As a geriatrician, I discuss the effects of aging with patients every day. I wish I had the opportunity to give my usual talk to everyone who laughs or tears their hair out at President Biden's suitability for his job.
First, memory. I explain to patients that there are three components to consider. One is training. Then storage. And finally, remember. The most common problem among older people is slow memory. This is the well-known “tip of the tongue” phenomenon, when a word seems to be hidden or a name does not come to mind. You know the name, it's in your memory bank, but it can't be accessed quickly. It usually comes with time.
This problem, called age-related memory decline, usually begins in people in their 30s and progresses gradually. It is a nuisance but not incapacitating. If, like me, you find yourself using the term “whatchamacallit,” you probably have it. Don't worry, you'll be fine.
Alzheimer's disease, the most common cause of dementia, is a different story. Those affected lose the ability to store new memories. They can still access old memories in their memory bank and can recount events that occurred decades ago. But they can't tell you what they had for breakfast because that never entered the memory bank. (I reassure my patients with age-related memory impairment by asking them if they remember their breakfast. They remember.)
Alzheimer's is cognitively crippling. Losing the ability to form new memories freezes one in time. Those affected cannot make new friends or face new situations without fresh memories. Additionally, the disease progressively affects other domains, including behavior and, ultimately, physical abilities.
Fortunately, President Biden shows no signs of Alzheimer's disease. At press conferences, he references new events and obviously creates new memories efficiently. He speaks slowly and pauses to find words like other people with benign age-related memory impairment. These problems are exacerbated by a chronic speech impediment. Biden has He struggled with stuttering since childhood, and the remnants of that condition have long been evident in his speech.
Unfortunately, hesitancy in words along with slight stuttering can't help but affect your public speaking. Biden's political opponents and uninformed people exploit it, along with stereotypes about older people, to create a false narrative about intellectual decline.
In my practice I care for many high-functioning seniors like President Biden. One I know, who is not a patient of mine, has been my family's attorney for five decades. Melvin Spears, 96, recently responded to an emailed legal question with concise and very specific advice, as he always has. When I spoke to him, he acknowledged some concessions to his age. He speaks more slowly and transportation is a challenge because he stopped driving. (He considers Uber and Lyft “a hassle.”) Like Biden, Spears focuses on his work and lets others worry about his age if they want.
Studies show that high-functioning seniors like Mel Spears and the president compensate for slower reaction time by applying superior knowledge and judgment. The presidency is not a job that requires lightning-fast reflexes. Firsthand experience with the successes and failures of American foreign policy over decades, for example, combined with time-tested judgment, offers much more than speed of speech or decision-making.
Actuarial tables show the 81-year-old president's life expectancy extends to nearly eight years, well beyond a second term. He receives excellent medical care, has no major chronic illnesses, and at his recent physical examination at Walter Reed Military Medical Center, he was declared “healthy, active” and “fit for duty.” All of that means Biden is likely to beat the actuarial estimate. Given his overall health and lack of current cognitive decline, he would likely complete a second term with stable cognition.
All candidates for political office in the United States deserve to be evaluated by their achievements and abilities rather than their age. Older people may be the last minority whose natural traits are mocked and stereotyped. If the American people disagree with President Biden's policies and prefer change, they should support his opponent. But in the absence of valid evidence of true cognitive impairment, your judgment should not be influenced by ageist social stereotypes. Biden and the American political process deserve better.
Daniel J. Stone is an internist and geriatrician in Beverly Hills.
