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Ask HN: My mother has shaky hands – guidance on iPhone accessibility settings?
105 points by frereubu 3 days ago | hide | past | web | favorite | 62 comments
As my mother ages (she's 89) her hands are getting quite shaky, and she's finding it more difficult to use her iPhone. I've been looking through the Touch settings in Settings > Accessibility, such as Touch Accommodations, but I'm a bit confused by the number of variables.

Her hands don't shake so much yet that she triggers Shake To Undo, it'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.

I'd really value guidance from people who'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.

She recently bought one of the new iPhone SEs, but I'm wondering if it wouldn't be better to get an XR with FaceID to avoid issues with TouchID.

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.

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.

I say this with sincere belief. I hope Jony Ive’s departure from Apple results in better changes to the interface elements and interactions. While the skeuomorphic design of iOS 6 and before looked over the top in comparison to the flat designs we see now, I believe Scott Forstall had something good going on with iOS interfaces (not talking about Maps and what happened with that). Things got worse after he was fired and Jony Ive took over the UI/UX part too.

I would use that confirm button.

In 10 years of owning an iPhone I’ve initiated ~10 phone calls that I intended and probably ~30 other calls.

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.

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.

> skeumorphic design

ios 7 was a real turn for the worse in that respect.

It may feel very strange for someone in their late 80s, but for making calls, Siri could be the answer.

This is what I'd suggest, too, for sure. Just don't use the Phone app at all, if it's causing issues.

My Mom, who is 75, routinely uses Siri for all kinds of stuff. She's taken to it quite naturally and it seems to work extremely well for her. If you're using a voice interface, shaky hands become irrelevant!

It’s almost sadistic how little languages Siri supports and how Apple restricts using other services (Google).

There are usability studies done, but the average Apple employee, while older than say facebook, is not likely to overlap much on the 'shakey hands' front.

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.

Thanks for the suggestions.

She primarily uses it when out and about, so carrying around an extra device for calls wouldn't really work.

In terms of zoom, do you mean Display & Brightness > View > Zoomed, because I have enabled that on her phone. Accessibility > Zoom I find pretty unintuitive, and I think her shakiness would make that a problem. I've also increased text size with Accessibility > Display & Text Size > Larger Text. I've done both of those things on my phone too, because I find it much easier to use despite not having any accessibility issues as such.

Out of interest, would the max-zoomed UI on the iPad Mini make any difference to gesture detection (e.g. detecting the start of a swipe rather than a tap)? Or is that more about muscle tension when trying to hold steady for a tap on a small area causing more shakes? Could you elaborate on that?

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

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.

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

Tutorial: https://www.youtube.com/watch?v=80AyUCjZYZM

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.

Has he tried Hawkeye Access at all? Pupil tracking via FaceID is a bit of my party trick.

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.

Thanks, this looks really interesting - I'll send her the videos and see what she thinks.

To just add on here - voice control AND a stylus might be a nice combo (and another user below also mentioned this). I'm not an expert, been around tech for 30+ years...and I'm always fascinated with how people use it.

I have family that has issues with grip and/or circulation --which causes other issues with capacitive touch. I found a stylus (and a nice collection of inexpensive ones too) goes a LONG way towards helping. In my non-medical opinion, I believe decades of muscle memory holding a pen/pencil helps the elderly navigate. Their hand also doesn't get in the way of their view either.

Voice control is a really amazing addition, but it may be overwhelming to recall some or most of the controls. So I would start small. I found a lot of success working with older adults and tech while just starting with small wins.

Also mind conditioning: start your day asking what the weather is like. That helps get them to feel less "funny" when using it. It becomes more casual and less embarrassing.

Thanks very much, that's really helpful. Like you I've been around tech for 30-odd years, but haven't dealt with this side of it before. Siri and a stylus was the conclusion I'd reached. Voice control does seem a bit too much for what she wants to do, but it may come in handy later on if the shaking gets worse.

Having been publicly released, Voice Control is beyond the experimental stage, but many of its features need refining.

That said, Voice Control is excellent for granular control of UI elements and for simulating and/or obviating swipe gestures. For example, "Go Home" replaces swiping up from bottom.

Voice Control also actively listens to everything as potential input. So, if an input field is active, merely speaking will trigger speech-to-text in that field. The accuracy is sometimes startling.

On the other hand, watching video with Voice Control active will result in Voice Control suggesting available commands (because Voice Control will interpret some of the audio as invalid [or sometimes valid!] commands).

I am not (yet) touch or motor impaired, but Voice Control is a godsend for hands-free manipulation of the UI. I hope your mum finds it similarly helpful.

Thanks for the pointers. I did wonder about accidental input when listening for commands, a bit like a friend of mine who's called Alexa!

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.

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.

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.

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.

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?)

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

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.

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.

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...)

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.

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

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


Thanks - that does look interesting for sure.

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

more https://support.apple.com/en-us/HT210546

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.

Apple's video of Assistive Touch (2m 10s): https://youtu.be/a0IO_tqsO5g

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/

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.

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.

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.

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.

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.

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

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.

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...

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

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.

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 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.

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”)

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.

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.

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.

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.

How does she get on with Siri and voice dictation?

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.

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

Doro phones are much better adapted for elderly people.

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.

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