Review of accessibility and usability guidelines for website design for the elderly people

By 2050, the growth of the elderly population in Colombia is estimated at 10% and thus a greater demand for special services (such as health services) for the elderly. This justifies the exploration of digital health content as an important source of information for this population. The accessibility and usability guidelines for website design –e.g., TAW and WACG– do not have specific guidelines to mitigate the motor, cognitive or visual disabilities characteristic of aging, which become a barrier for this group to consult necessary information for administrative processes that involve health. This review of accessibility and usability guidelines is presented, facilitating the consumption of specific contents and generating better interactions with such systems, which will lead to the construction of guidelines based on existing recommendations that allow the development of aspects related to interaction, legibility and usability in digital content for the elderly.


I. Introduction
Within the objectives of the ICT plan 2008-2019 of the Ministry of Telecommunications of Colombia, it is intended that "all Colombians be connected and informed by making efficient use of ICT to improve social inclusion and competitiveness..." (Ministerio de Salud y Protección Social, 2016).In Colombia, according to the Health, Welfare and Aging survey -SABE 2015 (Ministry of Health and Social Protection, 2015), 48.9% of the elderly people over 65 years of age are affiliated to the contributory health regime, 46.8% to the subsidized regime, 0.4% to the exception regime, 1.6% to the special regime and only 2.2% do not belong to any regime; this shows that only about half of that population can pay for a health system on their own.On the other hand, the higher strata have a complementary health plan, of which 95.2% are senior citizens of strata 5 and 6.This shows that only a small fraction of the elderly population can access to a quality health service.Such deficiency of homogenous coverage of the Colombian health system opens the possibility of considering Information and Communication Technologies [ICT] as an alternative that balances the provision of these services, so the way in which the digital contents about health are present to this population, becomes in a relevant issue that the Service Providers Entities [EPS] of the sector should prioritize in their health delivery strategy.

II. Telemedicine (e-Health) in Colombia
Colombia presents a geographical dispersion that generates variations in the degree of access of people to public services (e.g.health service), affecting institutional management (Ministry of Health and Social Protection, 2016).The coverage levels of the health system are concentrated in the main county towns, so the access of rural population to these services is difficult (Aparicio & Castang, 2006).These county towns contain the largest population of the country and present a constant increase of displaced population (Aparicio & Castang, 2006), which implies an insufficiency in the optimal coverage of basic services, among them health.
Advances in ICT are understood as " …the set of resources, tools, equipment, software, applications, networks and media, which allow the compilation, processing, storage, transmission of information such as voice, data, text, video and images" (Law 1341 of 2009) that allow to break the barriers and shorten the distances.These technological developments affect the social customs and the form of interaction between the individuals, and lead to the increase of
Review of accessibility and usability guidelines for website design for the elderly people.Sistemas & Telemática,15(42), opportunities for population groups separated and dispersed throughout the national territory (Ministry of Health and Social Protection, 2014).
According to the General Social Security System [SGSS] in 2014, 2.184 telemedicine services were enabled in 685 health service seats throughout the national territory, mainly in Antioquia and Bogotá -the areas with the most services enabled-and in the departments of Valle del Cauca and Bolívar (Ministry of Health and Social Protection, 2016).
According to the report of the same year, in the Valle del Cauca, 95 seats were enabled, corresponding to 13.87% of the seats that provide telemedicine services, and 216 services, corresponding to 9.89% of the total telemedicine services of the country (Ministry of Health and Social Protection, 2016).
Government entities, such as the SGSS in Colombia, have the responsibility of implementing the necessary measures and tools to ensure that health services are fully covered throughout the country and are optimal (Aparicio & Castang, 2006).One of the means for the provision of telemedicine implemented by health centers at the national level are its institutional web portals.Aparicio & Castang (2006) find that health web portals in Colombia are limited to giving information on services provided by EPS, but do not take advantage of all the benefits that online care can offer: remote patient care, prevention and attention and online education, which leads to think that the conception that has about the implementation of websites is biased, limited or mediated, as it is used for more internal than external purposes.

III. Legislation on web accessibility and usability in Colombia
According to Varela et al., (2012) in Colombia there are only laws about equal opportunities and right of access to information, but not specific laws about web accessibility.On the other hand, through Decree 2693 of 2014, the Minister of Information Technologies and Communications [Min-TIC] (Carvajal & Saab, 2010), the Government concludes the general guidelines for the operation of the Online Government program, and establishes the deadlines and the monitoring so that the services provided by the same are fulfilled.In the same rule, article seven dictates the general aspects to be taken into account in the provision of services and what refers to accessibility to them by users.On the other hand, through Law 1680 of 2013, the MinTIC establishes the requirements of accessibility that must be taken into account for people in situation of blindness or with low vision.
In terms of accessibility standards, the Icontec-5854/2011 standard is based on the accessibility guidelines proposed by the WCAG and the initiative WAI, which becomes the automatic accessibility and usability validator in Colombia, which will be taken up later.

IV. Health content on the Internet
In Spain, Jiménez, García and Bermudez (2009) analyzed the health websites of 78 large hospitals and showed that, in general, their quality and usability is low.It was concluded that they should increase the interaction with society outside the establishments through quality webs and demonstrated that they are possibly accessible to present information to the professional individual and to hospital providers, but they do not prioritize contents for those who use their services (Calvo, 2014).The fact that the main health centers determine contents that prioritize information at an internal level of the establishment, frustrates the processes of information exchange between the audience (patients) and the issuer (EPS, private or public hospital), reduces the audience and turns passive the communicative process between both (Fenoll, 2011).
Internet browsers are fairly efficient at locating information regarding a specific topic.In the United States of America, Berland et al. (2001) reviewed the pertinence, precision, and level of specialization of health content in portals in English and Spanish, comparing them to each other.Their study revealed that half of Internet consumers report spending about half an hour looking for a single health issue and expose the search engine performance to be optimal and, therefore, a priority when it comes to searching for content on the Internet.
A study of the contents of the pages about Spanish-speaking arterial hypertension (Trabalón, 2012) shows that although information on the Internet is moderately acceptable, not all of it is directed to the general population, which could confuse the user.This study selects 23 websites and analyzes them through the "questionnaire to evaluate health web sites according to European criteria" developed by Jiménez, García, Martín and Bermudez (2011), which evaluates more general aspects when developing or analyzing the design and development of a website, such as accessibility, transparency and lack of interest; authorship; personal data protection; updating the information and responsibility of the services.
The elderly people use the Internet very little today (22% of the total elderly population).However, the slightly younger population (59 to 68 years) is more adapted to the Internet and ICT, and uses technology to obtain information

VI. Accesibilidad
Según Petrié y Edwards (2001), existen muchos factores que median el proceso de diseño de accesibilidad en los productos y servicios, y muchas definiciones respecto de lograr que un producto o sistema sea usable y accesible para dos personas con discapacidades distintas.Recomienda que, quienes diseñen accesibilidad y usabilidad, deben tener claro aspectos universales del usuario y microambientes, como los aspectos legales y las características de about health aspects (Jiménez et al., 2009).This phenomenon could change the social stigmas against the use of the Internet by the elderly population.It is common to think of dissociation between technology and this population, because the legitimacy of age-specific disabilities is attributed: cognitive, motor, visual, auditory, etc.However, different studies (Aldana, García, & Jacobo, 2012) have demonstrated that the constant stimulation of the different capacities of the elderly people through ICT -although they are not the only means-, not only allow to maintain the cognitive level of the individual, but also to increase them, even after the 80 years.
Constant demographic growth and low birth rates have led to an accelerated aging of the world population.According to the UN, by 2050 the old age will represent 21% of the total population, which turns into about two billion people (Allés, 2012).This brings with it an enormous demand for different types of services and specific products to this population (Jiménez et al., 2009).A study about Internet use in the United States shows that it is used by 22% of people over 65 years and about 45% of the slightly younger people -between 55 and 65 years- (Jiménez et al., 2009), so it could be assumed that a greater use of ICT by the elderly people would result in wider uses and demand for more services and products for this population, which would open new markets for companies in different sectors.However, in order to fully satisfy the needs of this population group, companies should consider their particular characteristics, including age-specific disabilities.

V. Universal Design
Equality is a universal right stipulated in the Universal Declaration of Human Rights, therefore, all services must be available to all citizens, without any exclusion (Allés, 2012).This would suggest that companies must adapt their offer of goods and services, depending on the access possibilities of each senior citizen in their market segment.The product, therefore, must meet certain criteria of accessibility: physical, the product itself; communicative, graphic design and labels; and the distribution channel that allows reaching the user who requested it (Allés, 2012).This would also apply to web content, even more today, when cyberspace has become a place where different needs converge.Rafe and Monfaredzadeh (2012) state that in addition to the improvements in the provision of services, the use of the Internet enables hospitals to provide more qualified services, with lower expenses and in less time, and even allows them to outperform their competitors.

VI. Accessibility
According to Petrié and Edwards (2001), there are many factors that mediate the process of designing accessibility in products and services, and many definitions regarding making a product or system usable and accessible to two people with different disabilities.It is recommended that, those who design accessibility and usability should have clear universal aspects of the user and microenvironments, such as legal aspects and the characteristics of disabilities, among others: that there are people with disability situations, the needs that these people have with their disabilities have a relationship with technology and finally, how they can include those needs in the final development of accessible technology.
On the other hand, web usability and accessibility not only benefits people with physical, psychic, motor or sensory disabilities, but also all users in general (Oleo & Rodríguez, 2013).
According to Arch (2008), some of the benefits that the World Wide Web Consortium [W3C] considers are: • benefits new or infrequent users, and improves access to users with slow connections or old technologies; • improves the usability and accessibility of non-disabled people, disabled people and the elderly people; • supports literacy levels through a clear, consistent and logical navigation style throughout the website; • simplifies and reduces site development and maintenance time, which reduces server load; and • facilitates interoperability by enabling a good level of interaction, giving access to the device through different devices and configurations, depending on the characteristics or preferences of users.
In order for health services offered via web to be efficient for the user, it is necessary to take into account the pertinence of the accessibility and usability standards that allow the elderly users an intuitive and comfortable interaction for the execution of any task within the portal.In addition, the dissemination of available web accessibility tools would facilitate and stimulate accessible web design and development (Oleo & Rodríguez, 2013).

A. Automatic validators
The tools for evaluating automatic accessibility and usability are those that analyze the structure of HTML code las discapacidades, entre otras: que existen personas con situaciones de discapacidad, que las necesidades que tienen estas personas con su discapacidad tienen una relación con la tecnología y finalmente, de qué manera pueden incluir esas necesidades en el desarrollo final de tecnología accesible.
mechanically.However, automatic evaluation can leave aside aspects that cannot be verified because they do not belong to the proper structure of the HTML document (Oleo & Rodríguez, 2013).Such is the case of <alt> tags that are stipulated by the designer and contain specific descriptions of contents such as: images, videos and texts, typographic scoring, colors and shapes appropriate to the end user, among others.Table 1 presents the most widely used automatic validators.

W3C
The main objectives of this consortium are set at the limit of social inclusion and the search for equality in the use of technologies.They stipulate that a web platform is accessible and usable when it can be used by all people regardless of the hardware, software, user language, culture, location and physical or mental ability, which they call the Web Accessibility Initiative Web [WAI] (Arch, 2008).These protocols determine aspects in the area of mobility (mobile internet access), content quality, search engine optimization [SEO], good practices in web development and standardization (Arch, 2008).

Web Content Accessibility Guidelines [WCAG]
The W3C, based on the seven principles of Universal design, proposes four guidelines in which levels of accessibility
Las normas de accesibilidad web con mayor aceptación son las de la WCAG 1.0, publicadas en 1999 por la W3C Review of accessibility and usability guidelines for website design for the elderly people.Sistemas & Telemática,15(42), 9-29.

Validador
Detalle TAW Online (TAW CTIC, 2011) A tool based on the guidelines established in the WCAG, used to verify and check compliance with all items of accessibility and usability proposed by WCAG 2.0, which guarantee optimal usability and accessibility during and after the execution of a platform or website (Arch, 2008).It is one of the most used tools by the Spanish-speaking population (Oleo & Rodríguez, 2013) and takes into account the A, AA and AAA guidelines, which will be reviewed later / Herramienta basada en las pautas establecidas en la WCAG, usada para verificar y chequear el cumplimiento de todos los ítems de accesibilidad y usabilidad propuestos por la WCAG 2.0, que garanticen usabilidad y accesibilidad óptima durante y después de la realización de una plataforma o sitio web (Arch, 2008).Es una de las herramientas más usadas por la población de habla hispana (Oleo & Rodríguez, 2013) y tiene en cuenta las pautas A, AA y AAA, que se revisarán posteriormente.
AChecker ( 2011) Check the HTML code of web pages and their level of compliance with the standards stipulated by the WCAG / Comprueba el código HTML de las páginas web y su nivel de cumplimiento con los estándares estipulados por la WCAG.

Examinator (2015)
Validator of HTML code that rates with a number between 1 and 10 the level of compliance with the guidelines of WCAG 2.0./ Validador de código HTML que califica con un número entre 1 y 10 el nivel de cumplimiento con los lineamientos de la WCAG 2.0.

ntc5854 (Edu Labs, 2015)
Validator similar to the previous ones that results from the Colombian proposal of the Icontect standard 5854/2011 that establishes the criteria of accessibility and usability for the design of governmental portals / Validador similar a los anteriores que resulta de la propuesta colombiana de la norma Icontec 5854/2011, que establece los criterios de accesibilidad y usabilidad para el diseño de portales gubernamentales.(actualizadas en 2008), ellas adaptan los contenidos a las nuevas tecnologías y mejoran la aplicación e implementación de los lineamientos y criterios de accesibilidad y usabilidad propuestos por la versión anterior (W3C, 2008;Oleo & Rodríguez, 2013).En cuanto a temas de accesibilidad y usabilidad, la iniciativa WAI de la W3C, mediante la WCAG, establece los lineamientos para el diseño web inclusivo con base en los siete principios de diseño universal (Connel et al., 1997).
Las heurísticas básicas de Nielsen Nielsen (1995) estableció diez lienamientos básicos para que la usabilidad de un sitio web esté bien diseñada.and usability are categorized, the guidelines of the WCAG initiative establish the protocols for inclusive design: perceptible, feasible, comprehensible and robust.These guidelines contain, in turn, compliance criteria: A, a guideline that attributes greater importance to final accessibility; AA, eliminates important barriers to access the web; and AAA, minor importance, but it confers a good level of accessibility (Oleo & Rodríguez, 2013).
The most widely accepted web accessibility standards are those of WCAG 1.0, published in 1999 by the W3C (updated in 2008), they adapt the contents to new technologies and improve the application and implementation of the guidelines and criteria of accessibility and usability proposed by the previous version (W3C, 2008;Oleo & Rodríguez, 2013).
In terms of accessibility and usability issues, the WAI initiative of W3C, through the WCAG, establishes the guidelines for inclusive web design based on the seven principles of universal design (Connel et al., 1997).
• Equal use: the design must be easy to use and suitable for all people regardless of their skills and abilities, must provide the same ways of use for all users: identical when possible and equivalent when it is not.
• Flexibility of use: the design must be adapted to a wide range of individual preferences and abilities and allow the user to choose the mechanism of interaction or to adapt to the rhythm of use.
• Simple and intuitive design: the design should be easy to understand, regardless of experience, knowledge, skills or level of concentration of the user, establishes that unnecessary complexity should be eliminated and prioritize the organization of the information according to its importance.
• Perceptible information: design must communicate effectively the information required by the user, regardless of the sensory capabilities or environmental conditions.
• Error-tolerant design: design must minimize the risks and consequences of accidental or unintended actions.
• Use with little physical effort: the design must be used effectively and comfortably and with the minimum possible effort, avoiding or at least minimizing repetitive actions.
• Space and access for use: spaces and sizes must be appropriate for access, reach, manipulation and use by the user, regardless of size, position or mobility.
These principles of accessibility, applied to products and services offered to the community, avoid discrimination of the population in a situation of disability and improve their conditions of use and quality of life.The principles of universal design seek, above all, to support the process of designing objects and environments, so they are inclusive, without drastic adaptations for use in different population groups (Rovira, 2003).Both the universal design principles and the standards of usability and accessibility proposed by the W3C, seek to support design processes in order to broaden their scope.
The basic heuristics of Nielsen Nielsen (1995) established ten basic guidelines for usability of a website to be well designed.
• Visibility of system status: system should always keep users informed of the different processes that they are executing during a certain time and in a reasonable way.
• Match between system and the real world: system should speak in the language of the user, not in the language of the system, using phrases, images and concepts that follow the conventions of the real world.
• User control and freedom: users will want to correct actions not expected by the system that they have generated, so the system must give a clearly marked emergency exit.
• Consistency and standards: the site must handle established conventions that facilitate the understanding of the contents to the users.
• Error prevention: as far as possible, any errors in the system must be prevented and any improper action by the user must be anticipated.
• Recognition rather than recall: options to carry out a process in the system should be at hand, the user should not remember processes or information.
• Aesthetic and minimalist design: dialogues should not contain information which is irrelevant or rarely used, as it would conflict with the relevant information.
• Help users: errors should be solved through a correct instruction that accurately reports to the user.
• Help and documentation: Although the site does not need to use extra documentation for its use, it is necessary to include textual assistance and additional documentation for non-experienced users requiring assistance.
• JAWS es un lector de pantalla automático que convierte a voz el contenido visible en pantalla y permite a los usuarios en situación de discapacidad acceder a contenidos de diferente tipo, ya sean aplicaciones, The heuristics of Nielsen (1995) have been a world reference in the design and diagnosis of errors in user interfaces, since they establish the bases for their development.They are guidelines that streamline the identification of errors in each execution area in all types of interfaces, but do not take into account the type of user that uses the interface (Becker, 2004), which clearly establishes a need for the guidelines to include persons with disabilities.Pérez (2008) used them to perform a manual evaluation of three websites targeting the elderly people and TAW CTIC (2011) for the automatic evaluation of the interfaces of each site.

Recommendations of Shneiderman and Plaisant
There are eight recommendations for the design of human-computer interaction.These recommendations are very useful when designing interfaces that are based on the specific requirements of the users (Shneiderman & Plaisant, 2005).
• Consistency: icons, colors, fonts and other design elements that are familiar to the user should be used, so as not to force them to learn new ones and so they can use some of their cognitive heritage already apprehended.
• Shortcuts: shortcuts should be used to perform certain tasks on the system.
• Informative feedback: user should know the status of the processes running the system, what is happening.
• Dialog: system should be communicating with the user, a "thank you" for a specific action that the user executes is an information message that will keep the communication open with the user.
• Error handling: users should be given simple ways to correct errors, step by step and effectively, as this will avoid frustration.
• Permit easy reversal: the user of the interface should be allowed to step back on the steps followed in a given task, which facilitates task completion and retention of information, as well as it frees the user from anxiety.
• Encourage the sense of control: the user should be given the expected management of the system and facilitate the interaction.
• Reduction of memory load: the design of the page should be as simple as possible and demonstrate a hierarchy of information, in a way that facilitates the retention of information by the user, and thus the speed and effectiveness of each task.The user should not have to memorize very long processes or extensive information.

Lineamientos de Conie y Nielsen (2002)
Son el primer grupo de recomendaciones para el diseño de lineamientos de usabilidad aceptadas a nivel mundial, se centran en seis áreas básicas de intervención: presen-Guidelines for the Gobierno en Linea Program (Carvajal and Saab, 2010) Proposed by the MinTIC of Colombia to establish the usability and accessibility design criteria for user interfaces and any content or information they contain, such as typography, contrasts, HTML code semantics and information architecture.They are a series of specific guidelines that take into account the technical aspects of website creation, such as HTML and CSS structure, among others, and seek to improve the design of sites.They are born from the technical standard Icontec 5854/2011 that establishes all the technical aspects for the creation of governmental web portals.These guidelines are based on the standards of WCAG 2.0 and work within the same categories established by them for the rating of web portals.
Among the proposals of the MinTIC for the improvement of web accessibility, it is ConverTIC (ConverTIC, s.f.), which seeks to expand, through two automatic tools JAWS and MAGIC, described below, the types of users in situations of disability, so they can access different content.
• JAWS is an automatic screen reader that turns into voice the content visible on the screen and allows disabled users to access content of different types, whether applications, text, images or video.It works locally on the computer of the user and allows to execute tasks using voice commands in the Windows operating system (Serrano, 2009).
• MAGIC is a typography amplifier software that allows the variation of contrasts and colors on the screen, in order to make them more noticeable.
Likewise, the MinTIC (2016) has launched an accessibility validation seal that guarantees the compliance of the items that offer web accessibility in the portals.Jiménez et al., (2009) establish that the heuristics and methods of evaluation of general usability and accessibility leave aside the own aspects that entail the users in terms of disability, such as the diminution of the visual, motor and cognitive capacities.We continue to describe some studies that have taken these disabilities into account and have established guidelines in the different areas that affect the elderly.

C. Heuristics for the evaluation of web usability and accessibility for the elderly people
The following describes some studies that have taken into account these disabilities and have established guidelines in the different areas that affect the elderly people.

National Institute on Aging guideline [NIA]
It is a heuristic proposed by the NIA ( 2002) of the United States with suggestions for the design of the different elements that compose a website that involves senior citizens, such as typographies, typographic score, contrasts and color combinations and semantic aspects, such as phrasing, navigation, writing and content compression.This checklist seeks to establish guidelines for the design of websites for the elderly people.

Holt guidelines (2000)
These guidelines are suggestions that cover four broad categories of disability: visual, intellectual, auditory and motor.It is one of the first existing guidelines for usability and accessibility design for the elderly people, however, according to Arch (2008), although the bases of these guidelines are not clear, big part of Holt discussion reflects the control points of the WCAG 1.0 initiative.

AgeLight guidelines (2001)
They focus on six basic aspects: design and style, color, text, general usability and testing, accessibility and disability, and user customization.This list was developed with the help of focus groups that helped to understand the behavior of users with disabilities within the user interface.Many aspects of these guidelines were captured in the WCAG 1.0 standards (Arch, 2008).

Conie and Nielsen guidelines (2002)
They are the first group of recommendations for the design of usability guidelines accepted worldwide, they focus on six basic areas of intervention: presentation of information and text; presentation of navigational elements and links; look for forms and results; presentation of articles for sale, forms and data entry; Web address; and home page.Like many other guidelines, they make general recommendations that help other groups of people aside from the elderly.
ARPP guidelines (Chisnell & Redish, 2005) In this study, an expert review of fifty sites belonging to different categories of services is performed and follow up on the tasks executed in the system by two contracted users.The authors propose customized guidelines to evaluate the sites, since they maintain that the aspects of the standards for usability and accessibility analysis are very general and, therefore, the customization for an efficient and correct evaluation is appropriate.tación de información y texto; presentación de elementos y enlaces de navegación; buscar formularios y resultados; presentación de artículos para la venta, formularios y entrada de datos; dirección web; y página principal.Al igual que muchos otros lineamientos, hacen recomendaciones generales que ayudan a otros grupos de personas fuera de las de la tercera edad.

SPRAY Foundation guidelines (1999)
They pretend to be a guide for the design and development of websites for the elderly people, they state that this population, like all other people, is attracted by aspects of connectivity, dynamism and interactivity of the pages, and all other benefits that ICT have as a means of communication and technological advancement.Like other guidelines, they focus on visual aspects, such as colors, contrasts, nuances and typographic fonts.
Zaphiris, Kurniawan and Ghiawadwala guidelines (2007) The authors review the literature about Human Computer Interaction [HCI] and propose 52 guidelines that are derived in eleven categories, called SilverWeb Guidelines, these are: design of destination (link); graphics; navigation; browser window features; content design; golf course; cognitive user design; use of color and background; text design; search engine; and comments and user support.
Webcredible guidelines (Dunn, 2006) These guidelines are the result of an investigation with two groups of users: young and old people, where it was found that the second group tended to assign the blame to itself when executing a task in an incorrect way within the interface, among other aspects proper of the age.These guidelines categorize: • investigate ways to indicate that a page does not end and requires movement; • avoid technical terms, if possible; • identify links in a coherent and obvious way; • assure that links attract attention; • change the color in visited links; • provide all content as HTML, where possible; • make the content as clear and concise as possible; • provide a link "make the writing bigger" and always use high contrast; and • provide explicit instructions, using the imperative forms of verbs.et al., (2006) develope a document for the evaluation of health web sites, according to European criteria, which adapt the guidelines established by the WCAG to the requirements of a health web portal.It contains hand-filled fields that focus the heuristic analysis on the semantic aspects of web sites.Due to it is a validated document for the analysis of websites, it turns out to be a guide in Spanish-speaking for the evaluation of health web sites.Clearly defined by use of weights, underlining or change in status / Links already visited must change its color / Definidos claramente mediante uso de pesos, subrayado o cambio en su estado / Links ya visitados deben cambiar de color.
Involucrar la tecnología en las necesidades de las personas de la tercera edad tiene beneficios que aún no se aprovechan al máximo, que van desde mejorar las relaciones con los pacientes de determinadas enfermedades y la comunicación de peticiones por parte de las personas de la tercera edad, hasta mejorar la calidad de los contenidos web sobre salud que un paciente puede llegar a consultar (Bodenheimer & Grumbach, 2003).
En general, no existe un acuerdo que plantee a nivel internacional recomendaciones claras para el diseño de contenido digital para población de la tercera edad.Asimis- Becker (2004) uses it in the analysis of 125 sites offering web content on health for the elderly people; Trabalón (2012), for the evaluation of 23 web pages with information on arterial hypertension; Calvo (2014), to evaluate 53 websites of hospitals in Spain that provide health services and are priority health points in his city; and Jiménez et al., (2009) for the analysis of the accessibility of 35 Spanish health websites.It is also used by Conesa, Aguinana and Hernández (2011), who evaluate the quality of some health web pages in Spain, perform a statistical analysis and conclude a low level of quality in information; and by Fernández (2016), who carried out a study on the quality of websites related to obstetrical and maternity health information, applying the questionnaire and analyzing what kind of information they posed.
These guidelines arise from very specific needs of the elderly population with disabilities that need to be covered in the usability design.In that regard, Jiménez et al., (2009, p. 347) suggest: ...for future research, in addition to accessibility, which encompasses technical requirements and the physical and cognitive conditions of old age, it is necessary to evaluate the adequacy of websites to the needs and expectations of older people, in addition to the quality of the provided information.
The multiple disabilities associated with the elderly show the need for specific guidelines that guide usability design to each type of disability, it is imperative that the usability design understands very well the standards required by each area and apply them.Tables 2, 3 and 4 present the main recommendations related to the listed guidelines.

VIII. Discussion and conclusions
The elderly people are digital immigrants, that is, they do not belong to the generation of technology, they were educated in a different way and therefore they learn, on these subjects, in a slower way than the digital natives, who were born in the technological age and are accustomed to direct links to extra information and watch more than 20.000 hours of television a year, among other excesses of information (Prensky, 2001).This results in the multiple difficulties that a person of the elderly can have at the moment of facing the digital interfaces and the knowledge and information received by these means, without taking into account the motor difficulties specific to this age.
It is important then the 'good design' in the digital interfaces, which according to Galitz (2007) can increase the productivity of users from 25% to 40% and impact on the eco-nomic aspects of companies.Among many other aspects, the author mentions it is necessary to know the needs of the users and to understand the objectives of the interfaces, so that the tasks of the users are not frustrating or tiring.
Websites are products that must explain themselves to the user, regardless of the type of site; should be able to facilitate the execution of tasks within themselves and not make the process frustrating (Garrett, 2011).Therefore, it is necessary to investigate the needs of the users and to design interfaces to their measure, that can be useful for the objectives that are wanted to create (Chisnell & Redish, 2005).
An important part of the process are the usability validation tools named, which allow to know the problems that the pages pose and that can be improved to favor a better interaction with its users, especially when it comes to accessibility issues.
Involving technology in the needs of the elderly people has benefits that are not yet fully exploited, ranging from improving relationships with patients to certain diseases and communicating requests by the elderly people, to improve the quality of health web content that a patient can consult (Bodenheimer & Grumbach, 2003).
All accessibility aspects and recommendations should not be considered only for people with sensory disabilities, but also for common users, people with cognitive impairments, for different platforms, for different uses (including education) and for foreign users (Abadía, 2012).These technologies are focused on solving communicative problems in different population groups, so their use should not be limited.
In general, there is no agreement at the international level that considers clear recommendations for the design of digital content for the elderly population.Likewise, in Colombia there are no specific guidelines for accessibility and usability for this population, although some laws and decrees emphasize the importance of considering them within the processes of digital creation.A contribution of the present work is to leave the doors open, for the proposal of guidelines according to the technological, contextual and social conditions of the country, that favor the access and consumption of digital contents by the elderly people.

Table 4 .
Comparative of recommendations according to guidelines / Recomendaciones de acuerdo con los lineamientos revisados