Ann Leahy, PhD.
It is said that finding the words is a step in learning to see . ‘Disability’ or ‘disabled’ are words not always used about people experiencing impairment in older age. If we experience, say, mobility limitations as we age, we tend not to be considered ‘disabled’ in the same way as children or young adults might be [2,3]. This was one starting point for a study I carried out in Ireland exploring physical and sensory disability through interviews with older disabled people and people working in social care.
As in many other countries, Ireland's public services are separately organised for older people and disabled people with age 65 as the boundary. I explored this with policy-makers, social care providers and advocates in the two fields of disability and ageing .
A key finding related to language. There was often no concept of ‘disabled older person’ except for someone ageing with lifelong disability. Participants simultaneously acknowledged that older people could experience impairment or disability with ageing, but not be seen as ‘disabled’. Instead, they were seen as ‘elderly’ or ‘older’. Some stressed the importance of positive images of ageing, but lacked a language with which to discuss people who do experience disability with ageing – other than it being implicit in ideas about marginalisation or exclusion.
I found that these understandings (of what it is to be older and impaired) were related to the separate policy/service frameworks for ageing and disability within which participants worked. This meant that some considered it appropriate that services should have different aims for the two groups. For example, some characterised what people experience in older age as ‘decline,’ closely linked to end of life, and perceived that services for them were appropriately medicalized and narrowly focused. By contrast, the aims for disability services were perceived to appropriately incorporate social participation and self-direction and to include rehabilitative aspects (even if services sometimes fell short of their aims in practice). Participants sometimes made it clear that this thinking was influenced by funding pressures and their perceived need to focus on their existing client group.
Other participants took a different view. In fact, most study participants critiqued the over-medicalisation of services for older people and the consequent inattention to social and emotional needs – several instanced how this could result in a task-based approach that did not meet service-users’ needs. One stressed how the two sectors fail to learn from each other. But even participants who disputed the domination of medicalized approaches to care for older people often lacked terms with which to discuss people first experiencing impairment in older age (other than ‘elderly’ or ‘older’).
Those participants who did use the term ‘disabled’ of older people with impairments came from the non-profit disability sector and invoked a biopsychosocial model of disability. Several referred to the U.N. Convention on the Rights of Persons with Disabilities as providing a definition capable of encompassing both people experiencing disability with ageing and those ageing with long-standing disability. For example, one felt that inadequate services to support older people to live at home in Ireland was a disability issue and a human rights issue, though not generally recognised as such.
The definition of disability in the Convention on the Rights of Persons with Disabilities is a biopsychosocial one in which disability is said to arise from the interaction of individual conditions with contextual factors, including the natural and built environment, support and relationships, attitudes, services and policies . By contrast, medical definitions dominate in the field of ageing. In other words, impairment in older age is seen as an individual, bodily issue, not something contributed to by broader environments in which people live.
One of my conclusions is that different understandings, different languages and separately organised and funded policy/service frameworks are factors in the maintenance of what one of my participants called ‘false dichotomies’ operating between the fields of ageing and disability. One implication is that even though the term ‘disability’ can be contentious , applying a biopsychosocial or interactional understanding of disability to the issue of older people experiencing impairment may be a prerequisite to bridging the separate fields of disability and ageing. It might also help with identifying broader societal causes and contributions to the experience of disability in older age.
In short, shared concepts around the issue of impairment and disability are needed to open up a dialogue between the policy and scholarly fields of ageing and disability. I am reminded of the line, ‘Naming these things is the love-act and its pledge,’ from Irish Poet, Patrick Kavanagh , in which he asserts the importance and transformative power of naming ordinary things.
 Popova, M. How naming confers dignity upon life and gives meaning to existence. [Online] https://www.brainpickings.org/2015/07/23/robin-wall-kimmerer-gathering-moss-naming/Accessed May 14 2018
 Priestley, M. (2002). Whose voices? Representing the claims of older disabled people under new labour. Policy & Politics, 30(3), 361–372.
 Priestley, M. (2006). Disability and old age: or why it isn't all in the mind. In D. Goodley, & R. Lawthom (Eds.). Disability and psychology: Critical introductions and reflections (pp. 84–93). Basingstoke and New York: Palgrave MacMillan
 Leahy A, 2018. “Too many ‘false dichotomies’? Investigating the Division between Ageing and Disability in Social Care Services in Ireland: A Study with Statutory and Non-Statutory Organisations”. 44: 34-44 Journal of Aging Studies.
 World Health Organization and the World Bank (2011:5). World report on disability. Geneva: World Health Organization.
 Graby, S. (2015). Neurodiversity: Bridging the gap between the disabled people's movement and the mental health system survivors' movement? In H. Spandler, J.
Anderson, & B. Sapey (Eds.). Madness, distress and the politics of disablement. London: Policy Press.
 From Patrick Kavanagh’s poem, Hospital. See Kavanagh, P. 2004 Collected Poems. Ed, Quinn A. London: Allen Lane.
By Sue Lukersmith (Univeristy of Sydney), Michael Millington (University of Sydney) and Luis Salvador-Carulla (Australia National University)
For more information on this post, please do not hesitate to contact Sue Lukersmith at firstname.lastname@example.org)
Case management makes a unique contribution towards the long-term care, participation and support of a person with a complicated health condition. Case management is used in diverse contexts yet goes by different names. We see case managers from different health and social care backgrounds working in hospital, rehabilitation, long term care and community settings to support people with disabilities, older persons and chronic health conditions. Case management is a complex intervention. The complexity arises from the interaction of the different components: the model (theoretical basis), implementation context (service), population and health condition, the goals of the person/their family, the focus (target) and what the case manager does (actions). There is no common language because of the complexity and variability in case management, which impedes practice, quality analysis, policy and planning.
Over 18 months, Australian researchers developed the taxonomy of case management for a common understanding and language using different methods. The taxonomy identifies the components of case management and their relationship (two taxonomy trees) and provides a glossary. The service tree comprises acute, mobility and intensity characteristics. The intervention tree comprises nine main actions, 17 actions, 8 related actions of case manager interventions. It was developed over 18 months using different methods in four steps
After testing for feasibility, the taxonomy was disseminated to more than 50 different groups of people in 11 countries through personalised presentations or non-personalised methods such as conferences, and internet based media. The people exposed to the taxonomy came from International organisations, policy makers from macro and meso organisations, research, education and training sectors, and service delivery. Six months later the researchers assessed the impact of dissemination and how it had been used.
There was shown to be highly acceptable and practical as a tool in different sectors The case management taxonomy had been used as a common language and framework to better understand what is case management. Case managers and services had used the taxonomy in their day to day work and business structures. It was adopted into meso organisation policy, the concepts and language had been adopted in international frameworks, embedded in tertiary education and used in research.
Ageing and disability: the role of financial and regulatory incentives in facilitating intersectoral collaboration
By David McDaid and A-La Park
David McDaid is Associate Professorial Research Fellow and A-La Park is Assistant Professorial Research Fellow, Personal Social Services Research Unit, London School of Economics and Political Science.
The deaf-blind author and pioneering advocate for people with disabilities, Helen Keller, once said “alone we can do so little. Together we can do so much”. Too often organisations can be isolated within castles in their own fiefdoms when in fact there are opportunities to put down the drawbridge and collaborate with others including the public, policy makers, practitioners, and yes, even researchers, to address issues of mutual interest.
The issues of ageing and disability present one area where the castle walls could be torn down, as there are so many common concerns and opportunities. As individuals age they may acquire the sudden onset of a disability or just experience symptoms of gradual functional decline. At the same time more and more people with disabilities acquired earlier in life are reaching older age. The ageing and disability communities can learn from each other.
These challenges are be celebrated as they mean that we are all living longer; but more efforts are needed to protect and promote quality of life and wellbeing for people ageing with disability. Governments will be mindful of the future costs of long term care due to increased longevity. Yet there are also opportunities; even slight improvements in health and/or in ability to maintain independent living, as well as achieving synergies in the provision of services, eliminating duplication of effort, are likely to have positive downward impacts on these future costs. It should not be forgotten that this population group are also consumers helping to stimulate the economy. In 2014 the UK Department of Work and Pensions estimated that all households with a disability had combined income of £212 billion after housing costs. Another analysis suggested a positive net contribution from older people to the UK economy of £40 billion in 2010 rising to £77 billion by 2030. There is thus a business and economic case to foster better outcomes in this population; but how can things be made to happen?
Recognising the importance of this issue, in 2012 a group of researchers and practitioners in the fields of ageing and disability drafted the Toronto Declaration on Bridging Knowledge, Policy, and Practice in Ageing and Disability. It stated that “bridging encompasses a range of concepts, tasks, technologies and practices aimed at improving knowledge sharing and collaboration across stakeholders, organisations, and fields in care and support for persons with disabilities, their families and the ageing population”. 
One way in which collaboration between different sectors can be encouraged is through the use of financial and regulatory incentives. There is for instance a significant literature on how financial incentives have helped facilitate joint actions between the health and social care sectors. We undertook a systematic review of literature over the last decade to find out whether there were examples of effective practice were to be found re ageing and disability..
The results were disappointing. The literature tends to focus on barriers to collaboration between these sectors rather than discussing solutions. In short we only found a handful of relevant examples. These include the use of incentives to encourage continued participation in work by older people with disabilities, incentives for stimulation of the market for assisted living arrangements and technologies as well as the benefits of rolling out personalised budgets and other forms of consumer directed payments.
So there is a real opportunity to address this deficit evaluate the use of financial mechanisms to stimulate interaction and bridge ageing and disability sectors. Encouraging lessons might be learnt from elsewhere. For instance in a recent review for the WHO Health Evidence Network on collaboration across sectors for health promotion, mechanism identified included the use of earmarked funding conditional on collaborative activity (usually from a ministry of health or local government, recurring delegated financing allocated to an independent body that works across sectors, mandatory or voluntary pooling of budgets between different organisations, tax incentives and specialist contracting arrangements.
There is also an opportunity to look at other factors that can influence the implementation process, such as assessing the impact of communicating all the costs and benefits relevant to each stakeholder of collaborative action, or looking at different ways of build cross-sectoral working relationships, especially where there is no past history of collaboration. What impact, for instance, does the co-location of ageing and disability organisation personnel have in establishing trust. The recent creation of BADIN may also provide a forum for stakeholder to share examples of experience in the real world where the drawbridges have been lowered and the castle walls torn down.
 Royal Voluntary Service. Gold Age Pensioners. Valuing the Socio-Economic Contribution of Older People in the UK. Cardiff: WVRS, 2011.
 Bickenbach J, Bigby C, Salvadaor-Carulla et al. The Toronto Declaration on bridging knowledge, policy and practice in aging and disability. International Journal of Integrated Care 2012; Oct-Dec; 12: e205.7
 McDaid D, Park A-L. Evidence on financing and budgeting mechanisms to support intersectoral actions between health, education, social welfare and labour sectors Copenhagen, World Health Organisation Health Evidence Network Synthesis Reports, 2016.
By Tamar Heller
Tamar Heller is is the head of the Department of Disability and Human Development at the University of Illinois at Chicago (UIC) and its University Center of Excellence in Developmental Disabilities.
By Michelle Putnam
Michelle Putnam is a Professor at Simmons College School of Social Work in Boston, Massachusetts and is the Chair of BADIN.
The Bridging Aging and Disability International Network (BADIN) started as idea about a way to bring people together who are interested in thinking about the shared interests across aging and disability research, policy and practice fields. The intention was to create a dedicated place, a named group, of people who could start to work through the ideas of what bridging means in theory and in practice and who could share that with others who are thinking about or doing this work. The founding members of BADIN all have different areas of expertise – we are an interdisciplinary group – but all are aware that the historical and still common bifurcation of disability and aging expertise, programs and systems tends to result in difficulties for persons aging with disability who do not neatly fit into either system. It also results in a loss of efficiency in a time where resources are scarce in all nations. Efficiency does not always need to be viewed as fiscal. In our BADIN group we also discuss lack of shared expertise and knowledge, effort spent on duplicate (or very similar) policies and programs, etc. as a loss. Our concerns are about systems and their effective operations but also about individuals and families who do not benefit – or benefit less – when aging and disability systems are in silos.
One substantial challenge for BADIN and the work that is does is in trying to lay out the specifics of what bridging is – what it means – but also to identify when bridging aging and disability is a good thing to do and when it might not be. Given that there is only a very emergent study of bridging aging and disability, it is really not clear when bridging should be employed, how it should be employed and what we can expect the effect of bridging to be. There is very limited scholarly or scientific knowledge about this. That said, BADIN members do know that choices are being made in the field among entities like long-term service and support providers to take on both older and younger clients with disabilities or to stick with just one group; among disability service providers who have traditionally serve younger clients about how they will meet their needs as they age, among researchers deciding on age cut-offs for sample populations and about inclusion of certain disability variables in studies, and among policy makers considering whether in creating or modifying programs and departments they should integrate aging and disability services, older and younger clients, etc.
We know that these types of choices and challenges are present in the work people do and that they can have substantial impact on the lives of persons with disabilities of all ages as well as older adults with disabilities. We intend for BADIN to both engage directly in trying to build a foundation of knowledge and place for discussion of this work. But we also intend for BADIN to be an entity that draws people into the discussion and helps to facilitate that discussion. I hope that if you are reading this, you will consider joining BADIN as we embark on this journey.
Jennifer Mendez, Ph.D., Assistant Professor, Wayne State University School of Medicine, email@example.com
Barbara LeRoy, Ph.D., Director, Developmental Disabilities Institute, Wayne State University, B_Le_Roy@wayne.edu
Edward F. Ansello, Ph.D., Director, Virginia Center on Aging, Virginia Commonwealth University, firstname.lastname@example.org
The following blog post was written by the authors and originally posted in the Spring/Summer 2013 Newsletter of the Association for Gerontology in Higher Education.
The population of people over the age of 60 worldwide is forecast to reach 1.5 billion by 2050 (Global Health and Aging Report 2011). Similarly, the World Health Organization and the World Bank estimate that there are over one billion people with disabilities, variously defined, throughout the world. Additionally, many individuals with disabilities can now expect to live nearly as long as their peers without disabilities, increasing the diversity within aging populations. The greater longevity of these populations will present unprecedented opportunities and challenges for families, communities, businesses, governments, and, of course, higher education. Increases in populations of adults with lifelong disabilities, as well as the increased life expectancies of adults with late onset disabilities, will result in greater numbers of individuals with chronic health conditions, such as diabetes, cardiovascular disease, cancer, and mental health disorders, and have implications for family and community care providers. Consequently, this dual phenomenon of global aging and increased longevity for individuals with disabilities demands a significant emphasis on public health and education.
Recent changes in federal agencies and programs are bringing aging and disability sectors together. For example, Health and Human Services has combined the Office of Aging and the Administration on Developmental Disabilities into the Administration for Community Living. This new title also reinforces the national vision of individuals being able to live within the community with supports and services throughout their lifespan. Similarly, Centers for Medicaid and Medicare is funding demonstration projects to integrate disability and aging health and community services into managed care programs.
These population, policy, and practice changes will require new professionals who have been well trained in an interdisciplinary approach to service provision across aging and disability populations to meet the care giving needs. This offers an opportunity for AGHE to take the lead in developing thoughtful curriculum responses to these opportunities. Core values to be transmitted to these professionals through a new aging and disabilities curriculum should include appreciation of heterogeneity; health and well-being; community inclusion and participation; choice and self-directed long term supports and services; income security; and sustained relationships. Related to these values, training should focus on the providers and societies to meet the needs of populations aging with and aging into disability; preventing and managing
age- and disability associated secondary conditions and chronic diseases; designing sustainable policies to support healthy aging and community-living as well as long-term and palliative care; identifying strategies to address the strains on pension and social security systems; preparing age- and disability-friendly services and settings, and fostering meaningful relationships within extended communities.