Creative Arts-Based Research in Aged Care
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Creative Arts-Based Research in Aged Care

Photovoice, Photography, and Poetry in Action

Evonne Miller

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eBook - ePub

Creative Arts-Based Research in Aged Care

Photovoice, Photography, and Poetry in Action

Evonne Miller

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About This Book

This timely book explores what it is like to live in an aged care home: the expectations that new residents and their families enter with, their relationships with fellow residents and formal caregivers, and how they approach, in different ways, the reality that this place is where they will die.

Creative Arts-Based Research in Aged Care draws on an immersive semi-longitudinal four-year study and purposely privileges the voices and perspective of older residents. Using creative arts-based qualitative research methods, specifically participatory photography and research poetry, it demonstrates the experience of contemporary aged care from the perspective of those who matter most: older residents. Divided into three parts covering entering residential aged care, daily life in aged care and dying in aged care, the book stimulates debate and discussion about current practice, and the future of aged care in the context of rapid population ageing and care automation.

It is essential reading for all scholars and students working in the fields of gerontology, social work, psychology, design, and nursing, particularly those tasked with redesigning aged care in the twenty-first century.

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Information

Publisher
Routledge
Year
2021
ISBN
9781000374001
Subtopic
Gerontology
Edition
1

1
Why we must talk about residential aged care

Outside
I don’t know many outside any more –
I don’t know many.
I have outlived them.
I just look forward.
I just look forward to being alive tomorrow.
I think, “Well, I do what I can”.
I can still crochet,
I can still move my hands.
I read the paper.
I have to relax.
I am used to dealing with things myself.
I get them to put the bottom sheet on,
but I do the rest.
Another pair of hands is always a big help.
Don’t worry about going into aged care.
Don’t worry.
It’s like boarding school,
it’s like a second childhood:
you have got to put yourself in their hands.
Pearl, 90 years
This poem was created from an interview with 90-year-old Pearl,1 in a process known as research poetry where poem-like prose is created from interview transcripts. Pearl, a keen letter writer who is going deaf, is a kind, gentle and creative woman who tries hard to adopt a positive outlook on life. As the poem reveals, Pearl tries to do as much as she can herself but needs help from the staff – as she explains, she is “in their hands”.
Pearl and I met in her small but beautifully furnished single room in a Brisbane aged care residence. I was there to interview her and her fellow residents about their expectations and experiences of moving into, living in and then eventually dying in aged care. Pearl and I bonded almost immediately, as I sat perched on a corner of her bed, and we discovered a shared love for the popular and long-running soap opera The Bold and the Beautiful. After a brief conversation about what Brooke and Ridge were up to that week and her shared interest in Stephanie’s antics, we turned to the reason for my visit: a research project.
Would she, I wondered, be interested and willing to participate in this unusual and evolving research project? It would mean taking photographs about highlights and lowlights of her daily life in a care home, in addition to being interviewed every few months for the next year or so. Pearl consented and was one of the first participants in a qualitative research project that would run for nearly four years, culminating in a large-scale public exhibition of residents’ photographs and poems, Living in Aged Care: A Photographic Exhibition of Laughter, Loss and Leisure, in 2017 at the State Library of Queensland. Figure 1.1, an exhibition advertisement, shows Pearl seated in her cosy bedroom, close to her beloved writing desk, surrounded by her cherished possessions.
Figure 1.1 Pearl, beside her writing desk, on the exhibition flyer
Figure 1.1 Pearl, beside her writing desk, on the exhibition flyer
In this book, I use arts-based research to reflect on and share the tales of Pearl and her fellow residents, living the last few days, months and years of their life in one ordinary, outer-suburban aged care home located in Brisbane, Australia. In doing so, I shine some light on a seldom discussed, unfamiliar and often-feared experience: entering, living in and dying in aged care residences.

Preparing for population ageing: by reframing ageing

Before discussing why aged care residences is such a taboo subject in our society, I will review contemporary sociocultural narratives of ageing to show how they influence the ways older people view ageing, the possibility of entering (and dying) in aged care.
Most of us are familiar with the statistics. Our population is ageing rapidly. Ageing, French philosopher and feminist Simone de Beauvoir reminds us, is a natural process, “an unavoidable and irreversible phenomenon” (1970, p. 42). In 2020, however, for the first time in human history, older people outnumber children. The United Nations predicts that the number of older persons (defined as 60 years and older) will double by 2050 to 2.1 billion and triple by 2100 to 3.1 billion (United Nations, 2017).
The magnitude of this change is perhaps best illustrated by the growth in the number of congratulatory birthday cards that Queen Elizabeth II sends each year to Commonwealth citizens who reach 100 years of age. In 2020, approximately 2500 Australians turned 100 years. By 2050, that number will grow to nearly 20,000. The number of centenarians in the United Kingdom has increased 350% in the last 30 years, with over 14,000 Britons currently aged 100 years and older. As the number of centenarians expecting a birthday card has rapidly grown, the Queen’s birthday card team has expanded – from one person to a team of 7!
As the large Baby Boomer generation (born 1946–1965) approaches retirement age, policymakers and practitioners are increasingly focused on how best to improve their health and well-being. While expectations and personal experiences of ageing vary significantly, depending on people’s specific individual, sociocultural, historical, geographic and political-economic context,2 the public sociocultural discourse on ageing has shifted dramatically – from an inevitable time of decline, decay and dependency to one of activity, productivity and participation. This change is perhaps best epitomized in the World Health Organization’s well-known dictum ‘years have been added to life; now we must add life to years’.
Contemporary public policy frameworks, which include “successful ageing”, “active ageing”, “healthy ageing”, “positive ageing” or “productive aging”, all emphasize how individuals can take control of and enhance their own ageing experience by staying physically and cognitively active, productive and socially connected. These approaches, which emerged partly to counter ageism and the dominant narrative of old age as a time of decline, mean that the ‘young-old’ (in their 60s to 80s) now expect to enjoy a third age of extended post-retirement years leading independent, healthy, active and productive lives, joining the ranks of the celebrated 70, 80 and 90 year olds who play tennis, run marathons, sky-dive, work part-time, care for grandchildren, paint masterpieces, travel internationally and write books. Intuitively, as Lamb (2014) argues, who wouldn’t want to age like this? Who wouldn’t want to be fit, healthy, active, productive and independent?
The problem, as many critical and feminist gerontologists have noted (Freixas et al., 2012; Higgs & Gilleard, 2015; Holstein & Minkler, 2003), is that these models of active, successful, productive and healthy ageing are not particularly realistic. This sociocultural ideal of mythical agelessness seemingly values not really ageing at all; as Lamb (2014) reminds us, very “few of us are able to live life in perfect health until suddenly dropping dead at age 100” (p. 49). The notions of ‘successful’ and ‘active’ ageing, while positively challenging and changing many negative age-related stereotypes and prejudices, also ignore the diverse heterogeneity of older people, whose ability to ‘actively’ or ‘successfully’ age is impacted by race, gender, class, income and health status. Critics argue that the neoliberal macro-level discourse on active, productive and successful ageing (rather than a focus on, for example, ‘comfortable’ ageing; see Cruikshank, 2013; Freixas et al., 2012) actually denies the very real changes of (old) age, and the inevitable declines, burdens and limitations of impending mortality and the individual subjectivity of the ageing process.

Fearing the ‘fourth age’ of later life

Over 50 years ago, in her novel Old Age, Simone de Beauvoir lamented that there exists a conspiracy of silence about the aged where society wrongly “looks upon old age as a kind of shameful secret that is unseemly to mention” (1970, p. 7). Unfortunately, that silence on old age continues today. While we talk much more about the positive ‘exemplars of ageing’ and how the ‘young-old’ enjoy an active and healthy ‘third age’, we very rarely talk, or think, about ‘the fourth age’ – when the inevitable infirmities and dependencies associated with ageing start to take their toll.
Growing older remains a process of becoming progressively invisible. Our culture teaches us “to feel bad about aging” (Freixas et al., 2012, p. 53) and to fear and fight the inevitable age-related changes said to make our body ‘unattractive’, wrinkled, grey-haired, fat or ‘incompetent’ – that is, forgetful, frail, disabled and/or dependent. In this age- and death-avoidant culture, we talk far too much about skydiving elders and far too little about the older woman living with the pain of arthritis, the frail older man with incontinence living in aged care and the experience of bodily ageing at the end of life – an experience we know occurs but “do our best, culturally speaking, to avoid or deny” (Biggs, 2017, p. 98).
Laslett, in his book A Fresh Map of Life (1991), was the first to draw attention to the binary oppositions in how later life is represented: a fit, healthy and active later life – the third age – and ‘real’ or ‘deep’ old age, a time of ill health, decline, loss and decrepitude – the fourth age. While Laslett was reluctant to assign chronological age boundaries to these categories, explaining that “it does not necessarily occur in every individual, it can come at any point in the life course and can be variable in length” (1991, p. 444), it is generally agreed that those living beyond their 80s are approaching the fourth age – the unpleasant but necessary end of life, dominated by loss, decline and frailty. The notion of frailty distinguishes the fourth age, and it is in this fourth age when “the positivity of the news about human ageing begins to crumble” (Baltes & Smith, 2003, p. 128), as the realization sinks in that “being 60 is not the same as being 90” (Freixas et al., 2012, p. 52).
Learning to be old, as Cruikshank (2013) explains, is so hard because it often means learning to accept frailty, ill health, decline and dependency with grace. Instead, there is an othering and rejection of this metaphorical fourth age as “both an identity and destination” (Higgs & Gilleard, 2015, p. 18). As most people fear growing “past the long midlife into frail old age” (Gullette, 2015, p. 22), this book purposely explores an aspect of ageing – the fourth age, and specifically living and dying in aged care – that is too often neglected and feared.

The fear of residential aged care

Nowhere is this fear of the fourth age more evident than in how we perceive and speak about residential aged care. Most people have a strong desire to age in place in their own homes and e...

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