This paper offers a reflexive methodological account of the River of Life (RoL) as an arts-based, participant-led approach for researching ageing and identifying need in culturally and politically constrained contexts. In LGBTQIA+ ageing research, need is often understood through indicators such as service access, social isolation, mental health, or discrimination. While important, these measures may miss needs that are relational, culturally mediated, and difficult to voice directly under conditions of stigma and risk. Drawing on a study with older trans women in Malaysia (n=27), I show how River of Life can help make such needs visible. Rather than treating drawings simply as discussion prompts, I analyse them alongside interview narratives and fieldnotes to explore how people represent life events, relationships, uncertainty, and future concerns. The paper shows how needs emerge not only as service gaps, but also through problems of recognition, documentation, kinship, safety, and future manageability. I argue that arts-based, participant-led methods such as River of Life can expand how older LGBTQIA+ needs are understood across different social and cultural contexts.