By Jerome Bickenbach
Dr. Jerome Bickenbach is a professor at the University of Lucerne and Swiss Paraplegic Research, Nottwil, and Emeritus Professor at Queen’s University, Canada.
Nearly thirty years ago the American sociologist Irving Zola noted that older persons and people with disabilities have traditionally been split by health and social policies into opposing camps that duplicate programmes and raise costs, and that is urgently needed are universal policies that recognize that the entire population is at risk from disability and growing old . He mused that, barring sudden death, everyone with a disability will age, and everyone who is ageing will acquire one or more disabilities. Recent evidence has confirmed his view. We now know that at least 15% of the European population experiences severe disability and that far more experience moderate levels . We also know that more people with severe congenital or injury-based impairments are living longer  and that, by the time a person is 70 he or she has nearly a 50% chance of experiencing severe disability . Indeed, if we are more realistic and take in account the reality of living with multiple, low- or medium-severity impairments across the spectrum of mobility, sensory, and cognitive domains, it is effectively inevitable that at some point along the aging process, people will experience some level of disability .
Despite these facts, throughout Europe, and around the world, health and social programmes and policies for adults continue to be segmented by age, and disability programs by impairment category, creating permanent ageing and disability policies, programs and services ‘silos’. This categorical segmentation has both generated and been reinforced by distinct fields of scientific and scholarly research, professional training, and even advocacy. The silo system dramatically increases social costs through service inefficiencies from duplication and the failure to take up opportunities for knowledge translation and co-funding. The silo approach has also meant that people in need of services can be left unserved, stranded between the ageing and the disabilities silos. Fundamentally, as one American researcher complains, the failure to bridge ageing and disability has yielded “age-based theories and conceptual frameworks, bifurcated scientific knowledge bases, parallel fields of professional practice, and system-specific ideologies, vocabularies and cultures of service delivery.”  It is hardly surprising that all of this is carried over to socially-entrenched self-images in which older persons will insist, for example, that they are not ‘disabled’, they merely have a harder time climbing stairs because of arthritis, and younger people with disabilities demand access to employment so as not be sidelined like ‘old, retired, folks’.
The irony is that people with disabilities, of any age, and older persons share common cause in many areas. Both groups profit from accessible public environments and protections against discrimination; both need access to assistive technologies from mobility aids to mobile phone apps; both suffer from autonomy-defeating assumptions about lack of capacity to make decisions about themselves; and both have long-term service requirements to live independently, with dignity, in their preferred communities. Bridging the fields of ageing and disability research, policy, and practice is critical for meeting these challenges. The experience of growing older with a disability and growing older into a disability differ – in part because of the different dynamics of ageism and ableism and the differences in economic and social conditions that result – but these life course trajectories present similar challenges and opportunities.
Arguably, both the ageing population and persons with disabilities have been utterly discounted in health and social policy, in Europe and elsewhere; they have been viewed as not part of the mainstream. This has resulted in their voices being silenced, and has made them passively dependent on the welfare system, thus removing them from community. The public perception of both disability and ageing have been produced in society through dominant forces, such as labour market exclusive , underwritten by programmes which offer pensions and other income supplements in order to remove them from the mainstream.
Undoubtedly, the social significance of ageing with and ageing into disability can be stark, given the difference in accumulated inequality experienced by those ageing with disabilities in terms of their health, social, and economic standing.  By the same token, the ageing and disability social identities can diverge significantly, not only across cultures, but across socio-economic groups within cultures. Yet, at bottom the link between ageing and disability is not contingent, it is conceptual. Although ageing is a complex biopsychosocial process, biologically ageing simply is a process of increased likelihood of acquiring impairments of some level of severity. Ageing is also characterised by multimorbidity, in which several low or moderately severe impairments, across mobility, sensory and cognitive domains, accumulate with the overall impact on a person’s life being far greatly than the level of severity of each impairment.
Moreover, conceptually, there is a broad consensus about the determinants of the ageing and disability experiences. Gerontologists agree that the experience of ageing results from physical change associated with advancing chronological age in interaction with the physical, social, cultural and economic environment. But disability too is now universally understood, not as a medical deficiency, but as the result of a complex interaction between intrinsic functional states of the person and similar environmental factors.  The experience of both ageing and of disability is therefore results of interactions between the individual and the individual's physical, human-built, attitudinal, social and political environment. This commonality is fundamental and profound.
Finally, in the last few decades, there has been a consilience at the international level on the recognition of the needs and aspirations of both populations. The culmination of international activities in response to the socially constructed disadvantages experienced by 15% of the world’s population who live with disability was the United Nations’ Convention on the Rights of Persons with Disabilities (CRPD) . The objectives of this ground-breaking human rights treaty are to guarantee to persons with disabilities respect for their inherent dignity, individual autonomy and independence of persons and to ensure that they enjoy full and effective participation and inclusion in society. Internationally, the World Health Organization (WHO) has been the most active in raising the banner for ‘active ageing’ , and across Europe, from the declaration of the European Year for Active Ageing and Solidarity between Generations,  and The European Innovation Partnership on Active and Healthy Ageing . And since 2010, a United Nations General Assembly Open-ended Working Group on Ageing has meet to assess whether the human rights of older persons were adequately addressed in existing international conventions and declarations or whether further measures were required.  Finally, only very recently, the UN Human Rights Council's Independent Expert on the enjoyment of all human rights by older persons, has submitted her final report, pointing to the insufficiency of existing human rights instruments regarding older persons. [14a] All of these efforts aim to optimise the health and opportunities of the ageing population to ensure full and active participation and inclusion in society. 
It is bears repeating that the need at the level of policy to ‘bridge’ the domains of ageing and disability is primarily a blunt issue of the efficiency and effectiveness of health and social policy. The existence of discrete policy silos creates service duplication and other inefficiencies, the removal of which improves not only efficiency but equity of care, inclusion and support at all levels, from the person to the society. More fundamentally, bridging embodies the recognition of the complexity of the human condition from birth to death, the capabilities of all people, and the need for a conceptual vision that takes into consideration planning for a society where participation and inclusion of all citizens are the ultimate goals. Finally, in light of the deep grounding of common cause between the disability and ageing populations, and the international efforts to formalize these concerns, bridging is fundamentally a matter of human rights
In simple terms, the metaphor of ‘bridging’ signals activities that bring the fields of ageing and disability together by creating pathways across domains for sharing existing and developing new knowledge in areas of professional practice, policy, and research . Operationally, bridging encompasses a range of concepts, tasks, technologies and practices aimed at improving knowledge sharing and collaboration across stakeholders, organizations and fields of care and support for persons with disabilities, their families, and the ageing population. Bridging tasks include activities of dissemination, coordination, assessment, empowerment, service delivery, management, financing and policy.  Attitudinally, bridging presupposes a strategic disentangling of stereotypes in both the domains of ageing and disability, suffusing and shaping the dominant disciplines of gerontology, disability research and health and social service fields, including social work and rehabilitation. Law and policy either reflect current stereotypes of ‘special’ disability or ageing needs, or reinforce them through legislative, judicial and regulatory stances.
The need to bridge ageing and disability for service, policy and research coherence and effectiveness has been recognized in several international declarations: the 2006 Graz Declaration on Disability and Ageing, the 2009 Barcelona Declaration on Bridging Knowledge in Long-Term Care and Support; the 2012 Linz Declaration: Independent Living for Ageing Persons with Disabilities; and finally the Toronto Declaration Bridging Knowledge, Policy and Practice in Aging and Disability.  All of these declarations urge multi-dimensional and intersectorial ‘bridging’ activities – new frameworks, methods of analysis, knowledge translation, professionals, service delivery models and policy designs – in order, finally, to recognize “…the complexity of the human condition from birth to death, the capabilities of all people, and the need for a conceptual vision that takes into consideration planning for a society where participation of all citizens is the ultimate goal.” 
Currently, the momentum for bridging is perhaps most powerfully felt in the United States. This has primarily been in response to the increased lifespan of people with intellectual and developmental disabilities and the blunt realization that long term care and other ‘ageing’ services were simply not available to them: these individuals were ‘disabled’ and only eligible for services acknowledged by the disability policy silo.  It was recognized that the most profound impact of the policy silos was the reinforcement of specialized practice and research domains single-mindedly focusing, either on older adults or younger people with disabilities, but not both. The situation was intolerable, so attempts have been made as early as the 1980s to bridge the policy domains specifically to strengthen the long-term care social service system networks. 
The very real and immediate objective of independence and community living, and the avoidance of institutionalized long-term care, was seen as the clearest example of common cause upon which bridging can build.  Increasingly at the research level, the domains of ageing and disability have ideologically converged on the fundamental belief that people not only subjective prefer, but objectively flourish, when their identities are integrated into cohesive social networks and communities. The shared service and human rights outcome of successful and supported community living has become in the United States the platform for supporting research related to bridge ageing and disability towards a bridged health and social policy re-envisioning, beginning with long term care.
The most emblematic example of ‘de-siloing’ in the United States was in 2012 with the reorganization, within the Department of Health and Human Services, of the Administration on Ageing, the Office of Disability, and the Administration on Intellectual and Developmental Disabilities under the umbrella of the Administration for Community Living (ACL) with the goal of ‘‘increasing access to community supports and full participation, while focusing attention and resources on the unique needs of older Americans and people with disabilities.’’ More concrete measures have built on the existing Medicaid programme, designed for older persons, to extend disability-related benefits to this population through what are called ‘rebalancing programs’ such as the policy ‘Money Follows the Person’. Other programmes have sought to avoid the duplication created by two discrete programmes providing essentially the same assistive technology, one for younger persons with, for example, mobility limitations, and the other for ageing persons with the same limitations caused by age-related impairments.
A related area where the interests and needs of the ageing and disability populations converge is in decisional autonomy, enunciated in the CRPD as ‘the freedom to make one’s own choices’ and under Article 12 as the right to ‘enjoy legal capacity on an equal basis with others in all aspects of life’ coupled with the support required to exercise that capacity. The number of people living with dementia worldwide in 2015 was estimated at 47.5 million, and is predicted to reach 75.6 million by 2030.  These numbers are increasing because of population ageing: the longer we live the more likely we will experience some form of dementia. As with individuals with intellectual impairments or mental health problems, people with dementia all too frequently are denied the fundamental right of autonomy, to make decisions about where they will live and with whom. Bridging ageing and disability entails, in this case, a radical revisioning of the autonomy of older persons, whether experiencing or not, brought about by advances in the domain of disability, and in particular the re-capturing of personhood achieved by the disability rights revolution.
It should be emphasized that "bridging" does not mean erasing, ignoring or avoiding the uniqueness of each social group. Older persons are not necessarily persons with disability, and persons with disability are not necessarily old. Moreover, the social, historical and psychological roots of ageism and ableism have different sources and theoretical foundations. From a politics of identity it is important not to diminish the uniqueness of each group's social identity. This only underscores the challenge of the "bridging" project.
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