addressing the device by name and then being baffled by its lack of human dialogue, or 2. Elders picking their way through a simple function to the regard of cheering family members. The products may be designed for Boomers and Grays, but the marketing is to their children and grandchildren, which is perhaps a little demeaning all by itself.

Hands, the Instruments of Our Minds

Aging, bottle cap
As our hands age, our ability to easily accomplish the simplest daily tasks, such as unscrewing a cap becomes a challenge. Image courtesy of Metaphase Design Group, Inc.

Ninety-five percent of all everyday products involves our hands. Hands are the instruments of our minds. They allow us to exercise control over everything we do. But one of the cruelest facts of aging is that as our hands age our ability to easily accomplish the simplest daily tasks, such as unscrewing the cap from a peanut butter jar, holding a cell phone, peeling a potato or opening a wine bottle become increasingly difficult and monumentally frustrating.

Intensifying these natural physical debilities of aging is the loss of sensory feedback, especially in the fingertips. A young, healthy hand has approximately 20,000 sensors across all 10 fingertips. These are specialized sensory receptors that provide specific feedback on heat, cold, stretch, pressure and proprioception. These 20,000 sensors provide vast amounts of real-time information about the nature of the product being used. They provide the ability to sense textures, edges, corners, contours, temperature and weight—all confirming what is visualized.

As we age, our fingertips prune. Soft fingertips that naturally conform to the surface being touched, effectively presenting all sensory receptors, lose this compliant cushion of tissue over time, becoming more sensitive to pressure points as pain points. As a result, textures designed to feel delightful to a 20-year-old can easily feel uncomfortable, and even painful, to a 65-year-old user. With age, gone too is the ability to sense subtle textural differences that a youthful hand can sense as small as 3 µm. Smart dexterous hands transform with age into clumsy mitts that afford little precision and control.

Good Design Matters for Dignity, and for Business

Regardless of socioeconomic stature, aging with dignity—growing older with grace—is the most important thing in life for older people. Every little challenge, confusion, worry or inability to accomplish something that was easy while young or during the first half of life, erodes a person’s dignity day by day. Intelligent and sensitive design stops the erosion of dignity and replaces it with empowerment, a sense of purpose, love for life and daily vitality. Good design considers how physical and cognitive abilities change over the arc of life and it extends every person’s ability to accomplish day-to-day tasks with satisfaction.

While it is easy to recognize the social importance of products that allow people to age with self esteem intact, and that enduring vitality is an unprecedented value to aging consumers, designing for dignity is also good for business. Ten thousand people a day will turn age 65 for the next two decades. Boomers represent the largest cohort entering retirement in history. They also possess the highest historical level of disposable income of any retirees, which translates into significant purchasing power. It pays to pay attention to this segment of consumers!

Good product design extends the lifespan of our human physical capabilities by offsetting the limitations that come to all who are lucky enough to grow old. These are human factors. And human factors engineering is not something you sprinkle on design concepts at the beginning of a project. Rather, they shape and inform each decision about what the design needs to be when it grows up.

Good design empowers all to live independently, age gracefully and live with dignity. Dignity is not an option; it is a moral right that design must respond to. Creating thoughtful designs that consider the aging process generates products that create their own demand and drive increased sales and market share.

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Bryce Rutter, Metaphase

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