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Introduction This study investigates comments that prostate cancer patients spontaneously write in the margins of the Expanded Prostate Cancer Index Short Form (EPIC-26) questionnaire. We aim to show the possible barriers that patients face while answering the survey, and to consider how these barriers may affect the response data generated. We investigate the kind of information patients’ comments on EPIC-26 contain, and patients’ motivations to provide this information. We also study why some EPIC domains spark more comments than others. Method We analyzed 28 pages of transcribed comments and four pages of supplementary letters from our survey participants (n = 496). Using inductive content analysis, we generated 10 categories describing the content of participants’ comments, and four themes demonstrating their motives for commenting. The comments regarding each EPIC domain were quantified to discover any differences between domains. Results The sexual domain of EPIC-26 provoked over half of all comments. Patients without recent sexual activity or desire had difficulties answering sexual function questions 8–10. The lack of instructions on whether to take erectile aid use into account when answering erectile function questions led to a diversity of answering strategies. Patients with urinary catheters could not find suitable answer options for questions 1–4. All domains sparked comments containing additional information about experienced symptoms. Conclusion Patients are mainly willing to report their symptoms, but a lack of suitable answer options causes missing data and differing answering strategies in the sexual and urinary domains of EPIC-26, weakening the quality of the response data received.

Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Theories of inclusive masculinity and horizontal homosociality describe how previously marginalized forms of masculinity are becoming socially acceptable. Studies within these theoretical frameworks have largely focused on privileged groups of men and men’s changing attitudes towards homosexuality. This raises questions about the extent to which the theories apply to marginalized groups of men and other inequalities between men. In this article, we analyse ethnographic data from two Finnish older men’s communities that emphasize equality between men as an essential part of their ethos, and ask how inclusive practices and horizontal homosociality operate in these communities. Our intersectional analysis shows that older men’s communities may involve varying levels of inclusive practices that do not necessarily relate to sexuality but, instead, to other aspects of inequality. Future studies should consider the contextuality of men’s practices and the intersectional differences between men that are the subjects of these inclusive or exclusionary practices.

Tutkimuksen tavoitteena on tehdä näkyväksi millaisia ideologisia valintoja Suomen neljä suurinta puoluetta ovat tehneet eduskuntavaaliohjelmissaan suhteessa hyvinvointivaltiokansalaisuusdiskursseihin 1991 vuodesta alkaen. Tarkastelemme erityisesti vaaliohjelmissa tuotettuja kansalaisen poliittisia ja sosiaalisia oikeuksia ja velvollisuuksia sekä kansalaisen ja valtion välistä oikeudellinen sidettä ja sen legitimointia. Tarkastelemme puolueiden hyvinvointivaltiokansalaisuusdiskursseja pohjoismaisesta hyvinvointivaltiomallista käytävän kamppailun viitekehyksessä. Kansalaisuustulkinnat ohjaavat yhteiskuntapolitiikkaa ja esimerkiksi määritelmät kansalaisten tarpeista vaikuttavat palvelurakenteeseen. Tutkimuksen aineisto koostuu Kansallinen Kokoomus r.p.:n, Perussuomalaiset r.p.:n, Suomen Keskusta r.p.:n ja Suomen Sosialidemokraattinen Puolue r.p.:n eduskuntavaaliohjelmista vuosilta 1991–2019. Perussuomalaiset r.p.:n osalta aineisto kattaa vaalivuodet 1999–2019. Tutkimuksen menetelmällinen lähestymistapa on kriittinen diskurssianalyysi ja sen avulla pyritään erityisesti löytämään argumentaatiota ja keinoja, joilla vaaliohjelmissa perustellaan kansalaisuustulkintoja. Kansalaisen poliittisiin ja sosiaalisiin oikeuksiin ja velvollisuuksiin liittyen tunnistimme kaksi diskurssia: palveluiden kohteena olevan kansalaisen ja omatoimisen kansalaisen diskurssit. Kansalaisen ja valtion oikeudelliseen siteeseen ja legitimiteettiin liittyen tunnistimme kansanvallan diskurssin. Puolueiden diskurssien välillä ei ollut löydettävissä perustavanlaatuisia näkemyseroja, vaan erot liittyivät enemmänkin painotuksiin.

Radical treatments of prostate cancer often lead to a pervasive liminal state that is characterised by multiple uncertainties that relate both to a possible recurrence of cancer and recovery from side effects, such as erectile and urinary dysfunctions. Liminality can make it difficult for cancer patients to narrate their experiences, as their stories lack a definite ending. After interviews with 22 Finnish men who had undergone radical prostatectomy, we analysed how men produce closure in their illness narratives. Focusing on the timelines of control visits or their anticipated recovery from side effects, these interviewees sought provisional certainty within a seemingly chaotic future. By locating erectile dysfunction in the wider context of a life-course and interpreting their fading sexuality as a 'natural' consequence of ageing, these men were adjusting to their post-operative lives. Our study further shows that the inability to adjust personal experiences to positive culturally available storylines that provide a chance for the narrative reconstruction of life, can cause materialised negative consequences, such as relationship breakdowns.

Because paid work is taken to be central to manhood, scholarly and popular discourse have characterized retirement as presenting a “crisis of masculinity.” However, such a crisis is not borne out by research, perhaps because scholars have not considered how class might shape masculinities and thus expectations and experiences of retirement. Using data obtained from interviews with Finnish metal workers and engineers who are either approaching retirement or recently retired, we ask whether (1) this crisis discourse is reflected in their retirement expectations, (2) it matches their actual experiences of retirement, and (3) retirement disrupts the masculinities of some class groups more than others. We find evidence of this retirement crisis discourse in our respondents’ views of retirement, but not in their actual experiences, belying the homogeneity of masculinity implied by it. Class shapes both the perceived content of crises and the actual retirement experiences.

Transfer from a private home to an assisted living facility has been pictured as a major change in an older person's life. Older people themselves tend to perceive the change as something eventual that breaks the bonds and familiarities of previous life. The aim of this article is to shed light on residents’ chances to reach affiliation (as Nussbaum defines it) in their new living surroundings, and thus adjust to that social environment. Based on ethnographical data gathered in a Finnish sheltered home in 2013–14, we studied residents’ affiliations through ruptures, namely residents’ perceived social isolation. Social isolation was found to be connected with two separate social worlds: the one inside the facility and the one outside. Social isolation resulted from different factors connected to the quality of social interaction with co-residents and the staff, daily routines of the institution and residents’ personal life histories. Also, residents’ older friends seemed to avoid visiting care facilities which caused perceived social isolation. This article deepens the insights into the perceived social isolation of assisted living and thus helps care providers to create new strategies to enable due affiliation for their residents.

Most citations to “hegemonic masculinity” focus on gender ideals and men’s attempts to justify domination. Few scholars have tested the theory that masculinity can be hegemonic in effect by gaining the overt consent of others to their domination. We specify this largely untested theory and use data from a pilot study of middle-age men for our demonstration of how to operationalize and recognize hegemony. We argue that scholars will find that effect at intersections of gender and other inequalities such as age. We show that, in their discussion of linked ideals of gender and age, three respondents mention domination of older men by younger men, and then both consent to that domination and accept personal responsibility for forestalling it through regimens of fitness, productivity, and health. We call for further research on the hegemony of masculinity via study of intersections of gender with such understudied inequities as age.

Culturally, institutional care has been seen to strip older people of their status as full adult members of society and turn them into ‘have-nots’ in terms of agency. The substantial emphasis in gerontology of measuring the activity and functional ability of the elderly has unintentionally fostered these stereotypes, as have traditional definitions of agency that emphasise individuals’ choices and capacities. The aim of this paper is to discover what kind of opportunities to feel agentic exist for people who have reduced functional abilities and therefore reside in assisted living. In this paper, agency is approached empirically from the viewpoint of Finnish sheltered housing residents. The data were gathered using participant observation and thematic interviews. This study suggests that even people with substantial declines in their functional abilities may feel more or less agentic depending on their functional and material surroundings and the support they receive from the staff, relatives and other residents. The perception that residents’ agency in assisted living cannot be reduced to measurable activity has methodological implications for gerontological research on agency. Care providers can utilise our findings in reasserting their residents’ quality of life.

The concept of resident-facility fit has largely been used to illustrate whether a residential care facility and a resident are together able to meet requirements set by only the hampering functional abilities of the latter. The purpose of this paper is to study how assisted living residents perceive resident-facility fit. The data were gathered ethnographically from both observations and resident interviews in a sheltered home in Finland during 2013-2014. Perceived resident-facility fit is based on several relational factors that connect to both the residents as individuals and their surroundings. This fit seems also to be partly conditional and indeed depends on residents' trust in having their own potential to act. Good resident-facility fit results in feeling at home in a facility, whereas poor fit can even result in residents' feeling imprisoned. Care providers can thus utilize our results to affirm residents' quality of life in residential facilities.

The purpose of this study was to explore the views of mental health professionals on deinstitutionalization reforms in Russia. Qualitative interviews were conducted with 33 specialists from outpatient mental health clinics. The data were analyzed using thematic analysis. The results revealed that the professionals appeared very restrained in supporting the reforms. They argued for the preservation of the existing mental health care system rather than its transformation. Their lines of argumentation were organized around four key themes as follows: 1) critiques of state policies and a suspicion of reforms, 2) tradition instead of innovation: reclaiming the image of Soviet psychiatry, 3) hospitals as a means of social control, and 4) reform as a threat to the protection of people with mental health problems. The findings suggest that practitioner resistance to deinstitutionalization is a complex phenomenon, demonstrating how various political, economic, social, and cultural factors are intertwined ...

Becoming a resident in a long-term care facility challenges older people's continuity of self in two major ways. Firstly, as they leave behind their previous home, neighborhood, and often their social surroundings, older people have to change their life-long lifestyles, causing fears of the loss of one's self. Secondly, modern-day care facilities have some features of 'total' institutions that produce patient-like role expectations and thus challenge older people's selves. Our ethnographic study in a geriatric hospital and a sheltered home in Finland aims to find out what features of daily life either support or challenge older people's continuity of self. A philosophical reading of the concept of recognition is used to explore how various daily practices and interactions support recognizing people as persons in long-term care. Categories of institution-centered and person-centered features are described to illustrate multiple ways in which people are recognized and misrecognized. The discussion highlights some ways in which long-term care providers could use the results of the study.

Autonomy is a pervasive concept in Western lifestyles today. However, people in the fourth age are assumed not to be autonomous but dependent on other people. The data of this study consisted of interviews with Finnish community-dwelling 90–91-year-old people. The study aim was to examine how these people see their own autonomy in their everyday lives. The analysis was based on membership categorisation analysis. Our respondents considered their autonomy through three distinct themes. Functional ability was considered in terms of being physically capable of managing daily tasks. Independence in decision making was based on material and financial self-sufficiency and on the respondents' supposition that they were capable of making decisions due to an absence of memory disorders. Additionally, autonomy was considered as contesting norms of age-appropriateness. Among respondents, chronological age seemed to have been replaced by functional and cognitive ability as a definer of categorisations; age-others became ability-others. Our study revealed that the perceptions of autonomy also included gendered features as they were linked with differing gendered ideals, roles and life domains of women and men. The results highlight the internal diversity among the oldest old and challenge the third/fourth age division. Instead, they suggest the existence of a certain ‘grey area’ within old age, and urge an analysis on the subtle meaning making involved in older people's constructions of age-categorisations.

The neo-liberal ideologies that point to individual responsibility for risks increasingly influence countries of the global North. The anti-ageing industry reflects this dictate and encourages middle-aged people to use their products and services to manage their ageing. However, given the negative connotations attached to the term ‘anti-ageing’, which is usually seen to focus on aesthetics and thus be a woman's concern, men may be likely to disavow being involved in such activities. The article uses interview data collected from men aged 42–70 from Finland and the United States of America to explore whether and how men adhere to the call to manage their ageing when such anti-ageing activities are seen to be potentially feminising. We find that these men reflected neo-liberalism in the sense that they felt that, although ageing cannot be prevented, it can be controlled. Also while they generally rejected anti-ageing products and services that they judged to affect aesthetics, they reported that they use those that they define as promoting health and performance instead. For them, masculinity is the instrumental focus on performance to the exclusion of beauty or attractiveness. Masculine anti-ageing bodily strategies must also be ‘natural’, involving hard work rather than the use of products, which they regard as never having been scientifically proven to enhance performance. Thus, in talk of their anti-ageing, men distance themselves from women.

This article explores the ways in which a group of male factory workers uses bodies as bases for hierarchical categorization of men by age in their talk of mundane aspects of their lives. Analysis of interviews about health (4 focus groups and 5 personal interviews) with Finnish working-class men under 40 years old shows that they portray age groups to which they do not belong as careless, even irresponsible toward health and its maintenance. As they categorize youth and old people by age, they leave themselves unmarked by it, providing no vocabulary to describe their own group. Despite their tendency to distance themselves particularly from old people, they also distinguish among older men by familiarity, providing relatively nuanced accounts of their fathers' aging. We discuss the marking of age groups in terms of social inequality and talk of fathers in terms of intergenerational relations. Even family ties among men of diverse ages involve ageism, which familiarity serves both to mitigate and to make less visible. This article documents the maintenance of age inequality in everyday, mundane behavior.

Objective To conduct an intersectional analysis of relations between gender and age in the health behaviors of middle-aged men, informed by cross-national comparison between Finland and the United States. Methods Thematic and discourse analysis of data from interviews conducted among professional and working-class, middle-aged men in the U.S. and Finland. Results Respondents report that middle age inspires them to regard many bodily changes as more than transitory; and they assume a sense of responsibility that can lead to greater self-care. Men reported using such strategies as discipline, routine, and monitoring in their attempts to forestall aging. Conclusions The men face contradictions: While they may adopt ideologies of masculinity and control and accept responsibility for influencing their health, their bodies may also present them with age-based limitations to their abilities to do so. How men respond to these changes varies by context, including their aging and these nations' different systems of health care.

This article focuses on the intersections of age, gender and class in interpretations of the aging and situational identity work of middle-aged working-class men. Empirically the article is based on interview data (4 focus groups and 9 personal interviews with 40+ men) in which Finnish paper-mill workers are interviewed about health. Based on the theoretical implications of intersectionality, the article provides an empirical analysis of how age-based cultural hierarchies and distinctions are used flexibly in the process of self-identification and how categorizations of age and conceptualizations of aging are tightly interwoven with gender and class. The analyses show that the middle-aged interviewees base their interpretations of the aging self on negotiating their position between the age categories of the ‘young’ and ‘old’. Both these groups are labeled with rather negative characteristics regarding the irresponsibility for health among the young and impaired functional ability of the old, which conflicts with the working-class expectations regarding masculine identity. The findings suggest that studying how people ‘do age’ requires consideration of the respects in which aging is an age-specific and gendered process shaped by class-based values, ideals and practices.

The aim of this study was to examine if there are differences in self-rated health (SRH) between older people in St. Petersburg, Russia, and Tampere, Finland. Two SRH measures were examined: a global measure without any frame of reference, and an age-comparative SRH with an explicitly elicited reference of age peers. The Tampere data, consisting of 737 60–89-year-old respondents, came from the Tampere Longitudinal Study on Ageing (TamELSA) in 1989. The St. Petersburg data, consisting of 1,168 people aged 60–89 years, came from the Planning of Medical and Social Services within Elder Care in St. Petersburg project (IPSE) in 2000. In both cities the data were collected by same structured questionnaire. Self-rated health, both global and comparative, was better in Tampere than in St. Petersburg when symptoms, chronic diseases and functional ability were adjusted for. Also, the association of chronic diseases with global SRH was different in St. Petersburg and Tampere. In addition to the real differences in the prevalence and seriousness of health problems, the differences in SRH may be caused by different ways of evaluating health. Our conclusion is that self-rated health is sensitive to cultural and social factors. Direct comparisons between different countries should be made with caution, and the differences in language use must be taken into account when interpreting the results.

Purpose We explore the motivations of middle-aged consumers of anti-aging products and services in relation to aging, health, and appearance. Admission of use of anti-aging products and services could align a respondent with a stigmatized group, old people, and also connotes a feminine concern with aesthetics. For these reasons, people, particularly men, will be unlikely to report using them for this purpose. Design and methods Semi-structured, in-depth interviews were conducted among 19 men and women aged 42-61 years. Topics included their perceptions of bodily changes and their responses to these. We analyzed data qualitatively. Results Respondents frame their uses of anti-aging products in terms of health and appearance, not anti-aging per se. Both men and women see anti-aging as related to beautiful appearance and thus as a feminized activity. Both are concerned about appearance, but in gendered ways. Overall, respondents conflate bodily appearance, health, and aging in their constructions of anti-aging. Implications This conflation maintains inequality by stigmatizing old age as unhealthy and unseemly. Our results point to the limits of studying the consumption of anti-aging products and services if researchers ask only about anti-aging uses per se. They also point to the ways that discourses of health and appearance naturalize ageism, as they suggest that old age inheres in bodies that "naturally" decline and thus should be excluded.

The substantial gender difference in life-expectancy is among the key characteristics of current health crisis in Russia. Despite a relatively large body of epidemiological literature on gender difference, there is little empirical research on the gendered meanings of health among Russian lay people. This study aims to enhance understanding of gendered meanings of health by analysing lay accounts of the gender gap in life-expectancy on the basis of 29 interviews with Russians aged 15-81. The analysis showed that gender difference was largely attributed to structural conditions and changes in Russian society and, to a lesser extent, to behavioural factors. Another important conclusion drawn from the analysis was that talk about gender included very few alternatives to conventional gender relations, or negotiation of their effects on health and illness. We interpret these findings to reflect, first, the culturally weak role of the individual in Russian discourses of health that are still largely focused on the role of government as primarily responsible for public health. Secondly, it seems that there are few alternatives to conventional discourses of gender in post-Soviet Russia; the gender relations in people's understanding appear to be static and persistent despite recent profound social changes.