The mouse presents a number of challenges to the elder computer user. Some of the difficulties stem from lack of experience with the mouse, and some with the design decisions made in the computer interface.

Starting with the Basics

For many elders, the mouse is a completely novel input device. They may not know how to grip the mouse, how to move it, or how to click. All of these features must be explained.

Holding the Mouse

Many elders hold the mouse incorrectly until instructedClick image for a larger view.

Because the mouse is an unusual device for many elders, the means of holding the mouse must be made clear. Since the device is described by the name of a rodent, many elders will want to hold the "nose" of the mouse facing forward, and the tail toward the edge of the table. Holding a mouse with the tail extending from the fingers is counterintuitive, and must be explained.

The "tail" of the mouse extends from the finger tips.Click image for a larger view.

Next, the grip should be demonstrated. For right-handed users, the thumb lies along the concave, left side of the mouse, and the fourth and fifth digits along the right side. The index and middle fingers of a young hand will then fall naturally onto the left and right buttons of the mouse. Many elders, however, have hands that do not conform as well to the mouse. With ulnar drift and degeneration of the joints of the fingers, it is not uncommon for the index finger to fall on the right mouse button. It is also common with aging for sensation in the fingers to be diminished, so that the elder may not be aware of finger position.

With aging, finger alignment may change.Click image for a larger view.

Moving the Mouse

It has been observed that "lessons learned young stay with you for your entire life." Many elders were taught, in their youth, that a polite individual does not "slide" dishes on the table, but picks them up and places them. This mandate appears to carry over to the mouse as well. Many elders will hold the mouse slightly above the surface of the table to move it, rather than sliding it along the desktop. Proper mouse movement must be carefully taught, demonstrated, and, in some cases, cued with "hand over hand" movements.

One behavior of the mouse that appears to be difficult for the elder novice to grasp occurs when the mouse reaches the edge of the mousepad before the mouse cursor reaches the target. Experienced users know that the mouse can be lifted, and moved without moving the cursor, in order to reposition the physical mouse. This process of "rowing across the screen" becomes automatic to the experienced mouse user, and is seldom concious. However, this movement is not intuitively obvious. In the course of our development, many seniors were observed to hold the mouse in the air, lift and place the mouse in the same location, or attempt to move further in the "target" direction, so that they could not return the mouse to the desktop. Repeated explanations, hand-over-hand demonstration, and a great deal of practice seems to be necessary to master this movement.

The only acdtive point on the mouse cursor is the very tip of the arrow.

A final component of mouse use that appears to be a challenge to elders is positioning the mouse pointer. Experienced mouse users seldom think about it, but, regardless of the size of the mouse pointer, there is only a single pixel that is important for mouse operations. This point, the "hot-spot," is located at the tip of the arrow in the selection cursor, or the tip of the finger in the web selection cursor. When a mouse button is pressed, the action occurs at the screen location of the hot-spot.

The default crosshairs can be very hard for an elder to see.

Many of the elders in our study tended to place the "center of mass" of the mouse pointer over screen controls. If the control were sufficiently large, this strategy would work because the hot-spot of the cursor was within the area of the screen control. But for many screen controls, the hot-spot might lie outside the bounds of the control, or so close to the edge that mouse actions became erratic. Two solutions to this problem are possible. Extensive training in the use of the mouse, perhaps with games like Mouse Trainer ( can teach elders how to activate the mouse. Alternatively, changing the system cursors (see below) to the crosshairs would make the hot-spot the center of the cursor, and would accommodate this behavior.

While the standard system cross-hairs would place the hot-spot in an intuitive location, this cursor is also very small and difficult to see for a person with limited vision. If this strategy is chosen, replacement of the conventional mouse cursors with a larger version, such as the "Huge Mouse" cursors, would allow the cross-hairs to be easily located on the screen.

Hardware and Software Components

A number of aspects of the mouse are relatively easy for young adults to perform, but can be difficult for elders. Key components of the Elder Interface involve changing system settings to accommodate the changes in human performance that occur with normal aging.

Left or Right Button

The One-button mouse remains available.One-button mice can still be purchased for elder's computers. Click image for a larger view.

When Apple Computer first designed the interface of the Macintosh, they determined that, with more than one button on the mouse, some users became confused. When Windows became popular, it also became common to deride users that couldn't count to two (mouse buttons). However, while young adults (after training) can use two mouse buttons easily, many elders have difficulty. Remembering whether to use the left or right mouse button to perform a task can be difficult for beginners (and elders may be "beginners" for the remainder of their lives).

One common question, for virtually all novices arises when using the contextual menus which can be summoned with a right-click. For example, in our development of the Elder Interface, we asked elders to format a floppy disk. To complete this task, the elder would right-click on the floppy disk icon, then click on "Format" from the context menu. A large portion of elders would, at this point, ask if this was a right-click, or a left-click. Since the menu was opened with a right-click, it seemed reasonable that actions within it would use the same button.

For elders, the added problems of deviation of the fingers makes pressing the correct button especially challenging.

If an elder is having difficulty remembering or accurately pressing the appropriate mouse button, we recommend replacing the conventional two-button mouse with a single-button USB mouse designed for the Macintosh computer. These are available from a number of vendors for under $30. However, for those elders who have experience using the mouse, the two-button mouse was often reported to be easier to use.

When using a one-button mouse, of course, the right-button functions will not be available. In most cases, this is not a problem, as the "Application" key of the computer keyboard will open the menus that are accessed by the right mouse button.

There are, reportedly, a very few actions in the Windows environment that require a right-mouse click. There are at least two identified ways to generate a right mouse-click without a right mouse-button.


The Control Panel can be opened from an item near the middle of the right side of the start menu.Click image for a larger view.

The Windows operating system has included, since Windows 95, a feature known as MouseKeys. MouseKeys allows the numeric keypad of the computer to be used to move the mouse.

Click the Mouse Tab in Accessibility Options to set MouseKeysClick image for a larger view.

To activate MouseKeys, open the Accessibility Options Control Panel. This can be found by opening Start>Control Panels. Double-click on the Accessibility Options control panel to open a window with a number tabs along the upper portion. (Note: if your system is set to "category view," you will click on "Accessibility Options," then, in the resulting window, on "Accessibility Options" again.)Click on the tab for "Mouse" and check the box for Use MouseKeys.

Click the Settings button to adjust be behavior of the MouseKeys. Most of the settings here adjust how quickly the mouse will move when the keys of the keypad are pressed, which are not important for this acdtivity.

Be sure to set Use MouseKeys when NumLock is OffClick image for a larger view.

At the top of the window is an option to use the Keyboard Shortcut to control MouseKeys activation. When this feature is turned on, holding down the left Shift and Alt keys, then pressing the Num Lock key of the keypad will activate mousekeys, or disactivate it if it is running. Since the elder using MouseKeys will likely want it on at all times, and since the keyboard shortcut offers a means (however unlikely) of accidentally switching off MouseKeys, this box should be left unchecked.

Near the bottom of the window is an entry that reads, "Use MouseKeys when NumLock is:" If this is set to "On," the numeric keypad cannot be used to enter numbers when MouseKeys is active. But if it is set to "Off," the keypad can easily be switched between aiding mouse movement and entering numbers by pressing the "NumLock" key in the upper left corner of the keypad.

When MouseKeys is active, the "-" key in the upper right corner of the numeric keypad will make the "5" key of the keypad produce a right mouse click. When Mousekeys is active, numbers can still be typed from the top row of the keyboard, but not from the keypad.

Unfortunately, using this approach means that, in order to produce a mouse click, the elder must remember to press the NumLock key to activate MouseKeys, then press the "-" key. Then, if the keypad is to be used for numbers, press the NumLock key again. This level of complexity is likely to present an additional barrier to successful use of the Mouse. Worse, because the key is at the extreme right of the keyboard, right handed users must either reach entirely to the right side of the keyboard with their left hand, or release the mouse, hoping that it does not move as they do, and press the key with their right hand. An ideal solution would allow the click to be used at any time, and in combination with the Numeric Keypad.

Key Mouse Genie

fillerClick image for a larger view.

Key Mouse Genie1 is a low cost ($15) utility that allows the functions of the mouse to be assigned to nearly any key of the keyboard. While this program offers a lot of power to control the mouse, the Elder Interface requires only the ability to produce a right mouse-click.

Key Mouse Genie allows the mouse functions to be assigned to a wide range of keyboard keys. However, the For purposes of the Elder Interface, the only function that is desired is the "Right Click," which is set to "Control" from the pull-down menu. All other functions are set to "Disable," to avoid unexpected behavior.

To set the Right Click for the mouse, find the label for that function in the Key Mouse Genie window. Click once on the small arrow symbol at the far right of the pull-down menu box next to the label to produce a list of the keys that can activate a right click. Scroll down this list to "Control" and click that entry to select it. ("Control" is located after the "Num Lock" entries, and before the alphabetical entries.)

Repeat this process for each of the other functions except for the Left Button Down and Left Button Up controls, selecting "Disabled" for them.

Key Mouse Genie can be set to "auto run on launch," which means that it will run each time the computer is started. When it is active, the elder can position the click an icon with their dominant hand, and press the Control key with their non-dominant hand. The control key sends a "right mouse click" to the position of the last mouse action.

Click Size

A common problem experienced by seniors occurs when they click the mouse button. A mouse "click" is actually two computer events. The button is depressed at a location, then the mouse button is released at a location. The time that passes between the "mouse down" and "mouse up" events is not important, but the distance between the two events is. The Windows interface assumes that any movement greater than 4 pixels is intended to be a "drag" rather than a click.

Elders often, as they press the button, slide the mouse slightly forward. When the screen resolution was lower, a small amount of movement would be ignored. On a modern display, a movement of about 1/32 of an inch will be considered a "drag" rather than a click. When an elder attempts to click on an icon, they might see the icon "shiver" slightly as it drags out of position, then moves back, but the click will not occur.

While the controls included in the Windows operating system do not allow modification of this behavior, it can be changed.

Tweak UI

Tweak UI (User Interface) is a free, unsupported program (An "unsupported program" is an official program from a vendor, but which they will not answer questions regarding. The user of such a program must find any required assistance within their community.) from Microsoft which allows a number of changes to the user interface. It can be downloaded from

After installing Tweak UI on the computer being adapted, open it and select "Mouse" from the list on the left. (Don't click on the "+" sign to select, as this will open sub-menus that we are not using.)

The control for "Drag" can be used to set the click size.Click image for a larger view.

When "Mouse" is selected, right half of the screen will show two controls for Mouse Sensitivity. The upper control, Double-click:, will be discussed below. The lower control, "Drag:", adjusts how far the mouse "must move" before the motion is considered a drag. The default value, as noted earlier, is 4 pixels. While this control is presented in terms of drag sensitivity, it is also setting the tolerance for mouse movement between mouse-down and mouse-up during a click. Making the value larger makes the mouse easier to click. The value can be changed using the small arrows to the right, or by typing directly into the numeric box. It will accept values up to 32 pixels, which is the default size of an icon. Larger values can be typed into the control directly.

Since very few operations on the computer require dragging less than 32 pixels, the value can be maximized without loss of functionality. The only potential source of difficultly is that the object being dragged doesn't move until the mouse has traveled 32 pixels, so it is possible that a user may think that the "drag" missed at the start. Once the number has been set, click OK to set the new click distance.

Double-Click Size

In order to "double-click," the mouse must be clicked twice "in the same place." By default, the two clicks must occur in locations no more than 2 pixels apart. This can be very difficult for an elder, as it requires the mouse to be essentially motionless.

Double-click size determines how far apart two clicks can be and still be a double-click.Click image for a larger view.

Using Tweak UI, discussed in the section on Click Size, the space allowed between two clicks can be increased. After installing Tweak UI on the computer being adapted, open it and select "Mouse" from the list on the left. (Don't click on the "+" sign to select, as this will open sub-menus that we are not using.)

When "Mouse" is selected, right half of the screen will show two controls for Mouse Sensitivity. The upper control, Double-click:, sets the space allowed between two clicks. As with the click size, this value can be set to up to 32 pixels.

For elders, setting the maximum value seems optimal.

Double Click Speed

The action of a double-click, unlike a click, also requires that the two clicks occur within a set period of time. Many elders have difficulty producing double-clicks because they have difficulty clicking rapidly enough to count as a double-click.

The Mouse Control Panel allows adjusting mouse characteristics.Click image for a larger view.

The speed required for a double-click can be adjusted to some extent within the mouse control panel. Within the Mouse control panel (Start>Control Panel:Mouse), you will find a slider that changes the double-click speed from "Slow" to "Fast." Sliding the control to its left end will allow.9 seconds between clicks in a double-click, and may meet the needs of many elders.

If the elder continues to have difficulty in producing a valid double-click, the timing can be changed even further through a Windows utility named RegEdit (for Registry Editor). The Registry is the part of the Windows environment that controls Windows behavior, and errors in the Registry can prevent Windows for working at all, so be exceptionally careful using RegEdit.

Be careful using the Registry Editor to change system settings.Click image for a larger view.

RegEdit is started by selecting Start>Run. In the resulting dialog, type "regedit" (without the quotes). This will open the Registry Editor.

On the left side of the Registry Editor is a panel that displays a set of folders similar to that seen in the Windows File dialogs. Clicking a folder will show, on the right, the global values for a folder. Double-clicking, or clicking on the "+" to the left of a folder will open it to reveal sub-controls.

In the list on the left, double-click on the folder labeled HKEY_CURRENT_USER. Changes made within this folder affect only the user who is currently logged into the computer. If more than one person uses the computer being adapted, make sure you are logged in as the elder for whom you are installing adaptations.

Within the HKEY_CURRENT_USER folder, double-click on Control Panel, then single-click on Mouse. In the list that appears on the right, right-click on DoubleClickSpeed. From the resulting menu, select Modify.

Within the resulting window, you should see a highlighted value that is the current double-click speed, in milliseconds. If you have already adjusted the control panel slider to its lowest value (The longest possible double-click time produces the largest numbers), this will show 900.

You can enter longer delays into this box, but it does not appear that Windows will delay more than about 2000 milliseconds. After entering a new value, click OK to make the change, then exit the Registry Editor (Use File>Exit to assure that your changes are recorded.). It should now be easier for the elder to generate a double-click.

Pointer Size

The final mouse-related issue addressed by the Elder Interface is the tendency of Elders to lose the mouse pointer. The default mouse pointer is relatively small, and does not contrast with the background, making it difficult to find for those with limited visual acuity. The Mouse control panel does offer alternative schemes, including "Windows Black (extra large)(system scheme)," which produces a mouse pointer somewhat larger than the default, and easier to see.

If this pointer remains difficult to see, a free set of much larger cursors can be downloaded from Download, then unzip the file, "" (Note: in Windows, right click on a zipped folder, then select "Extract All" to unzip the contents.)

The Cursors Folder is inside the Windows FolderContent for class "floatpicright" id "Windows Cursors" Goes Here

The extracted folder can be placed inside the Windows cursor folder. Select Start>My Computer. From the resulting window, select your C: drive. (At any, or at several points in the next steps, you may receive a message that suggests that the user really doesn't want to look in this folder, but you may tell it that you really want to.) From the C: drive folder, open the Windows folder. Depending on how the computer has been configured, folders may be sorted by name, by date, or by other characteristics. (Shortcut: click once on anything inside the C: folder, then press the "w" key until the Windows folder is highlighted.)

Within the Windows folder, find and open the "Cursors" folder. There will be many files and folders inside the Windows folder, so the fastest way is to press the "c" key until the Cursors folder is highlighted. Once the Cursors folder is opened, simply drag the unzipped atechuge folder into the window to make the cursors available.

Activating the new cursors

Each mouse cursor can be customizedClick image for a larger view.

Once the Huge Mouse cursors are installed, you must tell Windows to use them. To do this, open the Mouse control panel. Select Start>Control Panel to open the Control Panels window. Within this window, find and double-click the Mouse control panel. This will open a window on the screen which allows setting mouse characteristics. (This is the same window used to set the double-click speed.)

Click the "Pointers" tab at the top of the "Mouse Properties" window. The contents will now show a "Scheme" selection menu at the top, and a large display of cursor types at the bottom.

Select the "Normal Select" cursor at the top of the display. In the lower right corner of the window, click the "Browse..." button. This will open a window containing many different cursors. Near the top, you should see a folder named "atechuge." Double-click on this folder.

Within the atechuge folder are two sets of cursors, one white, and one black. The black set will generally be more visible on a light colored background, the white set if the background is more commonly dark. To activate the black "normal select" cursor, select "hbarrow.cur," then click "Open." This will close the cursors window, and set the "normal select" cursor to the hbarrow (huge black arrow) pointer. Repeat this process for "Busy," "Precision Select," "Text Select" and any other cursors the elder has difficulty seeing.

When all of the cursors are selected, click OK in the Mouse control panel, and the Mouse Properties window will close, and the cursor will change to show your new selections.

Interestingly, some "ill behaved" applications, such as Adobe Framemaker, will not display the adapted cursors. The authors of these programs felt that creating their own mouse cursors had advantages over the system settings, and have chosen to ignore the desires of the user.

The One-Click Interface Option

For novice computer users or elders experiencing increasing difficulty with the conventional mouse, the Elder Interface recommends the one-button, one-click mouse.

The mouse vocabulary includes six possible events for the mouse (Note: because the mouse can be modified for left-handed users by reversing the buttons, we use the "primary" and "secondary" identifiers for mouse buttons.):

Primary Mouse Click: Select the item at the pointer

Secondary Mouse Click: Open the contextual menu at the pointer to modify the object using system actions

Primary Mouse Double-Click: Activate the item at the pointer

Secondary Mouse Double-Click: Not used

Primary Button Mouse Drag (Press and hold the mouse button, move the mouse to a new position, release the mouse button.): Move the object under the mouse at the beginning of the drag to the position of the button-release. In some cases, if a file is dropped on a program, that program will open the file.

Secondary Button Mouse Drag: At the release of the button, opens a context menu with the options to move the object, copy the object, or create a shortcut to the object at the drop location.

This mouse vocabulary can be thought of (and should be taught) as the actions to be taken, with one-button, one-click actions. This vocabulary assumes that the right-click function has been provided through Key Mouse Genie or an equivalent program.

Select an object: Move the cursor over an object and click the mouse button.

Activate an object: Move the cursor over an object, and click once to select, the press the Enter key (on the keyboard) to activate the object

Act on an object through the context menu: Move the cursor over an object and click once to select, then press the Windows key to open the context menu. To select an item from the menu, use the mouse button.

Move an object: To position an object on the screen or within a window, move the mouse pointer over the object, press and hold the mouse button, move the mouse to the new location, then release the mouse button. For elders who have difficulty holding the mouse button while moving the mouse, press the Home key rather than the mouse button, move the mouse, then press the Insert key.

For longer moves (between windows, for example), move the mouse over the object and click the button. Press the Control or Windows key to open the context menu, and select "Cut." Move to the new position for the object and click the mouse button, then press Control again. Select "Paste" from the context menu, and the object will appear in its new location.

Copy an object: Move the mouse over the object and click the button. Press the Control or Windows key to open the context menu, and select "Copy." Move to the new position for the object and click the mouse button, then press Control again. Select "Paste" from the context menu, and the copy of the object will appear in its new location.

Create a shortcut to an object: Move the mouse pointer over the object and click the button. Press the Control of Windows key to open the item menu. Select "Create Shortcut" to create a shortcut in the current location. Use the instructions above to move the shortcut to its desired location.

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