Are the current candidates for president too old? A medical and psychiatric perspective:
A special commentary submitted by Dr. Brian Still for Focus Daily News
I was recently talking to a fellow physician about who he would vote for in the upcoming Democratic primary. I asked him, “so are you going to vote for Biden or Bernie?” He laughed and said “neither. It is dangerous to have a president that is that old.” It was a response I was not expecting. Is it dangerous to have a president that is that old? Is this age discrimination or does my physician friend have the right perspective? And, if so, where should we draw the line?
Until now, the oldest president in United States history to ever hold office was Ronald Reagan as he was elected at age 69 and ended his presidency at the age of 77.
Unfortunately, we have very little official guidance on this issue. The Constitution places a limit on the youngest age person that should be allowed to be president but does not place any limit on the oldest. Are we now in a place, given the current candidates in the race, that we should evaluate this position?
It seems that medical experts including doctors of multiple specialties such as cardiologists, neurologists, psychiatrists and basic scientists should be providing some degree of guidance on this issue. However, to my knowledge, there are no consensus statements from medical organizations regarding this topic. Along these lines, I wrote this article the goal of educating the public at large and to encourage an evidence-based discussion among medical experts. I am a physician that is medically boarded in psychiatry and thus some of my thoughts may reflect that specific background.
So let’s zoom out:
The average male life expectancy in the United States as of 2016 was 78.6 years. Of note, on average, women live approximately five years longer.
Accordingly, on January 20, 2025, upon completing their presidential term in office our current candidates would be:
Bernie Sanders 83 years old (5 years above life expectancy)
Michael Bloomberg 82 years old (4 years above life expectancy)
Joe Biden 82 years old (4 years above life expectancy)
Donald Trump 78 years old (At life expectancy)
Elizabeth Warren 75 years old (8 years under life expectancy)
Accordingly, of our geriatric candidates, all but Elizabeth Warren would be either at or above full life expectancy by the end of the term in question. This thought alone is a little concerning but life expectancy is a crude measure and does it mean anything? For example, I have heard the argument, “isn’t that what a vice president is for?” But are there more concerns at play? How about the impacts of the president’s health on the office itself? What about the concerns of their cognitive health? What if our next geriatric president spends more time in recovery from illness than managing the business of their office?
Over the last two presidential terms, many Americans on both sides of the political spectrum have become acutely concerned about the limits of presidential power. During the recent impeachment hearing, presidential powers and their lack of limits have become a much more imminent issue. At the end of this recent impeachment hearing, one would have to conclude that it takes an enormous amount of time and effort to remove a president from office and it is questionable if it is even possible in this political climate regardless of the concern. Accordingly, the office of the president has enormous unchecked power.
This places an enormous amount of responsibility on the American voter to evaluate the mental stability, physical fitness for office and judgment of the individuals running for the presidency. One could argue that the mental stability of the officeholder is therefore just as important if not more so than their stance on the issues. But what if the candidate has a risk that we can’t see before voting?
Above the age of 65, a person’s risk of developing Alzheimer’s disease or vascular dementia doubles roughly every 5 years. It is estimated that dementia affects one in 14 people over 65 and one in six over 80. Further, nearly 1 in 4 of people aged 85-89 have dementia.
Well, “I guess that’s what the vice president is for” right? Not so fast… Having worked on inpatient hospital dementia units for years if there’s one thing that is common and virtually universal in dementia it is a lack of insight. Specifically, the patient does not know they have dementia and are unaware of their impairment. Further, the loss of insight itself, makes erroneous decisions more likely.
Okay, so we don’t want a president with dementia but is that the only risk?
Mild cognitive impairment (MCI) is a cognitive state intermediate between normal cognitive aging and dementia. According to the Alzheimer’s Association, approximately 15-20% of seniors 65 years of age and over have MCI. This is of questionable significance concerning the development of dementia since some of these patients will revert to normal cognitive functioning and others will progress to dementia.
One question naturally becomes are there any candidates in the race who we should be particularly concerned about? The answer to this question is challenging since we do not require candidates to release their full medical records. Given the above concerns, not only should we request their medical records but we should be specific about the type of medical evaluation conducted.
One of the presidential candidates recently had a Myocardial Infarction or heart attack. This history of a Myocardial infarction suggests a higher risk of dementia in this individual. Specifically, this risk is thought to be increased by chronic reduced blood flow of the brain after MI. In addition, patients with myocardial infarction have a higher risk of ischemic and hemorrhagic strokes, both of which in turn increase the risk of dementia.
Regarding potential testing and requests voters should ask of this candidate, this may be its own debate but certainly anyone with a history of cardiovascular disease should have to release an echocardiogram describing any wall function abnormalities and an ejection fraction both of which would reveal any concerns of current reduced blood flow. Further, a Doppler exam of the carotid arteries may be appropriate as well. Of note, using cardiac magnetic resonance imaging (MRI) as a method to measure cardiac function, studies have demonstrated that a cardiac index, as a marker of overall cardiac function, is positively related to total brain volume and processing speed.
Another candidate had demonstrated multiple verbal miscues and speech irregularities. This candidate has a history of a stutter and this may explain these verbal miscues but a casual review of multiple speeches over the last ten years seems to demonstrate that they have been occurring more frequently in the last year. There could be multiple explanations for this effect such as decreased sleep or high anxiety. But given this candidate’s age and the desired office, it seems it would be inappropriate to not have a comprehensive medical and psychiatric exam including comprehensive cognitive battery testing.
Another candidate has a history of poor impulse control, vulgar speech, regular attacking of others and intermittent tangential speech. Again, there could be multiple explanations for this effect such as decreased sleep, the stress of impeachment or high anxiety. But given this candidate’s age and current office, it seems it would be inappropriate to not have a comprehensive medical and psychiatric exam including comprehensive cognitive battery testing.
1. Higher Risk of Vascular Dementia in Myocardial Infarction Survivors
Jens Sundbøll , Erzsébet Horváth-Puhó, Kasper Adelborg, Morten Schmidt, Lars Pedersen, Hans Erik Bøtker, Victor W. Henderson, and Henrik Toft Sørensen
Originally published12 Oct 2017
2. Clin Epidemiol. 2013; 5: 135–145. Heart disease as a risk factor for dementia.
B Ng Justin,1 Michele Turek,2,3 and Antoine M Hakim4,5,6,7.
Written by Brian Still, M.D.
Brian Still, M.D. is a physician specializing in psychiatry that graduated medical school in 2006 from the University of South Carolina School of Medicine. He has additional postdoctoral training in clinical pathology from Emory University. In 2011, he completed a residency program in psychiatry at the Medical University of South Carolina. He is board certified by the American Board of Psychiatry and Neurology and is a diplomat of the American Board of Addiction Medicine. He is an actively practicing clinician that currently serves as the medical director for Carolina Addiction and Psychiatric Treatment Associates.