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While guidelines for designing websites and iTV applications for older adults exist, no previous work has suggested how to best design TV user interfaces (UIs) that are accessible to older adults. Building upon pertinent guidelines from related areas, this paper presents thirteen recommendations for designing UIs for TV applications for older adults. These recommendations are the result of iterative design, testing, and development of a TV-based health system for older adults that aims to provide a holistic solution to improve quality of life for older adults with chronic conditions by fostering their autonomy and reducing hospitalization costs. The authors' work and experience shows that widely known UI design guidelines unsurprisingly apply to the design of TV-based applications for older adults, but acquire a crucial importance in this context.