A total of 227 photos were analyzed. The titles of the photos used in this section are the ones given by the respondents.
The analysis of the photos resulted in the following themes: social contacts, living environment, pets, social participation, green spaces, important landmarks in the environment, facilities and services, and stressors.
The theme “social contacts” includes photos of family and friends, ex-colleagues and neighbors, shared moments and activities (eg holidays, celebrations, visiting museums or exhibitions). Most photos pictured family and friends, emphasizing their crucial role in participants’ living environment. Some photos, titles and logbook comments illustrated close relationship with neighbors, trust of and reliance on them
Photos of the house, spaces around the house, streets, neighborhood (including shops, pharmacy, bakery, GP practice), multiple environments and the city represented the “living environment” of the participants (Fig. 2–8). The photos highlight differences between participants in the geographical scale of the living environment. For some it was their house, for others their street or the entire city.
“Pets” were a separate and important theme. Respondents photographed their cats and dogs and showed that they have a special place in their life and living environment (Fig. 9). They were photographed inside and outside of the house, in the garden, walking on the street or park.
“Social participation” included photos depicting volunteer activities, informal caregiving, participation in clubs, and being involved in cultural activities (Fig. 10–12). Since many photos depicted works of art, music and festivals, indicating cultural activities play a special role in the living environment.
Photos of parks, gardens and playgrounds were part of the “green spaces” theme (Fig. 13). Logbooks provided additional information on the potential importance of the green spaces for our participants. They were considered as facilitating relaxation and good mood, providing routes for walking with pets and cycling, meeting neighbors and at the same time being a refuge from noise and source of beauty.
“Important landmarks” in the environment were covered by the photos of bridges, monuments, and other buildings and sites (eg library, municipality) (Fig. 14). They had significance for the respondents as they were also related to emotional experiences, historical or cultural importance and aesthetics of the living environment.
“Facilities and services” included public transportation, community centers, sport and cultural centers (Fig. 15). The titles of these photos showed that their importance for comfortable living and freedom, and showed a connection with the family or with other people. Moreover they also seemed to have a positive impact on physical health and quality of life.
The “stressors” theme included photos of waste on the street, evidence of vandalism and business on the street that created a lot of noise according to our respondents (Fig. 16, 17). The participants mentioned in their logbooks that these issues caused them stress and made them feel nervous.
All the names of the participants used in this section are pseudonymous.
Definitions of living environment
Living environment was often defined by participants as the physical environment, although social aspects were also mentioned. For example, living environment was often perceived as a house or area around the house, street, neighborhood, but at the same time family, friends, people whom you meet on the street, neighbors, pets and social activities were mentioned as essential parts of the living environment. These different definitions of participants’ living environment were explored during the interviews.
Some participants defined their living environment as their house and immediate space around the house, such as the garden. One of the participants mentioned the staircase that reflected for him the importance of independence and staying mobile to be able to enjoy the living environment. “As long as I am able to climb those stairs, I feel independent and independence is important for me…as it also helps to enjoy my environment fully”(Mr D, 68 years).
For other participants the living environment was their neighborhood, with shops, the pharmacy, their general practitioner’s practice, and cafes. Some saw it as the whole of Amsterdam.
“…that is Amsterdam. I am really attached to Amsterdam. It’s my living environment. I cannot imagine living somewhere else…My family and my friends live here…” (Mr F, 67 years).
Others had multiple living environments, describing that they live half of the time in Amsterdam and the other half in another city or country where they have another house. One of the participants pointed out that “your living environment is the place where you live and it is important how it is organized, what facilities are available, how you behave with your neighbors and how you feel about it, but especially family and friends are important” (Mrs E, 62 years).
Multiple participants mentioned pets as an important part of their living environment. Several participants also took photographs of their pets to show that they consider pets as an inseparable part of their environment and family. Pets create a nice and pleasant atmosphere and “give the feeling of good and vibrant environment”.
Mental health and living environment
All participants believed that different social and physical aspects of the living environment influence their mental health and well-being. These aspects included: social contacts and networks, feeling safe, social participation, stressful situations in the environment, and social cohesion. Social contacts and networks, safety and social participation were considered by our participants as the most crucial. Physical activity, accessibility of facilities and services, convenient public transportation, green spaces, loneliness and social isolation were also mentioned during the interviews, but less often. Notions such as social isolation and loneliness, meaning of life, feeling of involvement and engagement in the community, stress, irritation and negative emotions were more often mentioned by the participants than “mental health” and “well-being” as such.
Social contacts and networks
Among social contacts and networks mentioned by our participants were family, friends, neighbors, former colleagues, groups of interest, alumni and sport groups.
“The more social contacts you have, the more involved you feel. It influences your health and well-being” (Mr B, 67 years).
Despite the fact that family members did not always live close by, participants mentioned that family and friends formed their living environment, gathering together and sharing important moments in their lives. One of the participants said: “My son and his partner, my daughter and her partner… my family is very important and friends are also very important. It is the core” (Mr J, 65 years).
Neighbors were generally considered to be less important than family. Nevertheless, most participants mentioned that they have good and close contacts with the neighbors, they help and trust each another. One of the participants used a Dutch proverb to describe the importance of good neighbors. “Better a good neighbor, than a distant friend; I think it is really true” (Mr L, 70 years). However, other participants pointed out that their contacts with the neighbors were more superficial.
Diversity in their networks appeared to be beneficial. ”My social networks consist of men and women, people from different countries and of different ages. Very diverse. I think they make my life better, more meaningful” (Mrs H, 65 years).
Most of the participants consider their living environments as pleasant and safe. Feeling protected allows participants to enjoy their environment and, has a direct impact on their quality of life and well-being. Feeling safe was a recurring theme in the stories of the respondents. “I feel very safe here. I can walk everywhere. Also as a single woman I felt always safe in this neighborhood…and of course i† has influence on my quality of life and well-being” (Mrs A, 65 years).
Some participants felt unsafe in their living environment, due to past events or negative experiences with burglary and robbery, or street violence. Needless to say, they had a bearing on the well-being of participants. A few participants mentioned the existence of so called “neighborhood directors” who are protecting the neighborhood, observing people’s behavior and trying to keep the neighborhood clean and safe. Participants also mentioned “neighborhood surveillance apps”, used for looking after each other’s house or pets. These measures helped them to feel safer and feel support from the neighbors.
Sometimes, the combination of various aspects of the environment was perceived as crucial. For example, the combination of social contacts and safety in the living environment, influenced participants’ well-being. “It is important that you have social contacts in your environment. Also that there are good and accessible facilities and places, where I can easily go to and talk to people…and where I feel safe and comfortable” (Mr T, 64 years).
Social participation included a broad range of activities. These were related to informal caregiving, volunteering, and participating in various organizations, clubs and activities for older persons. Firstly, many participants offer informal care to their family members, friends or neighbors. Participants helped with various household chores such as grocery shopping, finances, cooking, and cleaning. Caregiving activities were thought to influence well-being.
Participants also work as volunteers at community centers, residents’ committees, parks, as the board members of organizations, and helping other older persons with administration. Helping people in their community give participants the feeling of being a part of their community, being engaged in the neighborhood, and these communities often defined the social fabric of their living environment. It also made their lives more meaningful, and made them to feel involved, active and busy: “to be active, have interests, keep your mind and body busy and keep contacts with people in the neighborhood” (Mrs A, 70 years). Participants talked about their volunteering experiences with enthusiasm: “At the moment I am one of the volunteers at the community center, I am cooking there once per month. It helps to feel connected with the community and environment”, and “I am volunteering in the park, helping in the rosary which is a part of my living environment”.
Almost all participants were members of specific organizations, often in their living environments. Being a member was associated with staying active and involved, and thus also had an influence on their well-being.
Stressful situations in the living environment
Situations in the living environments such as excessive noise, bustle/rush (many people around, a lot of traffic and careless cyclists), waste on the street, and quarrels or problems with neighbors were mentioned as stressful. For some participants, neighbors were causing constant stress and irritation by being noisy or unwilling to compromise or to discuss problems. “I have very nasty neighbors. They are the biggest source of misery and stress for me, they are not able to communicate in a proper way” (Mrs G, 69 years). Household waste, garbage and junk on the streets were also regarded as causing discomfort and unpleasant feelings.
Social cohesion includes themes as: trusting people and specifically neighbors; help and support from neighbors; and sharing norms and values with neighbors. Trusting neighbors was reflected in behaviors like leaving the neighbors the key while being away, collecting the post or watering their plants. For the participants it was essential to be able to trust others, especially people living in the same neighborhood. One of the participants pointed out: “I would like to have people in my environment whom I trust and who trust me” (Mrs L, 65 years).
In terms of informal social, mostly emotional, support, participants mentioned the support of family, friends and neighbors. One of the participants stated: “I receive support from my husband. Really incredible. He is great. And of course I have support from the cleaning lady. And I have support from my children and neighbors” (Mrs L, 69 years). Participants stated that they share personal things, problems, norms and values with their neighbors. One of them noted: “Yes, sure, we do share norms and values with neighbors, it goes much deeper than just a simple contact” (Mr L, 70 years). Others mentioned that they do not share personal issues or discuss problems with their neighbors. They had other people for sharing their personal experiences, norms and values.
Comparing the analysis of the photos and the interviews, it appeared that several themes are prominent in both, for instance the themes of social contacts and networks, social participation, living environment and pets, and stressors in the environment. Some themes in the photos and the interviews do not match. Photos of green spaces (eg parks, gardens) and cultural activities suggest that these are important for the respondents. Green spaces were presented as reflecting the aesthetics of the neighborhood, or places to relax. However, green spaces and cultural activities were not mentioned often during the interviews as aspects of the environment that could influence mental health.