Aske Juul Lassen

Communication and interaction with public authorities and healthcare professionals in Denmark primarily go through digital self-service platforms, requiring diverse skills and device access. In this article, we describe how senior citizens in Denmark handle and make sense of public digitalization through different forms of digital support. Through an ethnographic study of community-led initiatives of digital support, we highlight how senior citizens find socio-technical ways of managing digital obligations and argue that citizens’ digital agency in day-to-day interactions with public digitalization relies heavily on distributed socio-material relations. We suggest that the ways of engaging with healthcare through digital means should be of increasing concern to medical humanities scholars, as digital literacies and technologies have become gatekeepers to welfare and healthcare. Drawing on Donna Haraway’s reconceptualization of responsibility as response-ability, and Jane Bennett’s notion of distributed agency, we argue that the ability of digital citizens to respond is a result of a distributed and combined responsiveness of human, technological, and digital actants. We point to two opposite but interrelated assemblages: public digital as distributed intervening mediated through computers, smartphones, tablets, public digital mail platforms, et cetera, and digital support as distributed response , which serves to mitigate and translate demands and obligations of the digitalized welfare state. Consequently, as digital developments tend to generate an increasingly individualizing gaze, medical humanities must be critically concerned with the manifold, subtle actants that co-constitute accessibility and responsiveness of patients and citizens.

In the field of medical humanities, there has been a general call to understand biocultural entanglements and to break down rigid distinctions between culture and health, as well as disciplinary boundaries. In line with this call, we suggest a medical humanities approach that further breaks down the distinction between basic and applied research. We conceptualize this approach as engaged medical humanities , as it both contributes to ongoing theoretical discussions and engages in empirical settings. Based on our ten-year practice of conducting medical humanities research at the Copenhagen Centre for Health Research in the Humanities (CoRe), and by zooming in on two collaborative research projects, we discuss how we realize and navigate these diverse engagements. On this basis, we offer a framework for conducting engaged medical humanities research to encourage and inspire future projects. First, we discuss how we take our main inspirations from the critical medical humanities and engaged research. Second, we identify several challenges that arise when our research approach is put into practice. We focus on our collaborations with stakeholders outside of academia, discussing how we navigate collaborative complexities while emphasizing the importance of empirical sensitivity and fluid accountabilities in studying health issues. Third, we discuss our knowledge production, encompassing various formats spanning both theoretical and conceptual contributions within academia, as well as practical interventions and instrumentation aimed at societal needs. Finally, we offer reflections on the potential we see in our framework and discuss the conditions for further developing the engaged medical humanities in a Scandinavian context.

I de senere år har alderismen (aldersdiskrimination) på det danske arbejdsmarked været til debat. Men arbejdsmarkedet er kun et af de steder, hvor alderismen kommer til udtryk. Gennem etnografisk feltarbejde udforsker artiklen, hvordan alderisme opleves blandt ældre mennesker. Forfatteren analyserer, hvordan alderisme internaliseres og ofte bliver en del af ældre menneskers selvbillede.I mange tilfælde opleves alderismen som subtil og acceptabel, mens den i andre opleves som konkret og marginaliserende. Artiklen belyser alderismens mange fremkomster og bidrager til diskussionen om, hvor udbredt alderisme er, og hvad alder betyder for vores måder at omgås på.

In recent decades, the extension of individuals’ working life has been construed as an important policy issue in Western Europe. Here, retirement causes have been thoroughly researched in a quantitative way, but there is a dearth of qualitative studies on the subject. Through ethnographic fieldwork, we study the complex pathways that lead to the retirement of senior employees in the finance and production industries in Denmark. In particular in the finance industry, we find an insidious uncertainty haunting senior employees regarding their capacity and reputation. We term this uncertainty worn-out syndrome, demonstrating how many interlocutors fear that they are beginning to be seen as worn out, for example, less productive, less motivated, and too old to work. To some extent, this syndrome resembles the impostor syndrome, but it differs in one important aspect: the senior employees are mostly confident about their own skills. Worn-out syndrome is triggered by stereotypes and implicit ageist remarks by colleagues and managers. We show that the worn-out syndrome appears in at least three different ways: as a fear of already being worn out, as a fear of being perceived as worn out by colleagues and managers, and as a fear of becoming worn out in the future without realizing it in time. We argue that current retirement decisions are often fueled by this syndrome and that it leads to abrupt and untimely retirement decisions.

We scrutinize how the everyday lives of well-educated and healthy Danish retirees are structured and experienced and study how they organise their days and weeks. Our aim is to investigate how retirees manage and organise time and the ways these relate to societal rhythms in order to contribute to theories of retirement and social gerontology. We have combined qualitative (individual interviews, focus group interviews, design games, and drawings) and quantitative (activity monitoring, sleep quality, and health markers) data from 13 participants over the age of 65 years, who are research participants in a randomised controlled trial (RCT). Our interdisciplinary dataset allows us to analyse and compare subjective experiences of everyday activities with objective measures of daily activities. The older adults lead busy lives with many diverse activities and use these to structure their everyday lives in ways resembling the rhythms of the labour market with organised and busy mornings and loose afternoons and evenings. We discuss how our findings relate to continuity theory and suggest that Lefebvre’s rhythmanalysis allows us to study the retirement rhythms of older adults as part of both biological, social, and societal rhythms. This has practical as well as conceptual implications.

There is growing interest, within the social sciences, in understanding self‐quantification and how it affects health practices in contemporary society. There is, however, less research on how ageing and health measurement relate, even though this relationship has become more pertinent with the growing availability of services and devices offering biological, personalised age measurements, from simple online questionnaires to telomere length quantification. Little is known about who uses these devices, why they use them and the socio‐technical implications of such uses. To explore these issues, we conducted semi‐structured interviews and focus groups with users of measurements of biological age (BA) in Denmark. We found that participants engage with the measurements with a degree of scepticism regarding their technical validity, reliability and sensitivity. Rather than seeking an exact biological quantification, participants use measurements as a pragmatic, rough indication of individual health. We develop a conceptual model to understand participants’ engagement with BA measurements, which suggests that, instead of a substitution of chronological age for BA, users gauge the difference between the two to qualify their present and future individual trajectory in a lay model of the relationship between functional capacity and age.

When humans age, changes in body composition arise along with lifestyle-associated disorders influencing fitness and physical decline. Here we provide a comprehensive view of dietary intake, physical activity, gut microbiota (GM) and host metabolome in relation to physical fitness of 207 community dwelling subjects aged +65 years. Stratification on anthropometric/body-composition/physical-performance measurements (ABPm) variables identified two phenotypes (high/low-fitness) clearly linked to dietary intake, physical activity, GM and host metabolome patterns. Strikingly, despite a higher energy intake high-fitness subjects were characterized by leaner bodies and lower fasting proinsulin-C-peptide/blood glucose levels in a mechanism likely driven by higher dietary-fiber intake, physical activity and increased abundance of Bifidobacteriales and Clostridiales species in GM and associated metabolites (i.e. enterolactone). These factors explained 50.1% of the individual variation in physical fitness. We propose that targeting dietary strategies for modulation of GM and host metabolome interactions may allow establishing therapeutic approaches to delay and possibly revert comorbidities of aging.

The contemporary increase in life expectancy in Western countries has led to an intensified focus on good ageing processes as a way to manage ageing populations. We argue that while qualifications of the ageing process such as active and healthy ageing endeavour to compress morbidity through enhancement techniques, the idea of the good old age also implicitly tells a tale about the ‘good’ death. We explore how current discourses depict old age as an active, engaged and independent life phase and construct a specific idea of the good death as one that is quick and painless. By engaging with literature on ageing, death and enhancement technologies as well as current Danish healthcare initiatives, we examine the paradoxical, contemporary notion of death as natural, quick, painless and controllable. Danish rehabilitation programmes are provided as an example of specific enhancement techniques that through motivation and physical activity orchestrate the good death in a body that has been as healthy as possible for as long as possible. However, when such techniques become a moral injunction rather than a choice, questions arise concerning the relationship between autonomy and death. We argue that the discursive construction of the good death happens in tandem with enhancement techniques that postpone death, and that this postponement of death has increasingly become more of an imperative than an autonomous decision.

Aging is associated with decreased muscle mass and functional capacity, which in turn decrease quality of life. The number of citizens over the age of 65 years in the Western world will increase by 50 % over the next four decades, and this demographic shift brings forth new challenges at both societal and individual levels. Only a few longitudinal studies have been reported, but whey protein supplementation seems to improve muscle mass and function, and its combination with heavy strength training appears even more effective. However, heavy resistance training may reduce adherence to training, thereby attenuating the overall benefits of training. We hypothesize that light load resistance training is more efficient when both adherence and physical improvement are considered longitudinally. We launched the interdisciplinary project on Counteracting Age-related Loss of Skeletal Muscle Mass (CALM) to investigate the impact of lifestyle changes on physical and functional outcomes as well as everyday practices and habits in a qualitative context. We will randomize 205 participants older than 65 years to be given 1 year of two daily nutrient supplements with 10 g of sucrose and 20 g of either collagen protein, carbohydrates, or whey. Further, two groups will perform either heavy progressive resistance training or light load training on top of the whey supplement. The primary outcome of the CALM Intervention Study is the change in thigh cross-sectional area. Moreover, we will evaluate changes in physical performance, muscle fiber type and acute anabolic response to whey protein ingestion, sensory adaptation, gut microbiome, and a range of other measures, combined with questionnaires on life quality and qualitative interviews with selected subjects. The CALM Intervention Study will generate scientific evidence and recommendations to counteract age-related loss of skeletal muscle mass in elderly individuals. ClinicalTrials.gov NCT02034760 . Registered on 10 January 2014. ClinicalTrials.gov NCT02115698 . Registered on 14 April 2014. Danish regional committee of the Capital Region H-4-2013-070. Registered on 4 July 2013. Danish Data Protection Agency 2012-58-0004 – BBH-2015-001 I-Suite 03432. Registered on 9 January 2015.