Integrating Universal Design (UD) Principles and Mobile Design Guidelines to Improve Design of Mobile Health Applications for Older Adults Ljilja Ruzic Kascak, Dr. Claudia B. Rébola, Jon A. Sanford School of Industrial Design Georgia Institute of Technology Atlanta, USA ljilja@gatech.edu, crw@gatech.edu, jon.sanford@coa.gatech.edu Abstract— Mobile technology can improve lives of older adults through remote health monitoring (telehealth), memory aids (including medicine reminders), personal data management, and social and communication assistance. Although numerous design guidelines, design principles, and heuristics have been developed to improve the user interface (UI) design of mobile applications for older adults, many usability problems are still reported. Alternatively, universal design (UD) advocates designing products and interfaces usable by all people, with all ranges of abilities. Older adults population is diverse in terms of the ranges of limitations as well as combinations of limitations they have. Design guidelines targeted towards specific abilities and limitations are not effective in a case of multiple limitations or diversity of limitations in older adults. Applying design guidelines to UD principles would address diversity of limitations within this population group. This project explores the ways in which we can bridge discrepancies between the existing design guidelines and UD principles to improve design of mobile health applications for older adults. In this paper, we describe usability studies and redesign of the remote patient monitoring (RPM) mobile application UI for older adults, refined RPM mobile app interface using the UD approach, and a set of inclusive design guidelines that reconcile inconsistencies between design guidelines and UD principles. Keywords— human factors; mobile health applications; older adults; remote patient monitoring; universal design; user interface I. INTRODUCTION The health status of older adults is complex, with many of them having multiple diseases and consequent disabilities [1]. Among the health issues older adults face (e.g. chronic conditions, functional limitations, risk of falls and related injuries), chronic diseases are prevalent. Wolff, Starfield and Anderson [2] reported that in 1999, 82 percent of older adults enrolled in Medicare had one or more chronic conditions, with 65 percent of them having multiple chronic conditions. Chronic diseases account for majority of hospitalizations. Consequently, number of inpatient admissions increases with the number of chronic conditions. Remote patient monitoring (RPM) reduces avoidable hospitalization rates, especially for older adults with multiple chronic conditions. RPM uses electronic information and communication technologies to passively collect physiological and contextual data of patients in homes and other settings, using medical devices, software, and optionally environment sensors [3]. Data is transmitted to the remote healthcare provider for review and intervention. RPM dramatically reduces hospitalizations and days at bed, allowing patients to return to their homes and communities. Mobile technologies are used as a method for monitoring the health status of remote patients [4]. These technologies can improve lives of older adults with chronic conditions through health monitoring, memory aids (including medicine reminders), personal data management, orientation aids, and social and communication assistance [5]. RPM using the mobile devices adds mobility and flexibility in use [6]. The use of mobile devices for chronic patient monitoring will increase and become a focus of the use of RPM in the patient-centered care [7]. Mobile technologies for older adults need to be meaningful, engaging, easy to use, usable and motivate the adoption of technology by this user group [8]. Current mobile technologies do not meet the needs, experiences and limitations of older adults [9]. Several studies [10-15] reported that the benefit and potential of technology depend on usability and ease of use during the user interaction with devices. In order to improve performance of older adults while using technology it is fundamental to address usability issues [16]. For this purpose numerous web design guidelines [12, 17-19], design principles [5, 20] and heuristics [5] were developed. In addition, mobile and touch screen design guidelines and recommendations [21, 22], as well as mobile medical applications guidelines developed by the FDA [23] were proposed to general population to assist future development of mobile technologies. Although design guidelines were developed to help older adults while interacting with technology, existing design guidelines and principles are targeted towards specific limitations and disabilities. For a population that is diverse in its ranges and combinations of limitations this approach is too narrow and focused, and thus fails to include the whole population of older adults with its multiple limitations. Older adults encounter numerous barriers associated with aging while interacting with technology [24]. Lack of physical space, including small touch and physical buttons, confusion with their location within the context, use of menus that require