Drawing Ageing: Using Participant-Generated Drawing to Explore Older Australians Expectations and Experiences of Ageing in a Retirement Village

Abstract

This article discusses the use of an arts-based visual methodology, drawing, to explore older people’s experiences and expectations of ageing in a retirement village. Tactile, generative, and visual, drawing is a quick, inexpensive, and extremely participatory process, which, compared to traditional text-based data, provides rare and compelling insight into conscious and unconscious feelings, emotions, sentiments, and experiences. As part of a broader project exploring life in retirement villages, 12 older adults in their 70s and 80s were asked to sketch their experiences of ageing, as well as their expectations and experiences of retirement village life. Sketches were analysed using reflexive thematic analysis, which revealed that participants drew ageing as both a time for opportunity and enjoyment and decline, while retirement village life very much met their expectations in terms of being a place of fun, friendship, and leisure. While drawing as a method is rarely used in gerontological research, the outcomes of this project demonstrate how it enables the powerful production of evocative, interactive, and memorable imagery, and it should be a greater part of the methodological toolbox.

1. Introduction

As art enables the creative expression of thoughts, emotions, and experiences not easily expressed in words, a growing number of researchers are engaging with arts-based research methods. Arts-based research is a methodological approach that applies creative artistic processes, from performance (music, dance, drama) to literature (creative writing, poetry) and visual arts (photography, drawing, art) to any phases of the research process, from data collection, analysis, interpretation, to representation (Leavy 2020). Regardless of the specific form and approach taken, arts-based research engages our senses, evokes emotional responses, and promotes dialogue to connect “us with these who are similar and dissimilar, open up new ways of seeing and experiencing, and illuminate that which often remains in darkness” (p. ix, Leavy 2020). Arts-based research methods, therefore, promise fresh insight in exploring, understanding, and revealing often elusive psychosocial feelings, experiences, and meanings (see, for example, Bennett et al. 2019).

1.1. “Draw-and-Write”: The Participatory Visual Research Method of Drawing

This paper focuses on one arts-based research method: drawing. Tactile, generative, and visual, this participatory visual research method acts “as a nonverbal stepping-stone into the world of experiences and emotions” (np, Søndergaard and Reventlow 2019), enabling reflection and communication. Although all participatory visual research methods request that research participants develop something visual (drawings, artwork, photographs, collages, videos) about the research topic under investigation, what distinguishes drawing from other visual approaches is how quick, inexpensive, and extremely participatory, communicative, and impactful it is. As Mitchell et al. (2011) explain, drawings uniquely access the inner world of memories, thoughts, and feelings, the “conscious and unconscious issues and experiences” to make “parts of the self… visible” (p. 19).

There is no one prescriptive approach for how to integrate drawing into research projects. In the popular “draw-and-write technique”, participants are provided with paper and a selection of pens and then prompted to perform a drawing activity and write a written description (Angell et al. 2014; Backett-Milburn and McKie 1999). This drawing activity is usually done in conjunction with other qualitative data collection approaches (interview, focus group, workshop), with Mitchell et al. (2011) recommending five key processes: a reassuring invitation to draw (emphasising that the process is not about artistic talent or perfection), a choice of drawing tools (offering a selection of coloured pencils and thick marker pens), a leisurely pace (giving participants the time and space to think and draw quietly and independently), a shared analysis (encouraging participants to make and record the meaning of their drawings by writing descriptions, with the process of analysing drawings a collective, consensus discussion) and, finally, sharing the outcomes via civic dissemination.

1.2. Drawing Illness Beliefs, Behaviours, and Outcomes

Drawing is frequently used in research projects with children (Søndergaard and Reventlow 2019), and in health projects with adults (Cheung et al. 2016), where it is often used to better understand and communicate the experience of illness, and illness beliefs, behaviours, and outcomes (Cheung et al. 2016; Murray and Williams 2020). Medical researchers, for example, have asked patients to draw their illness experience with, for example, lupis (Nowicka-Sauer 2007), spinal cord injury (Cross et al. 2006), the experience of being in intensive care unit (Ewens et al. 2017), and heart disease (Broadbent et al. 2004). In fact, the heart drawing project found that how patients drew their hearts was associated with psychological and clinical indicators of health status, and predicted time taken to return to work better than any clinical indicator.

Drawing, therefore, provides clinicians with a different way to assess patients’ ideas and beliefs and subsequent prognosis, and an opportunity to discuss and counter any negative beliefs. For individual patients, drawing their illness provides a different approach for pausing, communicating, and reflecting on personal thoughts, beliefs, and emotions, as well as any fears or misgivings, which may in turn lead to increased health literacy and more active involvement in illness management/self-care (Cheung et al. 2016).

1.3. Drawing Ageing

To date, the drawing method has not been used to investigate how older adults envision and experience ageing. This is a surprising omission, given rapid population ageing: older adults now out-number children and the public discourse on ageing has generally shifted, from viewing old age as an inevitable time of decline, ill health, and dependency to one of activity, participation, and productivity. Indeed, to focus attention on this demographic transition and the need for age-friendly environments, combatting ageism, integrated and long-term care, the United Nations labelled 2021 to 2030 the Decade of Healthy Ageing (World Health Organization 2020).

As creative-arts methods have much to offer in uncovering beliefs, challenging stereotypes, and engaging the public in a reflexive conversation about the experience of old age and ageing, researchers increasingly use visual methods (such as photography and photovoice) with older people to document reflections on health, the experience of aged care, the experience of caregiving, and perceptions of respect and social inclusion in cities (see King and Miller 2021; Miller 2021; Miller and Zelenko 2022; Ronzi et al. 2016). However, aside from two notable exceptions, drawing has rarely been used with older people. Mitchell and Nørgaard (2011) asked older people to complete cartoon storyboards in response to provocative futuristic design concepts and, more recently, Brookfield et al. (2020) asked older adults to work with design students to co-create their vision of age-friendly urban design by drawing the features in their neighbourhood they liked and disliked.

At this juncture, it is also important to note that while drawing is a core part of many design, art, and architecture professions that use manual or digital drawings to envision, plan, develop, record, and reflect, in a research context, the artistic merit and quality of the work produced is not critical. Instead, the focus is on how participants drawings might differently communicate ideas, experiences, thoughts, aspirations, memories, emotions, and hidden prejudices associated with the specific concept under investigation (Bowden et al. 2015; Mitchell et al. 2011).

The current study applied the “draw and tell” technique with older adults living in a unique context: in a retirement village1, an amenity-rich community designed especially for older people. In Australia, 184,000 older people currently live in retirement villages, rates, which are estimated to double by 2025 to 382,000—7.5% of those aged 65 years or older (Grant Thornton 2014). As well as the appeal of being co-located within range of recreational leisure (e.g., swimming pools, tennis courts, bowling greens, community halls, gardens) and health (e.g., aged care) facilities, the primary driver for relocating to a retirement village are the many opportunities for social interactions, connections, and a sense of community (Miller and Buys 2007). Indeed, while some older people move into a retirement village community to proactively ‘future-proof’ against impeding age-related health declines, recent research in both Australia and the United Kingdom concluded that the majority moved to “facilitate “active living” as they aged” (p. 977, Carr and Fang 2022).

The aims of this study were threefold. Firstly, to explore the acceptability of the participatory “draw and tell” technique with older people, documenting their experience and the communitive impact of their drawings. Secondly, to identify the type of images older people have in their head and draw to document their experience of ageing. Finally, as growing numbers of older people are considering moving into retirement villages, current residents were asked to draw both their expectations and experiences of retirement village life.

2. Method

2.1. Participants

The 12 participants resided in one retirement village, located in outer suburban Brisbane, Australia. The 5 males and 8 females were white Australians, ranging in age from 76 to 86 years, and had resided in the retirement village for less than two years. Buying one of the 290 low-to medium density apartment in this retirement village ranged from approximately A$118,000 (studio) to A$690,000 (3 bedroom apartments), which is the average price for housing in that area, along with a ~$100–$140/week services fee. Residents have access to communal village facilities, including a swimming pool and spa, library, indoor bowling green, gym, gardens, workshop, and village bus. Participants responded to an advertisement from the village management to participate in a university research project exploring their experiences and expectations of ageing in a retirement village, part of a larger research project using photography and research poetry (creating poems from interview data) to explore and document the aged care experience (see Miller 2021). The project received ethical approval from the university (QUT1400000409), with all participants provided with project information sheets and completing consent forms, where they indicated their chosen research pseudonym (first name, full name, or another preferred name).

2.2. Materials and Procedure

Participants took part in a one in-person group session in the meeting room at their retirement village. The 90-min session was lead facilitated by the author and ended with a morning tea as a thank you for participating. All participants provided written informed consent prior to the session, completed a brief socio-demographic questionnaire recording gender, age, and duration of time in this retirement village. The ‘draw and write’ activity was presented as a stapled print handout, with a separate page for each “draw and write” prompt.

Participants were provided with ballpoint pens and were reassured that artistic ability was not important, the focus was on capturing and conveying their views visually. The printed instructions in the booklet further noted that “there is no right or wrong way to draw” and to “enjoy the drawing process”. Participants completed 3 separate “draw and write” questions, each on a separate page: (1) please draw/sketch your experience of ageing; (2) please draw/sketch your expectations of retirement village living (i.e., what you thought it would be like); and (3) finally, please draw/sketch your experience of retirement village living (i.e., what it is like for you living here). To encouraging participants to describe their sketch in writing, each page had two headings at the bottom of title and label/description. Following Mitchell et al. (2011), there was no time limit on the drawing activity. The research team stayed in the room, reassuring participants that everyone can draw and the focus was not on artistic ability but on communicating their ideas. Given age, energy levels and arthritic fingers, not all participants were able to draw answers for all questions. When everyone had drawn all they could, there was an enthusiastic group sharing and discussion of the images. As drawings can be interpreted subjectively in different ways, the research team clarified the meanings of drawings and took field notes to record detailed descriptions. Notably, while participants were engaged in the sharing, discussion and co-construction of image meanings, the timeframe of this analysis meant that participants were not engaged in the thematic analysis process outlined below.

2.3. Analysis

The analysis of visuals can take many different forms from a focus on their content, composition and/or representation, with their diverse and subjective nature making all-inclusive categorisations challenging. Here, following Braun and Clarke’s (2021) six-phase approach, an inductive reflexive thematic analysis of participants’ sketches focussed on the visual content (including the written explanations provided) was conducted by the author: a middle-aged white female with a background in psychology/design, and extensive expertise in qualitative and creative arts-based research in aged care. She designed and led the workshop, discussing the emerging analysis coding and concepts with colleagues.

The first phase of Braun and Clarke’s (2021) six-phase approach is familiarisation, with the researcher immersing herself in the visual data, becoming deeply familiar with each sketch and associated interview data and fieldnotes, critically reflecting on what was and was not depicted. At this stage, as Braun and Clarke explain, asking questions, such as how ‘common-sense’ or ‘socially normative’ the story is, and how it fits within your understanding of the world (as both a person and a researcher) is a key part of the analysis process.

Phases 2, 3 and 4, respectively, focus on coding, generating initial themes, and developing and reviewing themes, with a theme capturing “the patterning of meaning across the dataset” (p. 76, Braun and Clarke 2021). Here, the researcher critically interrogates the data, making decisions about whether themes are coherent and meaningful as they develop a rich, contextualised, compelling, and coherent narrative. For example, in developing and refining the themes below, for a time, the researcher considered having a separate theme on generativity (which is the concern and care individuals feel for the next generation), but finally decided to integrate it into an overall theme of engagement. As well as critically examining the ideas and images drawn, there was also a purposeful focus on reflecting on and identifying anything that was conspicuous by their absence: experiences or expectations that participants might have not drawn. Phase 5 focuses on refining, defining, and naming themes, while Phase 6 is the write up, with participants identified by their own chosen pseudonym.

3. Results

These results provide novel insight into the meaning and public consciousness associated with ageing, and the experience of daily life in a retirement village. There is an incredible consistency in the images: ageing is a time for family, leisure, and fun, and relocating to a retirement village has enabled that. An inductive reflexive thematic analysis of participants’ sketches generated three key themes: “ageing as a time of opportunity and joy”; “ageing as a time of decline”; and “fun, friendship and leisure—retirement village life meets expectations”. Each theme is presented, and discussed, below, supported by drawings.

3.1. Theme 1: Ageing—A Time of Opportunity and Joy

The first theme captures the fact that, for all these participants, their experiences of ageing were centred on ageing as a time of opportunity and joy. The dominant view was that ageing enabled them to spend time with family and friends, to engage in valued leisure activities, and it was up to them to make the most of this time and purposely create moments and memories that mattered. As one participant wrote, they had a “full life”. This is clearly visually demonstrated in Figure 1, with the top image drawn by 76-year-old Barry.

Titling his sketch “memories”, Barry explained that retirement was his time to enjoy engaging in leisure and sport, and spending time with his family, especially his grandchildren. Barry’s sketch powerfully communicates the love he has for this special time in life, showing a large smile on his face as he creates and remembers special moments and memories. Family was frequently present in sketches, as we see in the bottom image where A shows the joy and pride they experience in observing and participating in the lives of their children and grandchildren. Others were enjoying having their husbands more actively involved in day-to-day activities, with 78-year-old Sunrise sketching her joy at sleeping in until 9 am, and then having her husband cook her bacon and eggs for breakfast—while she has her feet up, as we see in the bottom image in Figure 1.

Jill’s experience of ageing was very similar, as we see in Figure 2. Naming her sketch “Enjoying my 19 grandchildren”, Jill’s sketch showed more fun, less drudgery, as she did less housework and purposefully created more time for the things she enjoyed in life: more time for reading, hobbies, and leisure activities (table-tennis, music), more time for enjoying her 19 grandchildren, and, simply, more time for “togetherness” with friends and family. Jill did not negate some of the negative health challenges of her ageing experience, drawing a picture of her ‘creaking joints’ which made getting out of bed each morning harder and her need for hearing aids—but her drawing focussed on the more positive moments and enjoying the gift of time.

3.2. Theme 2: Ageing—A Time of Decline and Slowing Down

While family and fun were very clear priorities, evident in all sketches, there was also an acknowledgment of the harder aspects of ageing, which was associated with decline and ‘slowing down’. Figure 3 shows participant’s experience of ageing: of tiredness, a decline in energy and general slowing down. In the first image, 86-year-old Ron drew a stick figure lying on a bed, dozing, while Colin drew a downward arrow (indicting decline) with the comment: “where has my energy gone?”.

Declining levels of energy and physical health had not yet impeded participants active enjoyment of daily life, as we see in the bottom sketch in Figure 3. Here, Anne draws how she enjoys her grandchildren, coffee with friends and travelling, but is also finding that she is simply slower these days, especially in terms of walking. When looking critically at these images, it is interesting to note the general omission of significant ill-health, disability, and diseases; the absence of such perhaps reflects participants, who were aged in their 70s to 80s, relatively good physical and mental health.

The middle left image in Figure 3, from 84-year-old Loretta shows her decline, from running to walking and then death. The sketch on the middle right is from 86-year-old Jane, who likes to do the exercises at the gym and walk around the retirement village every evening but is finding it harder to “get muscles moving”.

3.3. Theme 3: Fun, Friendship, and Leisure—Retirement Village Life Meets Expectations

This third and final theme shows how residents experience of retirement village life met expectations, of living an active, fun-filled lifestyle, making friends, and engaging in enjoyable leisure activities with fellow residents and family. The drawings in Figure 4 and Figure 5 illustrate how retirement village life emphasised fun, compared to the mundane activities of daily life when they resided in their own home in the community. Jill’s sketch in Figure 4, for example, shows how she used to have stairs to climb and many years of household chores (mowing lawn, picking up her dog’s poo). She moved into the retirement village a year ago, when her dog died. While she mourned the loss of her dog, her expectations of retirement life—and what motivated her to relocate—was that day-to-day life would be easier and she would make friends, depicted by her sketches of “beautiful sunsets and tipples (drinks) in the twilight”.

Pa Lou, 78 years old, sketched himself surrounded by grandchildren and village friends (“friendship, companionship and fellowship”), while A’s sketch is of ‘living it up’, as depicted by holding balloons in one hand and a bottle of wine in the other. Barry’s sketch, which he entitled ‘Growing Old Gracefully’ shows how he expected to be enjoying walks together, on walkers, with his wife. Positivity and happiness exude from this sketch, as they walk together, aided by walkers, with large smiles on their faces. Sunrise’s sketch was of retirement living life to be “heaven”, as she sketched images of angels with the tagline: “time to relax and do whatever I wanted to”.

Fortunately for these residents, their experience of retirement life met their positive expectations, as Figure 6 and Figure 7 show. Figure 6 illustrates how Jill was very much enjoying her retirement village lifestyle, enjoying the many social activities on offer (for example, happy hour and regular dinning events), which provided rich opportunities for social interactions and the development of friendships.

The bottom left image in Figure 7 below shows how Sunrise was enjoying her ‘home among the gumtrees’, with other residents greatly appreciating the company of their loved ones, village friends and how easy living in the village made traveling. Barry’s sketch “Fun and Freedom” sketch shows him interacting happily with his wife, and how he enjoys many informal social interactions with fellow residents. In his sketch (top left), he has depicted himself with a chef’s hat, happily cooking a barbeque for village neighbours on the balcony of his retirement village unit. His speech bubble reads “Come and get it, ha ha”, and in his verbal explanation of the sketch, Barry explained that he was happily learning to cook in retirement and enjoying hosting fellow residents at his new home.

While this sketch, and in fact all Barry’s sketches, are extremely positive, part of the reason Barry and his wife had moved into a retirement village was that she was living with advanced dementia and Barry was her primary carer. Illness and death were also acknowledged in Tony’s sketch, which alongside praising retirement village life for making travel easy, also depicts an image of a grave and the letters RIP (rest in peace). As Tony explained to the group, they were well aware that death was at the end of the road for them, hopefully in the distant future, and their aim was to enjoy life as much as possible before then. The bottom right image in Figure 7 is from Barry’s wife Pat, showing her being dressed with her husband’s help2.

4. Discussion

This is the first study to explore older people’s experiences and expectations of ageing and daily life in a retirement village through the medium of drawing. The findings are powerfully engaging, with residents’ sketches providing uniquely emotive insight into what matters most in their lives as they age. From learning to cook for all their new friends in the retirement community to enjoying ‘a tipple in the twilight’, the sketches drawn by retirement village residents illustrate how developing friendships, and enjoying fun social activities and interactions were critical components of their vison of ageing well. There was, of course, an acknowledgment of the challenges of ageing (ill-health and declining energy), but overall, the drawings have an optimistic and enthusiastic tone.

Firstly, in terms of the research aims, there is no doubt that the ‘draw and tell’ approach is appropriate for use with an older population. Compared to more conventional research approaches, such as interviews, surveys, and focus groups, deploying the novel visual methodology of drawing enabled a diverse and engaging array of images. Aged in their 70s and 80s, these older adults, actively participated in and very much enjoyed the drawing activity. However, like many people, they were initially uncomfortable and unfamiliar with using the visual language of sketching for generating, developing, and communicating ideas. To that end, a continual reassuring reminder that this is not about artistic talent or perfection, but about communicating ideas helps (see also, Mitchell et al. 2011). As some of these older participants struggled to draw, the drawing method could be made more inclusive by supplementing the task with collage or image selection.

While drawing enables a unique expression of the self, the analysis of these visuals can often be challenging due to the “the richness of images” and “their amenability to interpretation” (p. 3, Mitchell et al. 2011). Future work could more explicitly code the content or style of the visual artifacts; integrate drawing into workshop activities; explore the value of building visual literacy by explicitly providing drawing training to participants; actively recruit and compare the perceptions of different groups (younger, older, people with dementia, those who are unable to speak etc.); and use this method with older people living in residential aged care to capture their experience, as well as the views of family and staff.

While the research instructions here explicitly reminded participants that artistic ability was not the focus, some observers might critique the visual quality of drawings and note that all are accompanied by textural interpretations, which enables meaning. In fact, it is common for research participants to label their drawings to aid in interpretation (see drawing examples from teachers in Beltman et al. 2015), and in some studies, researchers have explicitly instructed participants to label their drawings by providing empty speech bubbles (see Soulard et al. 2021). Drawing enables participants the opportunity to think deeply and differently about issues and to communicate personal experiences and expectations in a provocative and engaging manner that informs, educates, and elicits meaningful conversations.

Researchers interested in experimenting with visual methods, such as drawing, should intentionally reflect on such decisions regarding the task focus, and the specific data-collection and image generation process. Here, a practical and low-threshold approach was adopted: during a 90-min workshop, participants were provided with paper and a biro, and instructed to draw and annotate, via a caption. While providing coloured markers, detailed instructions about image-making or different prompts for participants to respond to may have generated different drawings, the diversity of insightful drawings developed in this project are evidence of the impact. Future iterations of this task could also consider tweaking the wording of the instructions; these participants were to sketch their expectations and experiences of ageing and retirement village living, with the resulting images overwhelmingly positive. While this may reflect the characteristics of this active, engaged and relatively healthy sample, we may have seen different images if they had been instructed to draw their fears about ageing, their experience of illness, or what an old man or old woman looks like, for example. As relatively little gerontological work to date has engaged with visual methods (see Miller 2021 for a notable exception), and there has been no research using drawing as a method with older people, this research has demonstrated the value of this visual method in this context.

Secondly, the images provided insight into both the experience of ageing and expectations and experiences of retirement village living. Consistent with existing research (e.g., Carr and Fang 2022; Miller and Buys 2007), retirement village residents greatly enjoyed the opportunity for “active living” afforded by their housing choice. Their drawings were full of people ‘doing’ things together, whether it was going for walks or enjoying barbeques together, the drawings showed residents placed great value on social connections and interactions. What was also interesting to note is what was missing in the images; the experience of ageing for these participants was about freedom, with significant ill-health rarely depicted, although there were some images showing a general decline in energy.

Future iterations of “draw and write” could explore how people of different ages view ageing and explore if there are differing perspectives on ‘ageing in place’ in the community versus in a retirement village or aged care (nursing home).

Additionally, at a very practical level, variations of this task might also enhance the transition to retirement living; as part of the orientation process, management could perhaps ask new residents to draw their hopes, dreams, expectations, fears and/or goals (individually or collectively) in commencing this new stage of life and then respond to this information. Indeed, in Taiwan, Liaw et al. (2022) recently applied the ‘draw and talk’ technique to engage post-graduate students with issues of ageing and disability. They instructed students to draw their envisioned “home” and “life as older adults”—and then asking them to reflect on if their home would be liveable if they were old or had a disability. Integrating drawing into teaching activities like this is a powerfully novel, low-cost, and impactful mechanism for uncovering, reflecting on and challenging any hidden prejudices, which may in turn improve knowledge, empathy, and clinical practice.

In closing, it is timely to remember what Elliot Eisner (1995, p. 1) argued, nearly three decades ago now: the power of images is that they provide an ‘all-at-once-ness’ that is harder to grasp through language or numbers. It is this ‘all-at-once-ness’ that makes these simple sketches so impactful. Narratives that might have been silenced, ignored or over-looked are privileged in this visual form, which is more memorable, more creative, more provocative, and more accessible than more traditional forms of academic research and discourse.

From Pat’s sketch of being helped to get dressed by her husband (who is also her informal carer), the image of Barry and his wife walking, together, while balancing on walkers, 86-year-old Ron’s stick figure showing him resting on his bed, to Sunrise’s amusing sketch of ‘being in heaven’ and resting while her husband cooks breakfast, these drawings engage and convey the experience of ageing in a retirement village with humour and compelling simplicity. As the ‘draw and write’ technique is impactful, inexpensive, and under-utilised in gerontological research, my challenge to readers is simple: experiment with a version in your next research project with older adults and see if and how drawing as method might foster engagement, creativity, and discovery.