“Shades of Grey”: Exploring Public Opinion about Later-Life Sexuality

ABSTRACT Public opinion on later-life sexuality affects older people’s sexual health, behaviour, and satisfaction. In this study, we explored public opinion on later-life sexuality by participants’ responding to an open-ended question rather than rank their level of agreement or disagreement with different statements about older people’s sexuality. Responses from 135 men and women reflecting on how sexuality changes in older age were thematically analysed. Five themes emerged, varying from positive to negative perceptions of later-life sexuality. Older people’s sexuality was described as declining, non-existent, conservative, narrow, tedious, and boring, but also as encompassing more emotions and feelings; being better and more “complete”. This study provides qualitative data and an opportunity to gain insights on valuable opinions on what young and middle-aged people think about later-life sexuality. Assessing what people think about later-life sexuality is the first stage in instilling more liberating views about the diversity of sexual expressions in old age.

Attitudes and perceptions regarding later-life sexuality can have a significant impact on older people's sexual health and the quality of treatment they receive for sexual health concerns (Balami, 2011;Bouman & Arcelus, 2001;Gewirtz-Meydan & Ayalon, 2017). To shift attitudes on later-life sexuality towards a more positive and supportive direction, it is first and foremost essential to deepen the understanding of how people believe (and assume) sexuality changes or develops over the years. The majority of studies on the attitudes towards later-life sexuality are quantitative, using a scale to measure positive versus negative attitudes. These studies are more prone to social desirability (as they are explicit); additionally, they do not enable diverse and complex responses. In the present study, we sought to explore public opinion regarding later-life sexuality. By allowing participants to respond to an open-ended question, we hoped to gain insights on valuable opinions on the topic of later-life sexuality and to understand the ambiguity and ambivalence that might characterise people's opinions.
Studies suggest there is a gap between explicit and implicit attitudes towards sexual expression in later life. Studies that surveyed explicit attitudes towards sexuality in later life were conducted by close-ended question surveys such as the Aging Sexual Knowledge and Attitudes Scale (ASKAS) by White (1982) which directly addressed attitudes towards later-life sexuality (e.g., Di Napoli, Breland, & Allen, 2013;Ewen & Brown, 2012;Filiz Adana et al., 2015;Flaget-Greener, Gonzalez, Sprankle, Gonzalez, & Are, 2015;Gewirtz-Meydan, Even-Zohar, & Werner, 2018;Mahieu et al., 2016;Syme & Cohn, 2016). Each of these studies used self-report methodologies and required participants to state their explicit attitudes towards later-life sexuality on a ranking scale. Whereas these studies found relatively permissive, accepting, tolerant, open-minded, and positive attitudes towards older people's sexuality, they may include some level of bias and overestimate positive attitudes towards the sexuality of older people by having invoked strong, liberal self-presentation or social desirability effects among respondents.
Older people also report being exposed to ageist perceptions by professionals (MacRae, 2018) and by the general population (Gewirtz-Meydan et al., 2019), which they describe as negatively impacting their sexual activity and interest (Heywood et al., 2019), and interfering with the process of seeking health care (Chrisler, Barney, & Palatino, 2016;Gott & Hinchliff, 2003a;Hinchliff & Gott, 2011). Taken together, these studies suggest that societal views regarding later-life sexuality are based in part on ageist stereotypes and are quite widespread yet difficult to identify. At least to a certain degree, people know what the expected societal response is even if it might be entirely different from their own innate beliefs. To overcome preconceived notions of what some consider to be socially desirable, and to enable participants to express complex and diverse attitudes, our study sought to examine attitudes towards later-life sexuality using a qualitative method, allowing participants to share their thoughts openly.

The Present Study
Attitudes on later-life sexuality can be internalised by older people (Fileborn et al., 2015;Graf & Patrick, 2014;Levy, 2009) and inhibit them from expressing their sexuality, impact upon attitudes towards their own sexuality, and potentially influence treatment-seeking behaviour for sexual difficulties. A recent study has reported that older men and women emphasised the need for normalising the occurrence of sex in later life in order to support and improve their sexual lives . Research on the visibility of older people as sexual beings and the attitudes on later-life sexuality is insufficient and contradicting. Studies have shown a significant gap between explicit and implicit attitudes, making it difficult to ascertain what people think about the sexuality of older adults. In the study discussed here, we explored public opinion regarding later-life sexuality by allowing participants to respond to an open-ended question rather than rank their level of agreement or disagreement with different statements about older people's sexuality. Collecting qualitative data on this matter was an opportunity to gain insights on valuable opinions on the topic of laterlife sexuality. It is possible that when respondents answered a close-ended questionnaire on their attitudes towards later-life sexuality, they wanted to appear as liberal, broad-minded, and tolerant. Open-ended questions assisted us to understand the variety of people's opinions and thoughts, which they chose to share spontaneously. Consequently, we avoided the bias that may otherwise have resulted from defining the concept to respondents by providing them with a close-ended set of responses (Reja, Manfreda, Hlebec, & Vehovar, 2003).

Participants
A total of 135 participants -100 women, 34 men, and one identified as "other"completed open-ended questions through an online questionnaire. Participants were from all over the world, yet the majority lived in Israel (67.4%). The mean participant age was 29.19 years (age range: 18 years to 56 years). The majority of participants identified as either married or in a relationship (74.1%). The majority of respondents did not have children (54.8%). The sample was highly educated, with 65.18 per cent (88 participants) possessing higher education, 30.37 per cent having completed high school and the remaining 4.45 per cent having fewer than 12 years of education. Demographics are described in Table 1.

Sampling and Procedure
The sample was collected through the social media (i.e., Facebook). To be included in the present study, participants had to be (a) older than the minimum consent age of 18 and (b) able to read and answer a survey in English or Hebrew. After the university ethics committee approved the study, an anonymous link using Qualtrics software was distributed via social media. Participants were offered an opportunity to take part in a short anonymous research project on the definition of sexuality and how it develops as people age.
Facebook recruitment is a cost-effective tool for rapidly recruiting large samples of participants and obtaining data on public opinion; moreover, it enables subject anonymity (Samuels & Zucco, 2013). The survey was published on Facebook pages of different groups in which the first author participates. According to Baltar and Brunet (2012), this method increases the level of confidence participants feel because the researchers show their personal information via Facebook's profile and also participates in their Facebook groups of interest. For the present study, we published the survey in Facebook's interest groups of sexuality, older adults, and research. However, the main limitation of Facebook recruitment is that the sample's representativeness cannot be entirely determined (Ramo & Prochaska, 2012).
We conducted the survey between January and August 2017. The participants initially completed a background questionnaire assessing demographics (e.g., gender, age, country of origin, years of education, marital status, and number of children). Then we asked participants to respond to two open-ended questions: (a) How do you define sexuality? and (b) How does sexuality among older people differ from sexuality among younger adults? We analysed answers to only the second question. We provided a brief introduction to the importance of the responses and an increasing size of answer space within the web survey to enhance the quality of responses (Smyth, Dillman, Melani Christian, & McBride, 2009).

Data Analysis
The data set in our analysis consisted of the written answers to the question "How does sexuality among older people differ from sexuality among younger people?" We applied a line-by-line, open-coding analysis (Strauss & Corbin, 1998). The analysis did not use preconceived a priori themes, but allowed themes to emerge directly from the text (Creswell, 1998). We thematically analysed the answers to the open-ended questions, according to Braun and Clarke's (2006) approach. The first author (AGM), a social worker and a certified sex therapist, familiarised herself with the data, reading and re-reading the data, documenting initial ideas. Then, initial codes were generated across the entire data set, and quotes relevant to each code were collated. The second author (LA), a clinical psychologist and a gerontologist, read all responses, and both of us (AGM and LA) then discussed the codes before grouping them into five main themes to identify response variations. Both of us also defined and named themes and formulated the overall storyline. Finally, to obtain a general picture of the distribution of the different attitudes, we counted the number of times each theme appeared. Answers which were complex and contained more than one theme were coded into the theme that was most dominant in the response. "Do not know" responses received a separate code.

Ethics
The study was approved by the ethics committee of the school of social work at Bar Ilan University, Israel. Participants did not sign an informed consent, but received detailed information concerning the study prior to their response. Participants' anonymity was guaranteed via a shareable link connecting to the survey. Participants completed the link at their own voluntary wish.

Results
In the initial phase of the analysis (data familiarisation), we found there were two distinct types of answers: (a) responses leaning towards viewing sexuality in later life from a positive point of view (as better, developed, and more satisfying in old age), and (b) responses leaning towards viewing sexuality in later life from a negative point of view (as declined, infrequent, or nonexistent). Very few people (n = 3, 4.5%) reported that they did not know the answer, and these responses were noted but their responses did not represent a theme. For a brief description of codes, see Table 2.
No significant differences between the two poles with regard to any of the socio-demographic variables (age, gender, children, years of education, marital status, country of origin, and language of the survey) were found, using t-test and chi-square test.
We regrouped the codes into five major themes all situated on a continuous scale ranging from absolute negative and ageist views on sexuality in later life to absolute positive views on later-life sexuality ( Figure 1).
On the negative side, we found two themes: (1) "The world belongs to the young" which described sexuality in later life as a definitive decline in all aspects of sexual function: desire, arousal, orgasm, ejaculation, and pain; and (2) "old school, old fashioned", which we grouped upon answers describing later-life sexuality as conservative, narrow, and tedious, and older people as closedminded, less adventurous, and introverted regarding sex. In the second theme, we found a sub-theme: "cohort effects", which usually was attached to responses describing sexual conservatism among older adults. This sub-theme of cohort effects attributed older adults' sexual conservatism to the atmosphere they were raised in and the lack of sexual education they experienced during their upbringing. Almost half of the sample (48.9%) held negative views on later-life sexuality, indicating that negative sexual ageism still exists.
On a more positive note, we found an additional three themes representing the positivity of sexuality in later life. Theme (3) was "More emotions attached", which described later-life sexuality as encompassing more emotional aspects in sex rather than just the physical sensation, and theme (4) was "People may age, but sexuality is part of your soul", which suggested there was no significant difference between sexuality in later years versus that in younger years. These two themes (3 and 4) we categorised as being partially positive (see Figure 1) as we explain later in the discussion. Finally, on the positive side, we found the fifth theme: (5) "With maturity comes satisfaction" which stated that older people have greater satisfaction and a better understanding of sexuality in later life. An equal number of respondents (48.9%) held positive attitudes towards later-life sexuality. All themes, codes, and example quotes are presented in Table 2. Following are detailed descriptions of the identified themes.
(1) "The World Belongs to the Young" Twenty-three per cent (n = 31) of the respondents thought sexuality in later life declines, and some even said it diminishes. Two participants described sex in later life as "rare", and another two doubted it exists; all  (23) • "Older people are less sexually active compared to younger people." • "Older people don't have as much as sexual desire as younger people." • "With time, there is less sexual desire, and so sexual interaction is less." • "There are bodily changes and the body does not function as it used to. The body is more tired and much less attractive." • "Lower sexual desire in older ages." • "Hormonal changes cause lower sexual desire …" • "Less enthusiastic and less strength for expressing your sexuality." • "Sex, when you're young, is just more fun. Everything looks prettier and brighter when you are young." • "Sex among the elderly is rare if it even exists. Young people have sex on a weekly basis." • "Older people are less sexual in terms of function but also thoughts. Young people are very sexual and think only about that." • "Sex in later life is less frequent and less enjoyable." 2 "Old school, old-fashioned" •Less adventurous • Conservativeness • Close minded • Introversion • Sexual orientation and gender identities 35 (25.9) • "I think older people are (sic) more black-white thinking, you are either straight, or you are gay. I think the younger generation is more flexible, and also more open to talking about it, and more experimental." • "Younger people may feel free to explore their options. Older people have settled into a relationship and no longer entertain multiple partners." • "Older people are more conservative about sex." • "I don't think older people are less sexual, but they are expressing their sexually more gently and in a respectful way. They are more restrained about expressing their sexuality." • "I think in younger ages people are more permissive about their sexuality and have a personal but also a social need for experimenting and gaining different sexual experiences …" • "I would guess older people are more conservative in expressing their sexuality, have less courage to try new things and experiment." • "Older people are less "bold" and therefore don't tend to be extroverts about their sexuality." • "I think that older people are more closed minded than the younger generation right now …" • "Older people are more stuck in the mindset that there are gay and straight people while I guess younger people have heard more about other sexualities." • "Younger people seem to have more flexible sexuality than people usually (are more open to other orientations and exploring their own)." • "Older people either don't really care as much or older people are so black and white that they won't accept different sexualities." 3 "More emotion attached" • "As you age, I believe you have more emotions attached to sexuality." • "I think that they [older people] give more importance to feelings than to physical sensations." • "I believe younger people have a much higher sex drive. Older people place different meaning/weight on sex in a relationship than younger adults, and (hopefully) do not see sexual activity is a marker of "success" but rather an aspect of one's life and relationship(s)." • "[Later-life sexuality is] more moderated and tends to be revolving around affection than strong sexual desire." • "Among older people, sexuality would be expressed more by personality traits and less by physical acts." • "In younger ages, it is more about lust and desire, while in older age it is more about love and the need for closeness." • Sexuality among the elderly is "softer", and it revolves more around emotional and bodily intimacy, warmth, and closeness and less on "performance." • "Sexuality among younger people is much stronger and is mainly based on physical attraction, while among older people sexuality is based on an interpersonal connection and intellectual attraction." 4 "People may age, but sexuality is part of your soul" • No difference 25 (18.5) • "It is no different in this sense but dynamic with possibilities." • "I do not think there is any real difference if you think that anyone expresses his or her sexuality in his or her own way."

Continued
Public Opinion on Later-Life Sexuality La Revue canadienne du vieillissement • "It is no different." • "It is not much different, as it relates to self-concept." • "It is not different. Each age has its own challenges of course." • "I believe it changes from one person to another. It's individual, and there is no built-in gap between younger people and older people." • "It doesn't have to be different. People may age, but sexuality is part of your soul." • "I don't think it is different. Still, every person has his/her sexuality." 5 "With maturity comes the satisfaction" • Confidence • "When you're young, you may have more energy, but more hesitation because it's all so new and taboo. As you get older, you feel more tired because of life's responsibilities, but when you have sex, you're more comfortable and vocal in making it worth both of your time … As you grow less shy with your partner, you're not ashamed to tell them what, and how, to reach a female climax." • "As you age you have more self-assurance and will be more comfortable saying what you need and how often." • "I think in most (not all cases) older people have figured out their sexuality because they have lived longer and had the time, whereas younger people are still trying to figure that out." • "Older people have their sexuality worked out better than younger ones." • "You are definitely more confident and self-assured and would find a person attractive because of their individual connection between you both which is free from labels." • "Generally, older people have a finer sense of their sexuality while younger people are still exploring." • "If you look at sexuality from a psychological perspective, so it is different, older people are more mature and developed emotionally." • "More sexual freedom, fewer inhibitions. There is a feeling that I have nothing to lose and if things don't happen now, they might never happen." • "More confidence and being more verbal about sexuality in older ages." • "Older people's sexuality is much more whole. They have established sexual behaviours and habits over the years and did not feel as if they need to prove something to someone. However, younger people still wonder after the sexual behaviours that fit them and are more impacted by society." • "There is a difference because older people are more experienced and younger people are in the stage of exploring their sexuality." • "Older people are more experienced and know what they want • "I think sexuality is healthier among older people because your soul and the personality are more developed." other participants (n = 27) assumed sex just becomes less frequent. This reasoning was compared to their thinking that young people engage in sex "on a weekly basis". Respondents believed older people lose their sexual desire and that the level of attraction to one another drops as well. The implication, therefore, is that older people are less sexually active and have minimal sexual interactions compared to younger adults. Some participants stated that older people are just "less sexual" and are not as engaged in thoughts about sex compared to younger people who "think about sex all the time".
Respondents partially attributed this decline to changes in bodily function and to illness. Bodily changes noted by respondents include tiredness and loss of strength, but also low levels of hormones which can cause sexual dysfunctions such as vaginal dryness and erectile dysfunction. Respondents also noted that the body becomes "less attractive" in later life, and, therefore, when compared with older people, younger people experience greater sexual attraction to one another. Changes in sexuality may inhibit the ability to engage in penetrative sex, which was noted by respondents as a significant difference between older versus younger people's sexuality.
Older people were seen as being less enthusiastic about sex. Respondents believed sex in later life is not only less frequent, but also less enjoyable and fun. As an 18-year-old male observed: "Sex, when you are young, is just more fun. Everything looks prettier and brighter when you are young." (2) "Old-fashioned, Old-school" A quarter (25.9%) of the participants did not necessarily indicate a decline in older people's sexuality but considered sexuality in later life to be a poorer and narrower experience compared to the sexuality of younger adults. According to 35 respondents, older people are not less sexual but express their sexuality differently. When people are young, they might be more open and extroverted about their sexuality, whereas in later life, sexuality may be more hidden and introverted. Respondents also stated that younger people have "wild" sexual engagements and encounters, compared to older people's sex, which is considered "restrained", "gentle", "moderated", and even "boring". Participants, regarding this theme, responded that when someone is young, he or she is more open-minded and willing to explore his or her own sexuality, whereas in later life, people are more conservative and closedminded about sex.
Participants explained that younger people hold more permissive attitudes towards sexuality and therefore feel free to "explore their options". Also, younger people were regarded as having a personal and social need for experimenting and gaining different sexual experiences. In contrast, older people were considered "retired" from sexual experimentation. Respondents estimated that older people have no urge to experience anymore, as they have already explored their sexuality. According to the study participants, older people have become more "reasonable" about their sexual engagement as they have "settled into a relationship" and no longer seek sexual experiences and adventures. Others assumed that older people do want to explore and experience new things in their sexuality but lack the courage and "boldness" to do so.
Another aspect respondents referred to concerned sexual orientation and gender identities. Older people were considered to hold more conservative attitudes and be less accepting of different sexualities. Whereas younger people considered themselves "open-minded", "flexible", and "more accepting", they considered older people as "closed-minded", having "black and white thinking", and viewing sexual orientation as dichotomous, as if one is either only gay or heterosexual.
When discussing older people's conservative sexual attitudes and alleged disapproval of various sexual orientations and gender identities, respondents brought up the topic of cohort effects. They assumed older people were impacted by societal and cultural norms that were common while they were growing up. According to 10 participants, older people were raised learning sex was a private matter not to be discussed and that some sexualities (aside from heterosexual behaviours) were not legitimate. Participants explained that, although older people were considered closed-minded and conservative, they were "forced" into that mind-set, as they were raised and taught that being attracted to the same sex was wrong, forbidden, and stigmatised. In addition, respondents explained how today's Western media ties sexual experiences to appearance (attractiveness) along with sexual pleasure and performance. Respondents explained the media messages could cause older people to detach themselves from being sexual or force them to hide or conceal their sexuality. Respondents also noted how, for the younger generations, current media have created a different environment in which a range of sexualities have become more acceptable and available.
(3) "More Emotions Attached" A theme noted by 10.4 per cent of respondents concerned a distinction between emotional versus physical aspects of sex. Respondents believed that sex in later life is based more on emotions than on a physical need or urge. They thought that emotions are more significant for the sexual motives (why older people engage in sex), the importance given to sex, the sexual act (how sex is expressed), and the source of satisfaction derived by older people.
According to 14 respondents, older people's sexuality is based on an interpersonal connection and intellectual attraction. They are motivated to engage in sex because of intimacy, love, and passion, whereas younger people are motivated to engage in sex because of appearance (e.g., looks, physical attraction) or the need for physical release. The sex itself is assumed to revolve more around emotions and intimacy, warmth, nurturing, love, and closeness, and less around "performance". Older people are also believed to give more importance to feelings, intimacy, and passion rather than to the physical sensations of sex. Moreover, they are believed to be in greater need of the emotional aspects of sex and therefore desire more touch, strokes, hugs, and someone who would listen to them compared to needs of younger adults. Sex in later life is considered a venue to attain an emotional connection, affection, and warmth. Physical acts and "performance" lose their importance, as friendship, love, and personality become the central features of sex. The relational aspect was emphasised when later-life sexuality was addressed. As years go by, relationships are considered by younger respondents to be deeper, closer, and more intimate. This reflects why many participants believed older people are more respectful and accepting towards their partner, and more considerate when it comes to giving sexual pleasure in comparison with younger people who may be more preoccupied with satisfying themselves.
This theme could be understood in either a positive or negative light. It could be that older people reached the optimal sex, which encompasses physical pleasure with a strong emotional bond. An example of this is illustrated in responses which described how younger people engaged in sex to feel popular and loved, which makes sex all about "performance". Older people were described as engaging in sex as an act of love, and their sex as based on stronger connections and emotional closeness. However, when discussing the growing appearance of emotions in later life, younger cohorts imply that intimacy and friendship may replace sex in later life. This is demonstrated in responses in which feelings seem to overtake the sex act, as a 48-year-old man reported: "I believe that they [older people] give more importance to feelings than to physical sensations," or as a 26-year-old female described: "older people would invest more in friendship than in sexual aspects." (4) "People May Age, but Sexuality Is Part of Your Soul" Almost one fifth (18.5%, n = 25) of the participants believed that there is no significant difference in sexuality between younger and older ages. Furthermore, participants explained that if there are any differences in sexuality between younger and older ages, it is not attributed to the age of the person, but rather to other variables. Two participants emphasised this by writing that there is no built-in gap, and sexuality does not have to change when people age. According to six participants, sexuality is considered to be an individual aspect which varies among people, unrelated to their age. When sexuality changes, it is related to possibilities, dynamics, self-concept, and personal challenges. For instance, a 36-year-old female wrote: "Every person expresses his own sexuality in his own way." Two respondents emphasised that every age "has its own challenges" (a 25-year-old female) but also provides different dynamics and possibilities (a 28-year-old female).
Eleven respondents explained that sexuality in later life does not differ from sexuality in younger people: that sexuality is part of one's soul and an integral part of being human. Therefore, sexuality develops and changes according to life experiences, personal challenges, and growth. Four respondents stated that it is not possible to identify differences in sexuality by age, as sexuality is an individual aspect which varies by person and not by age.

(5) "With Maturity Comes Satisfaction"
A fifth of the respondents (20%, n = 27) thought that with maturity comes greater sexual satisfaction. They believed that as you grow older, you have more selfassurance; you are more confident about yourself and your relationship than when you are young. This enables older people to be more comfortable and vocal about expressing their sexual needs (e.g., frequency, how to reach orgasm).
Whereas younger people are considered to be at the exploration stage of sexuality, older people are considered to have already received a finer sense of their sexuality. Regarding this theme, it was common to find participants who associated sexuality in later life with greater experience. The experience was described as the main thing that "makes all the difference", as sexuality is something that requires learning, or as a 28-year-old female participant metaphorised: "Sexuality is a language you have to study", meaning that, with age, people are able to practice and metaphorically "speak" this language better than they did when they were young.
Older people were assumed to have their sexuality "worked out" or "figured out" already because they lived longer, had more experience (sexual and general), and also had stable social networks. They were believed to be more mature and developed emotionally, which affords them the time and space to explore their sexuality deeply. That is why their sexuality was considered "complete" and why older people were regarded as being sexually "developed". As one participant expressed it, "They know what they want." Some participants explained the rationale: that sexuality is part of the personality and soul. Individuals develop over the years, and so does their sexuality.
Another aspect that study participants referred to was the high level of confidence they assumed that older people have in general and in sex in particular. According to 10 participants, older people have more confidence and acceptance towards their bodies, relationships, and themselves. This was described by a 32-year-old female as a process and as progress, advancing over the years: "They grew up to accept themselves, who they are. Therefore, they might also have a better body image". A 23-year-old male observed: "Older people know themselves better maybe because they are more experienced or have a greater acknowledge of their personal strengths …". They are considered more self-assured, with fewer inhibitions and free from labels or peer pressure. They do not need to impress other people or prove something to someone, and therefore enjoy greater sexual freedom. Also, sexual fantasies which will not be put into action at this stage might never happen as explained by participants: "Older people might feel they have nothing to lose and if things don't happen now, they might never happen." The motivation to accomplish things in later life, combined with being free from social pressure was illustrated by a 28-year-old female: Older people, at some point, are tired of running away from whom they are and start managing their sex lives as they wish. If they don't have sexual desire, they won't force themselves into sex just to impress someone. However, if they are interested in something, they will do it "because 'life is too short".
In contrast, younger people were believed to have greater sex anxiety and insecurities, which can impact sexual satisfaction. According to six participants, younger people are busy with impressing others, and are more influenced by society and social norms. In addition, whereas older people's sexuality was considered "complete"meaning they had discovered and developed their sexualityyounger people were thought to be at the "exploration stage".
Finally, only three participants (2.2%) said they do not know if there is any difference in sexuality in later life (they responded "I don't know"). Because the number of people indicating they do not know was small, we did not classify it as a theme.

Discussion
Our findings revealed a complex picture regarding public attitudes towards older people's sexuality and indicated a large diversity within answers. The current study adds to previous literature as it not only classifies participants as holding positive versus negative attitudes towards sexuality in later life, but it also provides the meaning and deeper understanding of these attitudes. For example, participants who reported positive attitudes towards older adults' sexuality explained how sexuality develops as people age, and how the experience and maturity enable older people to be more confident and self-assured over their sexuality and, therefore, to enjoy it more than younger people. According to respondents demonstrating negative attitudes, sexuality in later life is believed to be conservative, narrow, and tedious; and older people are viewed as closed-minded, less adventurous, and introverted when it comes to sex.
Gaining a comprehensive understanding of what people think about sexuality in later life, more than just asserting that they are supportive or non-supportive of later-life sexuality, can be attributed to the methodology we chose for this study. By means of an open-ended survey, answers were not indicated to respondents in advance and were not expected to confirm the researchers' hypotheses. Instead, respondents could report their own opinions freely. This allowed us to collect descriptive information on public opinion towards later-life sexuality (Geer, 1988;Smyth et al., 2009). Note that respondents were not always precise or definite but described later-life sexuality in many ways. We captured a large diversity of perceptions, beliefs, and attitudes. Some themes reflected real changes in older people's sexuality, and some reflected positive and negative ageism, namely attitudes towards older adults' sexuality, merely on the basis of their chronological age rather than on facts. It is important to note, though, that the leading question used in the survey had directly asked people to differentiate between young and old sexuality. Hence, it is possible that we did lead respondents in this direction.
The present study also adds to the literature as it surveyed the young and middle-aged population on their views on later-life sexuality. The majority of studies on attitudes towards later-life sexuality were conducted among health care professionals such as doctors (Dogan, Demir, Eker, & Karim, 2008;Langer-Most & Langer, 2010) or nurses (Mahieu, Van Elssen, & Gastmans, 2011), care staff (Haesler, Bauer, & Fetherstonhaugh, 2016), or students in health care professions (Ewen & Brown, 2012;Gomez-Barba & Mendoza-Ruvalcava, 2018). Our present study fills the gap in the literature by providing the perceptions of a wide range of middle-aged and young people. In addition, our study was conducted in a cultural context that has received no attention thus far, namely, the Israeli context. Israel is a society in transition, which is located in the East, yet its population represents a true mixture of East-West influences (Lavee & Katz, 2003). Hence, Israel serves as a unique context to examine how sexuality in later life is perceived by the younger generation. This population of older adults was raised in a conservative societytheir parents did not discuss sex with themand so now is going through a period of relative liberation .
Older people experience various physiological, psychological, and social changes which can impact their sexual function. Sexual problems such as lubrication difficulties among women, a lack of interest in sex, inability to reach an orgasm, and erectile difficulties among men are all correlated with age and are common among older people worldwide (Laumann et al., 2005;Lindau et al., 2007). In our study, the theme "The world belongs to the young" referred to the loss of sexual performance and the decline in sexual function in later life. Responses that we coded into this theme included not only a description of sexual problems commonly experienced at older ages but also assumed that due to these problems, sexual activity was non-existent, diminished, non-enjoyable, or even painful.
The literature, in contrast, shows that age-related physiological changes do not necessarily diminish sexual activity and could be modified with various interventions and appropriate medication. In fact, in a nationally representative sample of U.S. older adults, sexual problems were not an inevitable consequence of ageing, but instead represented responses to the presence of stressors in multiple life domains (Laumann, Das, & Waite, 2008) and to various health issues (Lindau et al., 2007).
The second theme, "Old school, old-fashioned", referred to older people as holding more traditional beliefs and attitudes towards sex than younger generations. Sexual conservatism was, according to respondents, manifested in sexual mindsets (settled and introverted), sex practices (mild), and sexual orientation (heterosexual). These responses were explained by the cultural and societal atmospheres in which older people were raised. However, although older people were raised by parents who lived by conservative sexual norms , it should be acknowledged that many of the older adults today (baby boomers born between 1946 and 1964) in fact reached sexual maturity during the time of the sexual revolution and the feminist movement, which are characterised by increased openness towards sexual expression (Bradway & Beard, 2015;Rowntree, 2014;Vares, Potts, Gavey, & Grace, 2007). Moreover, current trends in society define heterosexual intercourse as the gold standard of sex and set high standards of beauty which are fuelled by the media (Gewirtz-Meydan & Ayalon, 2018;Hurd Clarke, Bennett, & Liu, 2014;Montemurro & Chewning, 2017). Older people who are not able to reach these standards are excluded from the discourse on sexuality and become invisible or irrelevant.
The third theme, "More emotions attached", referred to older people's sexuality as being more emotional than physical. This perspective was documented in another study conducted among young adults which viewed sexual expression in later life as involving much more than the act of sexual intercourse, including masturbation, foreplay, cuddling, emotional connection, and fooling around (Allen & Roberto, 2009). Indeed, previous studies show that older people take on a wider focus regarding sexuality than penetration and demonstrate that it is possibleby holding, touching, and cuddlingto be "intimate and close without having sexual intercourse" (Hinchliff & Gott, 2004;Sandberg, 2013). Sexuality becomes more meaningful, and emotional connection to others takes precedence over the physical expressions of sexuality (Lemieux, 2004). Sexual satisfaction is perceived by many older people to be a given within intimate relationships, and this relates not only to gaining pleasure for oneself, but also pleasuring the other (Hinchliff & Gott, 2004). Pleasure could stem from emotional tenderness and physical closeness without penetration (Wentzell, 2013). Such a move is particularly desirable as it moves older adults from a heteronormative perception which equates sexual intercourse with successful ageing and allows for greater variability of expression.
Note that this theme can have a double meaning. On the one hand, intimacy, warmth, and emotional closeness have been shown to predict sexual satisfaction (Rubin & Campbell, 2011). Therefore, this implies that older people enjoy greater intimacy, love, and affection, and therefore experience better sex. Nonetheless, we also identified comments which suggest that intimacy and deep friendship replace sex in later life, and that older people may share a close but sexless emotional bond. Yet sex is a matter of definition. Whereas for some older adults sexual pleasure is about bonding, intimacy, and closeness, for others the corporeal, embodied pleasure of having an orgasm is most central (Fileborn, Sharron Hinchliff, et al., 2017).
Respondents who wrote there is "no difference" suggested sexuality is an integral and central part of being human, and therefore older people do not differ from young people in that matter. Although it could be argued that there is no eminent difference between older and younger people in some of the core elements of one's sexuality (World Health Organization, 2006), other elements (e.g., reproduction) are in fact different and some may have gone through changes (e.g., practices, beliefs, behaviours). Differences can exist as a result of hormonal or biological changes, changes in the relationship status, differential sexual education and other psychological and social factors . In addition, older adults are confronted with sexual ageism (Hall et al., 1982), which can hinder their sexual expression and/or damage their sexual selfconcept. Claiming that there is "no difference" might sound liberating, but it could also disregard the changes and problems associated with sexual function in later life and the delegitimization, myths, and misconceptions surrounding sexuality in later life.
Finally, the last theme, "With maturity comes satisfaction", reflects participants' perception that sex becomes better as people age. This is consistent with previous studies conducted among older people who report that the quality of their sex improved with age Stahl, Gale, Lewis, & Kleiber, 2019). The reasons given for improvements in sexual relationships and pleasures were increasing knowledge of one's body and the ability to get pleasure from it (both alone and partnered), feeling more comfortable with partners, knowing their partner's body and sexual preferences better, an increased level of maturity, a lack of stress from raising children, and an increase in the stability and emotional intimacy of the relationship (Mannila, 2012;Vares et al., 2007). Older people felt more confident and comfortable in their bodies (Rowntree, 2014), and older women were better able to assert their sexual desire which was sexually liberating for them (Meah, Hockey, & Robinson, 2011;Rowntree, 2014).

Limitations and Future Research Directions
This study contributes valuable insight into public opinion on later-life sexuality. The findings illustrate that views regarding older adults' sexuality vary widely from ageist and negative to supportive and positive. A significant limitation of the present study is the recruitment strategy. When we advertised the study on Facebook groups organised with a specific interest in sexuality, responses we received may have been biased and reflected more-positive views of later-life sexuality.
In addition, although it is common to ask about differences in ages as it is an opportunity to receive complex and ambivalent answers, asking about the differences could have been a leading question as it assumed that there are differences. Relatedly, asking about differences in age may also have encouraged participants to focus on differences associated with chronological age rather than with other aspects. Although some responses included attitudes that matched two or more of the themes, every response was categorised only into one theme in order for us to quantify responses. This decision may have eliminated the possibility of our understanding the ambiguity and ambivalence of some participants' ideas, but it assisted us in quantifying public attitudes.
It also is important to note that the potential role of the authors (both women in heterosexual relationships) likely has shaped the analysis of the responses. Further investigation is needed in examining how these public opinions are perceived and internalised by older people themselves, and if and how they shape their sexuality and sexual expression. Finally, it would be interesting to further examine older adults' views on sexual orientation, and whether older people really have more conservative views on sexual orientation or if they are just portrayed in this way by younger people.

Conclusion
In some ways, these themes reflect the reality experienced by many older people. Some struggle with changes in their sexual function (Laumann et al., 2009;Lindau, Schumm, Laumann, et al., 2007); some were raised in conservative homes where sexuality was never discussed and women and men were encouraged to pursue traditional sexual norms and gender roles (Atallah, 2016). We have not attempted to promote a definitive attitude or set of thoughts for public opinion only because these opinions could sometimes match older people's sexual lives, yet sometimes be completely unfitting, misleading, and even destructive in describing later-life sexuality. Whereas bodily and hormonal changes in later life are evident, sexuality is expressed not only in behaviours and practices but also in emotional, cognitional, and relational aspects such as thoughts, fantasies, desires, beliefs, attitudes, values, roles, and relationships (World Health Organization, 2006). These components might change over time, but not necessarily for the worse.
This study has important implications because public opinion not only shapes reality but is also shaped by it. Therefore, the way young and middle-aged people think of later-life sexuality is likely to impact the behaviours of older people, constrain them and may not allow them to reach their full potential or, alternatively, the way they think about later-life sexuality could free them to explore, experiment, and behave as they wish and are able (e.g., Ayalon, 2018;Ojala, Pietilä, & Nikander, 2016).
Assessing how people think about sexuality is the first stage in instilling more liberating views about the diversity of sexual expressions in old age. We call for public opinion to acknowledge the large diversity which occurs in later-life sexuality and the complex yet unique dynamics and opportunities it brings. Also, it should be recognised that sexual activity in later life may not be important to all older people (e.g., Bergeron et al., 2017), and this should be kept in mind in order not to create a new stereotype (as opposed to asexual older people), whereby all older people should be sexually active in order to be content or age "successfully" (Katz & Marshall, 2004).