...from the attached Opinion by an Internal Medicine/Geriatrics physician, with nearly 40 years experience, who's also dealt with an Alzheimers afflicted father...
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For almost 40 years I practiced internal and geriatric medicine in my own office and in emergency departments, hospitals, skilled nursing facilities, rehabilitation units, and long-term care communities. This means that I have had thousands of face-to-face interactions with folks from all walks of life: I’ve observed them, diagnosed and treated their conditions, and monitored their medical journeys over years, even decades. I have spent a lifetime paying attention to people’s medical needs.
In a restaurant or the post office, at a school reunion or sitting in an airport, I cannot help but pick out among my fellow travelers in this life those who have a Parkinsonian posture, a hemiparetic or neuropathic gait, or the jaundiced conjunctivae indicative of liver disease. I spot hundreds of clinical clues that I have long watched for in my patients.
I myself am a septuagenarian, and I shepherded a father with Alzheimer’s disease and a mother with diabetes, chronic lung disease, a stroke, frailty, and finally a fractured hip through to their ends at home, each dying in their own bed at 87 and 93 years of age. I know what it is to watch aging up close — and now to age in my own body.
I’ve watched President Joseph R. Biden age. When he was elected to the Senate in 1972, I was a medical student in Philadelphia. During his years as vice president, I was deep into my medical career. The year he was elected U.S. president, I had recently retired from active practice. My work life was exhausting; I can only imagine what his must be like, especially now that he is 80. If he runs again and wins, he will be 86 at the end of his second term. In gerontological speak, at that age he will be among America’s “oldest old.”
He’s a bit stooped, his gait stiffer, and his voice less forceful. His lifelong stutter is mild but manifests at times. In addition, he has some difficulty with throat clearing. According to the publicly available records, his physician of 15 years, Dr. Kevin O’Connor, performed a comprehensive examination on the president on November 19, 2021, and again in early 2023. In his reports, Dr. O’Connor addresses all these issues in turn thoroughly, including appropriate consultations and procedures by ear, nose, and throat, orthopedic, cardiac, neurological, and gastrointestinal specialists.
President Biden’s stiffened gait is explained by arthritis of the spine, old sports injuries, and a relatively recent right midfoot fracture. A neurological examination showed “no findings which would be consistent with any cerebellar or other central neurological disorder, such as stroke, multiple sclerosis, Parkinson’s or ascending lateral sclerosis.” His workup did reveal that the president has esophageal reflux — a benign, common condition — as a cause of his throat-clearing.
Dr. O’Connor did note that the president has “a mild sensory peripheral neuropathy.” Appropriate potential causes were investigated — including diabetes, certain vitamin deficiencies, and thyroid problems — but none were identified. Another potential cause, excessive alcohol intake, is not an issue in this president because he does not drink. As Dr. O’Connor notes, “in up to 46% of cases [of mild peripheral neuropathy] a specific cause is not identified.”
But does he have dementia? This has become the focus of media attention on the president’s current age and health.
All but the most partisan of us can make a reasonably objective assessment of President Biden’s cognitive capacity by watching him on television. His 2023 State of the Union speech showed him to be lively, feisty, and able to engage appropriately and extemporaneously with the audience — as he also has done during interviews since that time. To this geriatrician, he is not exhibiting signs of dementia. Should he have formal cognitive testing as part of his yearly comprehensive physical examination? Of course he should, and the results should be made public. Indeed, why not ask for the same from all members of Congress over a certain age?
But, really, how long can Biden last — and remain mentally intact? This is the bottom-line question that his detractors, and even many of his supporters, want answered. And it’s a reasonable question because if one looks at standard actuarial tables of life expectancy based on age, one finds that an 80-year-old man will — on average — live another nine years. And the average 80-year-old man will — on average — have a 30% chance of exhibiting some dementia by this age, which increases by 3% yearly thereafter (Demography 2017;54:1897–1919).
But none of us are exactly “average.” The particulars of our backgrounds — sex, genetics, race, family history, tobacco and alcohol use, diet, and current health habits — have a collective impact on our life expectancy and on our likelihood of developing dementia. If one takes the time to enter what is known about the president’s health status (including laboratory results from his last two examinations) into a predictive algorithm, the results are quite different from average estimates.
President Biden’s life expectancy is 95 years (Thomas Perle, MD, MPH, Living to 100: Life Expectancy Calculator, https://www.livingto100.com). His risk of a dementia diagnosis in the next five years is 16% (Project Big Life, “Dementia Calculator,” https://www.projectbiglife.ca/dementia). There are a number of such predictive algorithms, and gerontologists may debate which ones may be more accurate than others. We might all benefit from their discussion.
Many in our society will look at a man (or woman) with thinning white hair, wrinkled skin, stiff posture, and throat-clearing episodes and judge that person to be “over the hill” or demented. But this is ageism at its most elemental and detrimental. This prejudice will damage each and every one of us as we age.
Geriatricians have long noted that one of the best predictors of how well the patient sitting before us will age in the future is how old and how healthy our patient is at that moment. Given the current health information available to us, President Biden is a healthy, mentally intact 80-year-old man.
None of us is able to predict with any certainty what may happen tomorrow. But we can cease being ageist: we can look at the objective evidence before us and use the tools available in an attempt to make some reasonable predictions. I hope politicians and pundits of all political persuasions will endeavor to do this with the goal of making America a fairer, healthier society.
Dr. Winakur practiced internal and geriatric medicine for 36 years and is an adjunct faculty member in the Division of Geriatrics at UT-Health San Antonio. In his memoir-manifesto, Memory Lessons: A Doctor’s Story, he writes about caring for his father with Alzheimer’s disease, and the changes he has witnessed in the practice of medicine. The author’s views do not represent those of the Society or any other entity.
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For an 80 yr old man, JB is clearly above average in physical health and mental acuity, thus the expectation of his living well into his mid-90's...as many of us have seen others do...but then, there are always the "most partisan" among us who will never take an objective perspective.
Link: https://www.caringfortheages.com/article/S1526-4114(23)00188-9/fulltext