1. Nicoll, Leslie H. PhD, MBA, RN, Editor-in-Chief

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A recent move brought my parents much closer to my home, so I have had the opportunity to spend time teaching my father to use his computer. Previously, I tried to provide help and assistance over the phone; that was next to impossible and he did not make much progress. Now that he is in the neighborhood, I have been able to stand over his shoulder and see the computer through his eyes. It has been an enlightening experience!


At 78, my father is experiencing many of the losses typical of his age: visual impairment (sensory loss); decreased sensitivity and mobility in his hands and fingers (mobility loss); and short-term memory deficits (cognitive loss). Each of these provide different challenges in terms of making the computer accessible and usable, and as I watched my father, I experienced this firsthand. For example, he had difficulty reading the screen (sensory loss), but beyond that, the amount of information presented on each screen was tremendously confusing to him (cognitive loss). The diminished sensation in his hands made using the mouse very difficult, particularly mastering a "double-click." I also discovered, as I watched him, that he would "rest" his middle finger on the right mouse button and inadvertently click it, not realizing he was doing so. This resulted in more menus unexpectedly popping up on the screen, further adding to his confusion.


His experience is not unique. A study in Great Britain 1 found that 19.8% of persons over 75 experienced two losses (sensory plus mobility or cognition); 9% experienced all three. Unfortunately, many of the accessibility and usability solutions that are available only address single limitations and do not take into account the multiple functional losses experienced by elders. For example, changing the font on the screen to a larger size is a sensory-only solution; it does not address the information overload of the screen presentation. Similarly, many suggest using keyboard commands instead of the mouse to solve the mobility problem but, frankly, I find it hard to remember multiple keyboard commands. I don't think an elder with short-term memory loss is going to find "Alt-F-A" to save either intuitive or easy to remember!


Trying to come up with effective solutions for teaching elders (or others experiencing functional loss, for whatever reason), it is important to remember that there are, in general, two technological approaches to functionality: proactive and reactive. 2 In the former, effort is directed to building access features into a product or design from the beginning, while a reactive approach may be thought of as retrofitting, such as adapting the product to the meet the abilities and requirements of the end user. Much of what is presented about computer accessibility focuses on the proactive model, that is, developing designs for Web sites, software, and equipment to be accessible for all. However, those of us working at the individual level with end-users, whether we are teaching nurses, physicians, patients, and, yes, even loved ones, usually must create reactive solutions. While they are not discussed as often, these tailor-made solutions fill an important niche in breaking down barriers to functionality. As nurses in informatics we have a particular strength: we understand computers and assistive technology, as well as possessing empirical knowledge about age-related decline.


Even though my father is a sample of one, I think some of the strategies I employed to help him can be universal in their usefulness. As you approach reactive functionality, keep the following in mind:


* Identify one or two goals. Instead of trying to "learn the computer," we refocused the conversation to a few, clear, concrete goals. For my father, these were (1) sending e-mail to friends; (2) writing letters for business (or to friends without e-mail); and (3) simple surfing on the Internet (mostly to buy books, I discovered!). Others have shared similar goals: being able to research the family tree; keeping track of stocks and investments; and playing bridge online. Breaking the tasks into simple blocks made it easier for him to remember what he wanted to do and how to do it.


* Keep it simple. Cognitive decline and short-term memory loss are probably the most difficult issues that my father faces. I realized that to have any success at all, I needed to make his computer interface both simple and predictable. To this end, I got him off a certain (unnamed) commercial Internet service. The screen, with endless graphics and pop-up menus, was overwhelming to him. Even though this particular service has been described as the "training wheels of the Internet," for him, it was like a Harley-Davidson.In addition to providing him with a simpler Internet interface, I also "broke apart" his e-mail client. Now he has separate icons on his desktop: one for the Internet and one for e-mail. I also found easy-to-use programs for word processing and e-mail. One feature that he finds very helpful is they both make typing sounds! Although it would drive me crazy, for him, it makes the computer act like a typewriter, which is familiar and thus easier to use.


* Play with the accessibility features. I say play, because in my case it took some trial and error to find the right settings. We enlarged the font on the screen, put trailing tails on the cursor, and played with the double-click speed. Eventually we found the combination that worked for him.Even with these changes, he still couldn't master the two-button mouse, but through some research, I found a one-button mouse (designed for a Mac) that worked on his PC. The cost was $25 which has been our only cost for accessibility. The software we downloaded was free.


* Practice, practice, practice. Unfortunately, he doesn't do this enough (do any of us?) and every time he starts the computer we have a feeling of starting from scratch. Still, because we have narrowed down the applications he is using, it is getting easier and I think we are making steady progress.



My mother marvels at my patience but I have found this to be fun and rewarding. I have also learned quite a bit as we have worked through the process. I am interested in others' experiences with breaking down barriers for users. Please feel free to share them with me by e-mail at




1. Grundy E, Ahlbury D, Ali M, Breeze E, Slogget A. Disability in Great Britain. Huddersfield, UK: Charlesworth Group; 1999. [Context Link]


2. Kurniawan SH, Blenkhorn P. Adopting a reactive approach to develop a technological solution for older adults. Paper presented at: 16th British HCI Conference; September 2002; London. [Context Link]