As one of Doctors who recently expressed concerns I have long been concerned about President Joe Biden’s health and the possibility that it may decline significantly over the next four and a half years, so I was both relieved and deeply saddened when he ended his reelection campaign. In essence, as people keep saying, he had his car keys and driver’s license taken away, with the whole world watching. When he gave a short speech about his accomplishments this evening at the White House, his voice was weak, he stumbled over his prepared remarks and he seemed less present than he had been.
For months, I had hoped to have Biden in my office, not as President of the United States, but as a patient in my geriatrics clinic. Instead, as I watched from afar as he made his case for running, I wondered whether his doctors were being honest about his worrying symptoms and his poor chances of fulfilling the duties of another term. If they were discussing his future, I hoped they would point out the benefits of taking the lead in this situation, even if there were no ideal options for Biden. But given what they and the president had said publicly before wrapping up his campaign, I worried that was unlikely to happen. Despite the fact that the U.S. population is aging, Few trained clinicians They cannot care for the aging body, much less discuss the realities that threaten the developmental stage and identity of older adults.
In medicine, Difficult conversations Refers to a discussion of existential issues, especially issues of essence. Uncertainty and ambiguity. It works best when patients have had the opportunity to express, perhaps in front of family and friends, their health status and their hopes and fears for the future, listen to their physicians’ opinions, and consider in greater depth the possibilities for the next few years. I might have asked the president what worries or scares him, what brings him joy or meaning, and tried to identify what the best- and worst-case scenarios would be.
Part of what made it so hard to watch Biden cling to hope for a second term was watching people struggle to accept that the best-case scenario might not be possible. These situations happen every day in doctors’ offices and hospitals, and they’re always heartbreaking if you have any empathy. But these difficult conversations — or the great silence that often replaces them — rarely happen in public. Watching this conversation reminded me of just how unwelcome these conversations are in American life, even in the doctor’s office where bad news is delivered.
Certainly, by denying obvious changes to the way he walks, talks, and looks, Biden has contributed to the painful public debate about the question of what the next four or five years of life will be. But his actions distinguish him from the more common choices and behaviors of age denial. Think of the gray hair that many over 50 try so hard to hide, the aged bodies they toil in the gym, the graduation dates they don’t have on their resumes, and the common falsehood that “age is just a number.” These choices and statements are responses to a culture that sees aging as a personal failing rather than the natural progression of an organism. And there are certainly reasons why people in this country fear aging. It can be very isolating, many are locked up in warehouses, Treated in a way that doesn’t make sense A healthcare system that cannot keep up with the numbers and needs of the elderly.
In this election in particular, Americans are being bombarded with signals that “elderly” and “disabled” are categories that no one wants to fall into. magazine cover He briefly expressed doubts about the aging of politicians and their ability to project a pedestrian image. Trump scoffed. A journalist with a disability Wounded VeteransIn March he He mocked Biden’s stutter.and his nephew Claimed today time magazine Trump has said that people with disabilities “should die” (a statement to which he has yet to respond). Pundits and politicians alike have simplified, distorted, belittled, and inaccurately generalized people over 70. Many octogenarians are cognitively and physically healthy and, like Biden, would have made excellent candidates at that age. People who use walkers or other assistive devices would make equally great candidates, regardless of age.
Biden may have furthered the public conflation of old age with infirmity by staying on the campaign trail even after his health began to become worrying. The driving analogy is apt: Most of us will have to retire from driving at some point, but it is a much more positive experience for those who can choose when to stop. Still, retiring from driving, or working, or anything else, may feel like a tough choice in a country where the Republican presidential candidate has repeatedly used his largesse to suggest that older people and those who are not perfectly healthy are unworthy of our sympathy or attention..
Ironically, Trump is the oldest man ever to be nominated for president. His claims of comparative physical fitness compared to Biden have put him in a precarious position. Though he doesn’t look frail, health records released during his presidency show he was obese, had high cholesterol and heart disease. He doesn’t drink or smoke, but Eat a lot of fast food He doesn’t appear to exercise much except for a slow game of golf. It’s impossible to diagnose someone from afar, but his multiple cases Inaccurate memory His incoherent and rambling speech calls into question his basic communication and leadership skills, and raises the question of cognitive changes beyond those of normal aging. If Trump came to my clinic, I would perform a physical and cognitive evaluation, just as I did with Biden. I would also explore his interest in healthier approaches to aging, given that many risk factors increase the likelihood of adverse health outcomes, loss of function, and death. I hope that Trump’s doctors are now having such conversations with their patients.
Biden must now have another difficult (but potentially inspiring) conversation with himself and his family about what happens next. Obviously, after 81 years, most of his life is over. He can’t choose how many years he has left. But with the privilege of free time and enough money, he can choose how to pursue his health and happiness. Most importantly What is the most fun for him and what he wants to do so that he doesn’t have any regrets at the end of his life.
Most people will never become president, so they will not reach old age with a list of regrets, such as stepping down and watching their opponent win. They will not think that they might have won after all if the best-case scenario had been possible. I hope Biden never has such thoughts. Instead, I hope he will choose a different best-case scenario and show new leadership, one that shows how to take advantage of the opportunities of old age, even if it is something as simple as making sure you get a full night’s sleep and spend time with your family.
