Growing Older With A Disability (GOWD) Overview: The GOWD conference will be an action oriented program, in that all presenters will be asked to consider one of seven major topical themes that affect the lives of persons growing older with a disability and give it context, i.e., does the work being presented impact improvements in practice, policy development or research knowledge?  There is also an eighth theme for cross-cutting theoretical and policy presentations that span one or more of the conference topical areas. A statement of this conference structure is being developed.    The following themes delineate the focus of this conference: Age-Friendly Liveable Communities Health Promotion and Wellness Health Equity and the Elimination of Health Disparities Health Literacy, Health Communication and Health IT Long-Term Care and Community-based Services and Supports Social Engagement and Participation Employment, Economic Security and Retirement Cross-Cutting Theoretical and Policy Issues Some of the above themes may overlap with other conferences in which case there will be joint sessions, shared keynote speakers, to encourage inter-conference dialogue. There will also be three streams of sessions focused on Research, Policy, and Best Practice.   Presenters will need to select their choice of presentation format -- posters, papers, and symposia, as well as their choice of keywords reflected in the following eight conference themes. 1.      Age-Friendly Liveable Communities In an era of major demographic shift, “community” means more than just a physical space; “community” is proximity to people and places, familiarity with one’s environment, access to community events and businesses, and opportunities to interact with and have common cause with other people. Age-friendly, liveable communities offer an array of resources and services and supports  that are inviting and user-friendly, meeting the principles of universal design, equity quality and participation. Age-friendly liveable communities promote independence, interaction and inclusiveness through accessibility and diversity. Concepts such as community hubs, coordinated services, neighborly interfaces, and animated engagement of all individuals apply. 2.       Health Promotion and Wellness Until recently, health promotion for people with disabilities has been a neglected area of interest on the part of the policy makers and the general health community. This gap in policy and programs is due in large part to traditional definitions that describe health and disability at opposite ends of a single health continuum. (1) Today, newer models of wellness are emerging that view health as multidimensional and see optimal health, as maximizing one's potential along various dimensions, including a dynamic balance of physical, social, emotional, spiritual and intellectual factors. When health is viewed not as the absence of disability or chronic conditions, but as the ability to function effectively in given environments to fulfill needs and to adapt to major stresses, then disability poses no obstacle to maximizing one’s health and wellness. (2) The aims of health promotion for people with disabilities are to reduce secondary conditions (e.g., obesity, hypertension, pressure sores), to maintain functional independence, to provide an opportunity for leisure and enjoyment, and to enhance the overall quality of life by reducing environmental barriers to good health. (1)  Physical activity and fitness, good nutrition, self-management for chronic conditions, stress-reduction, and social support are important for everyone in maintaining health and wellness. But they may be more critical for people with disabilities due to sedentary lifestyles and what has sometimes been described as a “thinner margin of health.” (2) 3.       Health Equity and the Elimination of Health Disparities Until recently, people with disabilities have not been included in the health disparities research and policy agenda in the same way that other vulnerable and underserved populations have (that occur by race and ethnicity, gender, education or income, geographic location, or sexual orientation).  Yet, emerging evidence suggests that individuals with disabilities experience equal, if not greater, disparities in both access to health services and in positive health outcomes compared to those experienced by other underserved and vulnerable populations. This may be particularly true for middle-age adults with long-term disabilities who report significantly higher rates of numerous chronic conditions, such as depression, obesity, osteoporosis, and cardiovascular disease, compared to their non-disabled counterparts.   To eliminate health disparities and promote health equity requires new knowledge about the determinants of disease, causes of health disparities, and effective interventions for prevention and treatment.  It will also require improving access to the benefits of society, including quality preventive and specialty services, as well as innovative ways of working in partnership with health care systems, federal, state and local public health agencies and governments, tribal governments, academia, national and community-based organizations health and disability organizations and advocacy groups.   The disparaity in health equity relates also to the lack of accessibility in everything, i.e. physical or built space, information technology, transportation, etc.  4.       Health Literacy, Health Communication and Health IT Health literacy—the ability to obtain, process, and understand basic health information and services to make appropriate health decisions—is essential to promote healthy people and communities. Health literacy is particularly challenging for individuals aging with and aging into disability because of physical, sensory, emotional and cognitive impairments and chronic conditions that may make accessing and understanding health information more difficult.  Health literacy for people with disabilities is also closely related to broader issues of accessible health IT, since increasingly more and more health information is disseminated electronically via the Internet. Another challenge to health literary is the complexity of available health information, which in many cases may be too difficult for the average citizen to make use of in health decisions.  Health care institutions, public health systems, and government regulatory agencies all play a critical role in health literacy, making it easier or more difficult for people to find and use health information and services.  Innovative approaches and application of existing best practices to developing and disseminating accessible health information, as well as new policy development, are critically needed to increase the likelihood that people with disabilities have access to the knowledge, resources and programs they need to make healthy choices, successfully manage their own health, and make the best use of limited health care resources. Accessible health information is also vital to creating an inclusive society that is responsive to the needs of all its citizens.  5.       Long-Term Care and Community-based Services and Supports  Now and in the future there will be more flexibility for individuals who need long-term services and supports, whether these are delivered in residential or congregate care facilities or in home and community-based settings. The need for long-term care and community support is for families as well as the recipients of care, and creates a supportive and secure environment for both.   Historically, long-term care by its very nature has implied institutional support, but today the hallmark is flexibility, responsiveness, accountability, appropriate, and individual while recognizing that organization of care does require efficiency and economies of scale. Generalization and specialization both apply.    Formal and informal care applies in the community as well as in a long-term care, residential facility.  Related issues include:  consumer choice, consumer-directed services, person-centered planning, direct funding or money follows the person. 6.       Social Engagement and Participation Recent evidence indicates that social engagement is vital to productive aging for people with and without disabilities in terms of improving functioning and increasing life satisfaction.  Broadly defined, social engagement refers to being part of a community and pursuing everyday activities in ways that are meaningful to individuals where they live, work, and socialize.  Participation, as defined in the WHO International Classification of Health, Disability and Functioning is also a key indicator of well being, and frequently reported as the outcome of greatest importance for people with disabilities. Unfortunately, however, people growing older with disabilities face unique challenges in maintaining social engagement and participation due to barriers associated with housing, public accommodation and services, transportation, communication, recreation, and access to services and supports.   The goal of GOWD is to advance knowledge about effective strategies to removing these barriers and enhance social engagement and participation for the growing segment of the population aging with disabilities. 7.       Employment, Economic Security and Retirement   People with disabilities continue to have a disparate, unequal level of unemployment and low income relative to the rest of the working age population.  While society in Western countries is experiencing two competing paradigms, people aging with disabilities are likely caught between them.  The first trend is to redefine mandatory retirement, eliminating age discrimination and inequitable social and economic policies, to allow the continuation of employment by skilled workers and knowledge workers especially with demographics showing labor shortages, income from pensions is inadequate, tax bases are reduced etc. At the same time, changes in health status, pension incomes and multiple choices for retirement make it very attractive for many still to seek early retirement.  The deciding factors seem to be health, income, and job satisfaction. Trends seem to be at odds and for planning purposes there needs to be more studies.  The boomer generation is expected to leave the workforce en masse and the transfer of wealth from their parents to take place; however, the world-wide recession may have a huge impact. Studies on work and mental health are relevant also. What prolongs life? Physical and mental health and happiness? Where then do people with disabilities draw opportunity and ? Do we have stats on who retires, use of health benefits, longer-term needs for retirees and the impacts of unemployment on older workers with disabilities? 8.       Cross-Cutting Theoretical and Policy Issues    This theme refers to broad cross-cutting issues that span more than one of the above seven topical areas and seek to improve the lives of people growing older with disabilities through innovative proposals for theory, policy and/or program development.