The elderly are prone to various chronic diseases and have low adherence to medication. With the development of information technology, breakthrough has been made in solving the problem of the medication compliance of the elderly. From the perspective of design, the concept of service design and the thinking of system co-creation were used to explore the interface, structure and service scene of smart medicine boxes for the elderly, so as to innovate in the smart medicine boxes. Through questionnaire survey, unstructured interview, user journey chart and analytic hierarchy process, the elderly users' medication demand was comprehensively analyzed. Service design methods such as service system diagram and service blueprint were used to sort out the service process of smart medicine boxes for the elderly. The human-computer interaction and system design of smart medicine boxes are the pain points and main needs of this kind of product. The simplification of medicine taking process and wearable design occupy the highest weight and are the main service contents. The foreground and background process of the new smart medicine box system is reconstructed, and design practices on the display form, functional structure and interface background of new smart medicine boxes are conducted to provide new ideas for design of smart medicine boxes for the elderly.