
Ask HN: My mother has shaky hands – guidance on iPhone accessibility settings? - frereubu
As my mother ages (she&#x27;s 89) her hands are getting quite shaky, and she&#x27;s finding it more difficult to use her iPhone. I&#x27;ve been looking through the Touch settings in Settings &gt; Accessibility, such as Touch Accommodations, but I&#x27;m a bit confused by the number of variables.<p>Her hands don&#x27;t shake so much yet that she triggers Shake To Undo, it&#x27;s more about things like the screen detecting the start of a swipe when she wants to do a long press. I also think Touch ID can be a bit confused by slightly shaky fingers.<p>I&#x27;d really value guidance from people who&#x27;ve gone through the same process, either with relatives or themselves, whether through age or conditions like Parkinsons, so I can at least have a starting point to work from.<p>She recently bought one of the new iPhone SEs, but I&#x27;m wondering if it wouldn&#x27;t be better to get an XR with FaceID to avoid issues with TouchID.
======
m463
I kind of wonder if this is the kind of stuff that mostly gets developed and
tested at a desk or in a lab.

One particularly troublesome problem with the Phone app is that touching just
about anything accidentally initiates a call. That was hell for my mom and
I'll bet your mom has it worse.

One thing I always wish the Phone app had was a "confirm" dialog when dialing
a number (like what you get when you tap on a phone number external to the
Phone app)

on a similar note, I know Tesla's UI is probably tested at a desk where
everything is visible and stable, but in a moving car doing things like
scrolling through a list of music and selecting is almost impossible.

~~~
frereubu
Yeah, my mum does get tense about that kind of stuff. Tech support calls to
her are regularly interrupted by her saying things like "oh, what's happenened
now?!" I was originally pretty down on skeumorphic design in aesthetic terms,
but the new iOS design language is really hard to have intuitions about. When
talking to mum about clicking on one of those blue "back" links at the top
left in settings I really wish I could call it a "button", but it doesn't look
like a button, so I just have to say "click X at the top left", whereas if I
was able to say "the button that says X at the top left" it narrows down what
she's looking for significantly.

I really like the idea of a "confirm" button for significant taps, such as a
phone call, which could be enabled in Settings.

~~~
dublinben
Have you tried the "button shapes" option in the Display & Text Size section?
It's not perfect, but it makes buttons a bit more obvious.

~~~
frereubu
I tried that before, but unfortunately rather than showing a "button shape" it
just underlines the text. That's works for things like an email address in a
contact card, but not so much for the "back" links at the top left. Thanks for
the suggestion though.

------
Terretta
Consider upgrading size to iPad Mini, while on her phone tell it to share
cellular calls to her local WiFi devices.

Then on iPad Mini, use max zoomed UI.

A significant degree of shakiness perceived by the device comes from tentative
behaviors while she is trying not to miss small targets. With larger targets,
she can point and touch with more confidence due to larger margin for error.

~~~
jedimastert
This is an ancillary point to OP's, but as someone with very mildly shaky
hands, you shake more when you're trying not to shake. If I shook as much
trying to tap a 2mm x 2mm area as I did while typing, I simply wouldn't be
able to type

~~~
frereubu
Thanks, that's a really interesting insight. That must make it really
difficult to type on the iOS keyboard in portrait - I'm thinking more and more
about getting her to do stuff with voice commands.

------
sogen
Agree, maybe it'd be better one with Face ID.

I'd suggest give Voice Control a try, it can do swipes, clicks, etc:

Intro video:
[https://www.youtube.com/watch?v=aqoXFCCTfm4](https://www.youtube.com/watch?v=aqoXFCCTfm4)

Tutorial:
[https://www.youtube.com/watch?v=80AyUCjZYZM](https://www.youtube.com/watch?v=80AyUCjZYZM)

~~~
natemcintosh
To chime in, I have a loved one with ALS. He cannot move his hands at all.
Apple's Voice Control allows him to do almost everything he could want to do
with his iPad and it has really opened up his world again.

Learning to navigate takes a little practice, but is fairly intuitive once you
know the available commands.

~~~
frereubu
That's really good to hear. I have a feeling my Mum will end up being unable
to use a touchscreen, so the advances in voice control (presuming she keeps
all her marbles) will be a godsend.

------
elliekelly
Have you tried Apple’s Shortcuts app? I think it used to be called “Workflow”
before Apple acquired them. You can create chains of actions that she uses
often and trigger them at the press of a button or even by prompting Siri with
a phrase of your choice. It’s kind of like IFTTT for iPhone.

Unless she’s a _very_ savvy 89 year old you’d probably need to set up the
different workflows for her but IIRC it will suggest some of your most
frequent actions when you launch the app. They also have a gallery of actions
you can browse and might find something helpful.

Edit: It looks like they even have an “accessibility” section in the gallery.

~~~
frereubu
Thanks, that's an interesting idea to remove steps in repetitive chains. She
doesn't do a great deal on her phone (she much prefers using her landline and
has her mobile turned off most of the time "because someone might call" her!)
but she's going to need to do things like approve online transactions in her
banking app soon, hence my wondering about TouchID / FaceID. Most of her use
doesn't involve the same chains of actions, but I'll bear this in mind when
talking to her.

------
all_usernames
What's most interesting to me about this discussion is that most of the
participants will, within a few short decades, be needing the UI enhancements
we're talking about. It's interesting because until now accessibility is
definitely not a mainstream thing, but when all the X'ers and Millennials get
to retirement age, it certainly will be.

------
jtchang
I've been working on some hardware for my grandmother to help make phone
calls. She doesn't really understand much english and the most she knows about
tech is pressing a button to turn on the tv. I was wondering if anyone else
has this problem as well. Would love to create a one button design that can be
remotely managed for our loved ones.

~~~
MandieD
The “remote management” part would be killer for me - without a twin of the
device on hand, it’s really hard to give directions over the phone, especially
when helping my German in-laws, as I don’t know the exact word their device
uses for a given menu item (example: fertig/beenden/schließen?)

~~~
jtchang
Would you be interested in chatting more about your use case? My e-mail is in
my profile.

------
downerending
Unfortunately, UI developers as a group simply don't care about the problems
of the old and infirm. My dad, who's perfectly fine on a 70s phone, has to use
a cellphone in his facility. It's an utter trainwreck, and a few minutes
watching this really drives home how awful current UIs really are.

~~~
frereubu
Apple does seem to genuinely care about people with disabilities, but the old,
not so much. There are so many assumptions baked into phone OSes that make no
sense unless you already know about the conventions. I tried her on Android
for a while, which was much worse.

~~~
downerending
It feels like there's a real market here for people that just want a phone
that works as well as a 70s phone. _Maybe_ with voicemail, although again, it
should work as well as a 70s answering machine.

(Related: At this moment, my wife is trying to video chat with a friend for
the first time. Ho-ly crap is it a fail...)

~~~
frereubu
If you just want cellular service and SMS, Doro phones are supposed to be
good.

It does feel like there's a niche for a super-simple smarphone OS, but it
would take someone with very deep pockets to deliver that.

~~~
downerending
Thanks for the ref. That's about what my dad is using, and he struggles with
the complexity.

------
antigirl
Hey. I saw this on youtube a year ago. It’s not exactly an available solution
yet but something to keep an eye on

[https://www.microsoft.com/en-us/research/project/project-
emm...](https://www.microsoft.com/en-us/research/project/project-emma/)

~~~
frereubu
Thanks - that does look interesting for sure.

~~~
antigirl
Been thinking about this quite a bit and this solution isnt exactly mobile but
could work well for home. Its possible to use assistive touch with a mouse (a
rollerball mouse would work better than a traditional)

video of joystick mouse on ipad
[https://www.youtube.com/watch?v=xvvG5_rLQRk](https://www.youtube.com/watch?v=xvvG5_rLQRk)

more [https://support.apple.com/en-us/HT210546](https://support.apple.com/en-
us/HT210546)

~~~
frereubu
Thanks for the suggestion, but she's happy with a magic mouse and a MacBook
Air plugged into a display. I think the weight of the mouse really helps - as
I said she's not shaking so much that Shake To Undo is triggered, so the
intertia that the mouse provides is enough.

It does make me wonder whether a weighted touch "pen" might be useful though.
One of the issues is that she has quite big fingers, so it's easy for her to
obscure what she's trying to tap on, particularly the keyboard in portrait,
and if it's weighted enough that might help to counter the shaking.

------
eugeniub
You mentioned Shake to Undo is not a problem, but if it becomes one, you can
turn it off: [https://9to5mac.com/2019/04/16/shake-to-undo-
iphone/](https://9to5mac.com/2019/04/16/shake-to-undo-iphone/)

~~~
frereubu
Thanks - that was something I'd noticed, hence my mention of it, but it was
clearly a bit too tacit! I think I might get her to turn it off anyway,
because she's not used it so far and doesn't do anything on the phone where
undo would be useful.

~~~
docfort
iOS also has Touch Accommodations. These settings will essentially require her
to either hold still over a UI element before it is recognized as a tap, or
you can leave the finger on the screen and lift it to register a tap.

~~~
frereubu
Yes, I mentioned those in my initial post. What I'm not sure is quite how
intuitive they are. For example, she finds the delay before a click is
registered with an increased Hold Duration quite unintuitive.

------
unfunco
Have you tried speaking to a doctor? You've mentioned age-related conditions
but I'm not sure if that's what your mother has?

I have an essential tremor (I'm 34, my mum has the same tremor, and I've had
it since I was a child), and it was able to be stopped almost completely with
Propranolol, a beta-blocker. I'm not a medical professional, so I'm not sure
whether that's a good suggestion for your mother though, so seek professional
assistance first.

~~~
frereubu
Thanks for the thought. She's in regular contact with her doctor about various
conditions and medications that come with old age, so I think she's probably
talked to him about it, but that's just an assumption so I will ask her to be
sure.

------
base2john
Has she tried using a stylus? I wonder if grasping something alters her hand
stability.

~~~
frereubu
I think this plus Siri is going to be the answer. A heavy enough stylus so
there's inertia to counteract the shake, plus a few fingers around it to
counteract each other's shaking, as well as being thinner so it's easier to
see where it's going, should work better than just her fingers.

------
lalos
As a side note: I'm optimistic that there will be more solutions to the
symptoms of Parkinson (not sure if this is the case for this post but sharing
anyways). For example [https://www.microsoft.com/en-
us/research/project/project-emm...](https://www.microsoft.com/en-
us/research/project/project-emma/)

------
elicash
Would a gimbal/stabilizer be helpful here? Or any other hardware solutions?

Of course it wouldn't solve the problem, as you still have the other hand that
has to touch buttons. I ask because I recall seeing a "smart" spoon:
[https://www.youtube.com/watch?v=WiVQcgmIi08](https://www.youtube.com/watch?v=WiVQcgmIi08)

~~~
frereubu
Thanks - I remember being really struck by that spoon too. I don't think her
shakes are bad enough for that currently though, and it feels like the first
step is Siri / dictation and a stylus, and we can take it from there.

------
pascalxus
What I'm about to tell you is of a highly controversial topic, I'll go ahead
give you the source first:

Source: 100 and Healthy [https://www.youtube.com/watch?v=mb--
QxUnEv0&t=1338s](https://www.youtube.com/watch?v=mb--QxUnEv0&t=1338s) The
speaker is Dr. Oliverira.

Rosane Oliveira, DVM, PhD, is Founding Director of Integrative Medicine at the
University of California Davis School of Medicine with over 20 years of
experience as a molecular geneticist and has a special interest in nutritional
genetics and genomics

This condition is called Essential Tremors, and it is one of the impacts of
increased mTOR and IGF-1 levels that so many of us have from eating too much
meat. According to Dr. Oliverirea, as an example, in her presentation she
showed that eating 1.5 ounces of chicken per day, increases your chances of
getting Essential Tremors by x21!! Wow. Eating meat and diary in excess has
consequences and there's a lot of research to back that up.

Unfortunately, it maybe to late for your mother. But, this is for all the
other mothers and fathers out there.

------
jblarneyforward
Have you tried turning on voice control? That allows you to control the entire
screen without holding phone (“show numbers”, “Tap 5”, “Tap 4”, “Text I want
to enter”, “Tap send”)

------
Angostura
How does she get on with Siri and voice dictation?

~~~
frereubu
I haven't tried that yet, but it's definitely on my list after these comments.
However it does still leave issues like trying to open an app, but the hand
shake being interpreted as a desire to swipe.

------
uoaei
A perfect example of the XY problem.

The solution is to stop using iPhones and use something that interfaces with
her better.

Big physical buttons is a good start.

~~~
frereubu
I'll give you the fact that I didn't specify exactly what her use cases are,
but I hope you don't mind me saying that this feels like a pretty dismissive
reply without asking what the context is. Name me a phone with big physical
buttons that would allow her to approve online payments through her banking
app.

~~~
uoaei
Again, Y standing in for X here.

It's probably easier for her to interface with her bank through a desktop
computer. Small buttons on handheld devices is not the UI for this job. "Shaky
hands" plus "small touchscreen device" is enough context to reach this
conclusion.

If you want to make a project out of it, you could set up a browser with a few
extensions that limit her ability to expose herself to malware, etc. and make
it easy to connect to the services she uses regularly.

~~~
MandieD
There's a lot in our world that is starting to assume you have a modern
smartphone to hand, such as online banking - not for initiating transactions,
but for authorizing them. Also, parking payments. With more and more places
going cashless, having change on-hand is becoming a problem.

Just because someone’s hands aren’t steady enough to use a smartphone like a
young person doesn’t mean that they’re so frail that they have no interest in
or need to independently navigate the world we’re making.

------
jc01480
Can you show her how to use voice commands for emergencies? I don’t use them,
but they may be something helpful.

------
INTPenis
Doro phones are much better adapted for elderly people.

~~~
frereubu
From what I've seen the Android ones aren't much better than standard Android
ones, and the simpler ones won't enable her to use things like banking and
parking apps.

