Bridging policies and practice: challenges and opportunities for the governance of disability and ageing.

INTRODUCTION: In the context of an increasingly ageing society with a growing number of persons diagnosed with chronic disabling conditions including dementia and persons with disabilities, ageing and disability represent two policy fields which need to be jointly re-thought. So far, policymakers and other political actors have not adequately reacted to these changing demographics. DESCRIPTION OF POLICY AND PRACTICE: The two policy fields are based upon different presuppositions. Also, disability and ageing interest groups set different agendas. As several political actor groups with diverse interests and goals operate in the political space, efforts to bridge policies and practices in ageing and disability are confronted with several challenges. CONCLUSION AND DISCUSSION: In order to create a policy framework for disability and ageing, shared political priorities need to be developed. It is necessary to re-think current disability and ageing policies and the objectives formulated by diverse interest groups in both fields, and future policies should not only focus on 'active/healthy/normal ageing' vs. 'non-healthy/non-normal ageing'. Overlap of contents between disability and ageing policies exists with both fields informing one another. This mutual influence will shape policymaking and policy practices with regard to an ageing population with a growing number of persons with disabilities.

'The demented other': identity and difference in dementia.

This paper explores the impact of the concepts of identity and difference on demented persons (especially on persons with Alzheimer's disease). The diagnosis of dementia is often synonymous with the assertion that demented individuals are no longer capable of making reasonable decisions. But rationality is an important aspect of characterizing a person's identity. Hence, this prevailing image of dementia as a loss of self and a change of identity leads to the situation that demented persons represent difference and otherness. Here, the brain and the mind act as the source for difference. The paper discusses several identity concepts with regard to demented persons and the relationship between identity and difference in dementia. This analysis is accompanied by an examination of the current biopolitics of dementia and ageing as biopolitics constitutes the socio-political-medical understanding of dementia. Challenges and possibilities for dementia care will be explored in the context of this complex relationship between theoretical concepts and political, medical, and health-care practices.

'Self-care without a self': Alzheimer's disease and the concept of personal responsibility for health.

The article focuses on the impact of the concept of self-care on persons who are understood as incapable of self-care due to their physical and/or mental 'incapacity'. The article challenges the idea of this health care concept as empowerment and highlights the difficulties for persons who do not fit into this concept. To exemplify this, the self-care concept is discussed with regard to persons with Alzheimer's disease (AD). In the case of persons with AD, self-care is interpreted in many different ways-depending on the point of view, for instance as an affected person or a carer. To prevent a marginalisation of the growing group of elderly persons with dementia, the article argues that concepts such as those of personhood, wellbeing, autonomy, rationality and normality have to be re-thought with regard to an increasingly ageing population. Taking into account that AD as a socio-medical construct has to be understood in the context of power relations, the article focuses on the mutual influence between the concepts of self-care and of AD and its possible impact on governing dementia and AD in particular. Michel Foucault's considerations on 'technologies of the self' provide the basis for the discussion of the self-care concept within existing societal power relations.

Relocating health governance: personalized medicine in times of 'global genes'.

To date, governance questions related to personalized medicine - the consideration of the genetic and genomic determinants of varying drug response in patients - have been primarily addressed in terms of ethical implications. However, an analysis of the governance of personalized medicine should reach further. At present, governance issues arise in the context of an ongoing dispersion of national regulatory power. Due to the growing complexity of society, it has become impossible to govern society from a single center or by means of a single privileged governance mechanism. Governing increasingly includes the active participation of nongovernmental and individual actors by means of creating informal norms of conduct. Personalized medicine, due to its core concepts, fosters the emergence of new alliances (private and public, regional and global, for-profit and for-health) and thereby bears the promise to bridge some traditional dichotomies. Much rather than the quest for individualized drugs, it is this characteristic of personalized medicine that attracts so much attention from outside the medical and life science field.