Steady: helping older adults avoid missed and double doses
Older adults take more prescription medicines than any other age group. Missing a dose or taking one twice can put them in the emergency room. Steady is an iPhone and Apple Watch app that keeps a person’s medicines and appointments in one schedule. Setup reads each pharmacy label and turns its directions into times the person confirms. After that, Steady checks before a dose is marked twice and adjusts reminders around appointments like a fasting blood test.
Context
My own product, for older adults and the family who help them
My role
Product designer and design technologist. I did the research, designed both apps and built the prototype
Built with
A working iPhone and Apple Watch prototype that run one shared scenario. Native SwiftUI apps come next
Status
Working prototype. Not tested with users and not released
This is the working prototype. The phone and the Watch share one state, so marking a dose or opening a screen on one updates the other. The numbered buttons step through the scenario.
Taking several medicines a day is easy to get wrong
Four in ten adults over 65 take five or more prescription medicines. Each one has its own schedule and its own rules about food.
That leads to two common mistakes. A dose gets missed when the day doesn’t follow its usual pattern. Or a dose gets taken twice because the person can’t remember if they already took it. With a blood thinner or a diabetes drug, either mistake can lead to a hospital visit.
Appointments cause a third problem. Before a fasting blood test, some morning tablets have to wait until after the draw and some don’t. Those instructions come from the doctor’s office, and medication reminders don’t account for them.
Reminder apps already exist. Apple’s Health app has had medication reminders, follow-up reminders and Critical Alerts since iOS 17. But it keeps medicines and appointments separate. It can share a medication list with family, but Apple’s documentation doesn’t describe any alert to family when a dose is late.
of adults 65 and over took five or more prescription drugs in 2017 to 2020, up from 33.3% in 2001 to 2004.
CDC, Health, United States, from the national health survey
of emergency room visits for harm from a medicine were adults 65 and over. 43.6% of them were admitted to the hospital.
Shehab et al., JAMA 2016, 58 US emergency departments, 2013 to 2014
of medicine mistakes reported to US poison centers in 2024 were a dose taken twice by accident, the most common mistake on the list.
National Poison Data System, 2024 report, 361,402 cases
of outpatients arrived properly prepared for a blood test. Only 39% knew what fasting meant.
Kackov et al., Biochemia Medica 2013, 150 adults
Taking medicines as prescribed also matters over time. A 2019 review of studies in older adults linked missed doses to more hospital stays, and linked taking medicines as prescribed to a 21% lower long-term risk of death.
What this evidence doesn’t show. The poison center figure covers all ages, and the blood test figure comes from one clinic in Croatia. Cost isn’t the main reason older adults skip doses: 3.4% of adults 65 and over didn’t take medicine as prescribed because of cost in 2021 to 2022. I left out the often-quoted claim that missed doses cause 125,000 US deaths a year, because I couldn’t verify it in the original source.
What the design had to work within
Most of these limit what the app can say about medicine and when it can interrupt someone.
It can’t give medical advice
The FDA treats apps that track medicines and send reminders the user sets up as low risk. An app that tells someone to change a dose is regulated differently. So every instruction in Steady comes from the prescriber, the pharmacy label or the lab, and says which. FDA guidance on device software, 2022, Appendix B
Reminders can be silenced
Time Sensitive notifications get through Focus modes, but the user can turn that off. Critical Alerts play even when the phone is muted, but Apple has to approve each app that sends them. Apple developer documentation on Time Sensitive and Critical Alerts
Apple Health already sends reminders
Rebuilding Health’s reminders would add nothing. Since iOS 26, other apps can read the medicines a person keeps in Health, so Steady imports that list. Health shares which medicines a person takes, not when, so Steady reads the times from each label. Apple, WWDC 2025, read access only
Reading with older eyes
Medicine names and instructions are 18px or larger on the phone, and the main buttons are 60px tall. Each time of day has its own color, so morning and evening doses are easy to tell apart.
Help from family, not monitoring
Family involvement can easily become monitoring. June decides what Kate is told and can see every message Kate gets. Kate can’t change anything.
Three decisions that shaped it
Each decision had a cost. It’s listed at the end of each card.
Read the label’s text, not its barcode
What I chose
Setup brings in the list from Apple Health, then the camera reads each pharmacy label’s printed text. Steady checks the drug name against the national drug list and turns the directions into times June confirms.
What else I considered
Scanning the barcode, which is faster. Or typing each medicine in, which is how most reminder apps start.
Why
Pharmacy labels have no standard barcode content, and some only hold the pharmacy’s prescription number. The printed text always has the drug, the strength and the directions. Typing long drug names on a phone is where mistakes start.
What I gave up
Speed. Reading text takes a moment longer and can misread in poor light, so every line goes in front of June before it’s saved.
One schedule for medicines and appointments
What I chose
Medicines and appointments share one schedule. When a lab asks for fasting, that morning’s reminders change to match, and the office’s instructions are shown word for word.
What else I considered
A reminder app alongside a calendar. That’s how most people manage today, and how Apple’s Health and Calendar apps work.
Why
The conflict only shows up when both are in one place. A metformin reminder at 8:00 AM is wrong on a fasting morning.
What I gave up
A longer setup. Someone has to enter the office’s instructions, and Steady can only apply what it’s given.
A check before a second dose
What I chose
The Watch and the phone show what was taken and when. Marking a dose that’s already marked asks for confirmation first, on both devices.
What else I considered
A Watch app that only sends reminders, with the history kept on the phone.
Why
Taking a dose twice is the most common medicine mistake reported to US poison centers. I designed for June wearing her watch with her phone in another room.
What I gave up
An extra tap when a second dose really was taken. Steady records it and shows the pharmacist’s number, but doesn’t tell June what to do.
June’s medicines and her two days
The prototype and every example on this page follow the same two days.
June takes seven medicines at five times a day. On Wednesday her evening blood thinner is late. On Thursday at 8:30 AM she has a fasting blood test her doctor ordered.
June Ito, 79. Lives alone in Sunnyvale. Wears an Apple Watch her daughter gave her and keeps her phone in the kitchen.
Kate Ito, her daughter. Lives in Oakland. Helped June set up Steady on October 3, one pill bottle at a time. Gets alerts about the blood thinner only.
| When | Tablets | On Thursday, the test day |
|---|---|---|
| 7:00 AM, on waking | Levothyroxine, for her thyroid, on an empty stomach | No change |
| 8:00 AM, breakfast | Metformin, Eliquis, lisinopril, metoprolol and vitamin D | Split in two. Eliquis, lisinopril and metoprolol at 7:45 AM with water. Metformin and vitamin D with breakfast once the test is done |
| 6:00 PM, dinner | Metformin | No change |
| 8:00 PM | Eliquis, her blood thinner, 12 hours after the morning dose | No change. If it’s an hour late, Kate is told |
| 9:30 PM, bedtime | Atorvastatin, for cholesterol. Four tablets left | No change, plus a reminder to order a refill |
Five moments from the prototype
Each example below is the working prototype, opened at that point in the scenario. You can tap through all of it.
Setting up from the pill bottles
Kate and June set Steady up together at the kitchen table. Three medicines come in from Apple Health. Then June holds each bottle up to the camera, and Steady reads the label.
Every line Steady read is shown next to the label photo before anything is saved. Clear directions become suggested times: “twice daily, about 12 hours apart” becomes 8:00 AM and 8:00 PM. Vague ones become a question, so “once daily” asks when.
Setup ends with the whole day on one screen, ready to show her pharmacist. The Watch fills in each medicine as it’s added.
Marking the morning dose
The five breakfast tablets share one reminder. June can mark all of them with one tap on the Watch, or one at a time on the phone.
If her doctor has told her to hold a tablet, she can skip it and give a reason. A skipped tablet is recorded, isn’t counted as late, and doesn’t alert Kate.
Checking whether a dose was already taken
At 11:20 AM, June isn’t sure she took her blood thinner. The Watch and the phone both show Eliquis taken at 8:12 AM, with the next dose at 8:00 PM. If she tries to mark it again, both devices ask her to confirm first.
If she did take a second one, Steady records it and shows her pharmacist’s number. It doesn’t tell her what to do.
A late dose and the message to Kate
The evening Eliquis is due at 8:00 PM. At 8:30 PM the Watch reminds June again. At 9:00 PM it still isn’t marked, so Kate gets one message with a button to call her mom.
June’s Watch shows the medication guide’s instruction for a missed dose. It also lets her say she took it at 8:00 PM and only forgot to mark it. In that case Kate is told the dose was taken on time.
Preparing for a fasting blood test
The night before, the Watch tells June when to stop eating. In the morning, the breakfast tablets are already split: three before she leaves, with water, and two with breakfast after the test.
The after-test tablets come due when June marks the test done, not at a set time, because she can’t know how long the lab will take. The phone also shows the office’s instructions word for word and what to bring.
What goes on the Watch and what goes on the phone
I assumed June wears her watch all day and leaves her phone in one place.
So the Watch handles anything that needs a quick answer: a dose is due, a dose was already taken, a dose is late, or it’s time to stop eating. Each Watch screen asks one question and has one main button.
The phone handles anything that needs reading, like setup, the plan for a test morning and what Kate is told. Both devices show the same screen at the same time, so June can switch between them without losing her place.
Reminders
Time Sensitive notifications, so reminders get through Focus modes. I’d request Critical Alerts for the blood thinner only.
The medicine list
Brought in from Apple Health where it exists, with permission for each medicine. Each label is then scanned for its directions, and nothing is typed unless the camera can’t read one.
The Watch
A standalone Watch app that keeps the day’s schedule on the watch, so it can answer whether a dose was taken even when the phone is out of range.
Kate’s message
Sent only when one of June’s rules is triggered. No other health information leaves June’s devices.
Ideas I considered and left out
Each of these came up while I was designing Steady. These are the reasons I left them out.
Scanning the barcode
Pharmacy labels have no standard barcode content, and some carry only the pharmacy’s prescription number. A barcode can’t be relied on to fill in the medicine or the directions.
Typing each medicine in
Long drug names on a small keyboard are easy to get wrong. Typing stays as a fallback for the rare label the camera can’t read.
A caregiver dashboard with every dose
If Kate sees every vitamin, help becomes monitoring, and June has less reason to keep marking doses. June chooses what Kate hears about instead.
Photographing each tablet
A photo before every dose adds a step each time and fails in poor light. One tap to mark, with a check before a second dose, does the same job faster.
A connected pill dispenser
A dispenser can confirm a dose physically, but it costs money, needs setting up and refilling, and only works at home. Steady works with the bottles June already has.
Counting a dismissed reminder as taken
Steady only records a dose when June marks it. The check before a second dose depends on an accurate record, so it never assumes.
Streaks and rewards
A streak rewards an unbroken run, so one missed dose can feel like failure. The seven-day view shows a plain record instead.
Alerting emergency services
A late dose isn’t an emergency on its own. Alerts stop at the one family member June chose, who can call her.
AI answers about missed doses
Telling someone what to do about a missed dose is medical advice. Steady shows the medication guide’s own instruction and the pharmacist’s number.
What success would mean: fewer missed doses and no double doses
There are no results yet. Steady hasn’t been released or tested with users, so these are the targets I would measure it against.
What exists now is the working prototype. Both devices run the full two-day scenario, so every reminder, check and message can be tried.
| What is measured | Target | Why this number | If it’s missed |
|---|---|---|---|
| Labels read correctly on the first scan | 9 in 10 | Each correction slows setup down, and a misread June doesn’t catch becomes a wrong reminder. | Find which labels fail, like curved vials or small print, and add guidance for those. |
| Doses marked within an hour of their time | 9 in 10 | One hour is also when Kate is told, so both measures use the same definition of late. | Find which times of day run late, and move those reminders to fit June’s routine. |
| Second doses stopped by the check, compared with second doses recorded | More stopped than recorded | The check is meant to prevent double doses, not just record them. | The check is coming too late. Show the last dose time on the watch face. |
| Blood tests repeated because of preparation | Zero | The test morning plan exists to prevent this. A repeated test means another morning of fasting and another needle. | Show the lab’s instructions again the evening before, word for word. |
| Alerts to Kate when June had taken the dose but not marked it | Fewer than 1 in 5 | If Kate gets too many false alerts, she’ll start ignoring them. The option to say “I took it at 8:00 PM” exists for this. | Wait longer before telling Kate, or remind June once more on the Watch first. |
| People still marking doses after 90 days | 70% | Early use doesn’t say much. Three months shows whether marking doses has become routine. | Ask people who stopped what changed in the week before. |
The 9 in 10, 1 in 5 and 70% figures are my own starting points. I’d adjust them once there’s real data.
What I would test first
Whether people in their late seventies will mark doses consistently. Everything in Steady depends on that tap, and a dose taken but not marked sends a false alert to a family member. Before building anything else, I would give the Watch app to five people for two weeks and count how often that happens.
More case studies
Three more case studies about stopping a mistake before it happens.