Americans are not exactly thrilled about the prospect of a rematch between President Joe Biden and Donald Trump. Beyond voters’ tepid feelings about Biden’s performance and their more disdainful feelings toward Trump, there’s the matter of age. Biden is already the oldest president ever — older when he began his term than Ronald Reagan was when he left office. He’d be 86 at the end of a potential second term — and Trump is no spring chicken himself (he may spend his early 80s in the Oval Office or in prison). Though there’s no evidence Biden has suffered substantial cognitive decline, his physical movement and verbal dexterity both appear diminished, and he has kept a considerably lower profile than most presidents. As he attempts to turn his age into an asset as 2024 approaches, his advisers are taking special measures, like using note-card reminders and shorter sets of stairs, to try to ward off fierce conservative attacks and skepticism from the broader public.
But how likely is it that Biden will actually die in office, or decline rapidly, if he wins in 2024? And what about his rival? I spoke with Steven N. Austad, distinguished professor of biology at the University of Alabama at Birmingham and the university’s protective life endowed chair in healthy aging, about why he thinks Biden and Trump are well suited to keep chugging along and society’s common misconceptions about getting older.
In a recent Washington Post piece about age concerns around Biden and Trump, you said you don’t think age will be a major factor in the presidential race “unless something dramatic comes out during the campaign.” Did you mean that you don’t expect the candidates’ ages to affect their abilities over the next year-plus during a potential campaign? Or that voters shouldn’t be that concerned about electing either of them as president for another term?
I meant that at this point, they shouldn’t be worried about the candidates’ health. Clearly, age is so much in the news now, it’s going to be a consideration. No matter what, people are going to be thinking about it. I didn’t mean people shouldn’t think about it. It’s just that at this point there’s no reason to doubt their competency to fulfill the positions because of their age.
But beyond just the fact that Biden is 80 and Trump is 77, it’s easy to see why people have concerns. If you watch Biden from, say, his 2012 debate against Paul Ryan, he was much more confident in his speaking. And if you watch Trump from just a few years ago, he was much more forceful, faster, with a crisper delivery when he speaks — even if what he’s saying is nonsensical. Do these changes tell you much, if anything, about actual cognition?
One of the things that declines with age is cognitive processing speed, so it’s not surprising that they would talk slower and all that. Whether that affects the acuity of decision-making is another thing. This is where I’m not a big fan of presidential campaigns, because I typically think they select for traits that aren’t all that useful in actually governing.
I’m with you on that one.
But in this case, I think the pressure and the grueling pace of presidential campaigns is likely to tell us quite a bit about their current state of health. The biggest generality you can make about aging is that it affects people differently. Some people are 100 years old and still driving school buses, and some people are debilitated and drooling at 75. Clearly at this point, it looks to me like they’re both in reasonable health. It actually seems like Trump is in worse health, just because he’s obese. He doesn’t have good lifestyle habits.
And yet he’s perceived as — maybe not in better health per se, but as having changed less than Biden, mostly because of the way Biden speaks and presents himself.
Yeah. Biden has had speech difficulties his whole life — stuttering — and now he’s got an arthritic spine, and so he walks with kind of a stiff shuffle. As I recall, at some point he challenged Trump to a push-up contest or something.
The level of discourse is really high right now.
Exactly. But my feeling is that just from physical competency, not mental competency, they both seem like they can get around. Much was made of Biden tripping over that sandbag a few months back. But to me, somebody who thinks about and watches older people a lot, the important thing was that he caught himself. He didn’t hit his head, he didn’t get hurt.
He’s still got the instincts not to.
Yeah, exactly right. And to me, anybody could trip over a sandbag and fall, but a lot of older people would do that and they’d hit their face and they’d end up with a concussion. He seemed to be fine.
The Post article I mentioned cited a few different actuarial models, all of which suggest that Biden or Trump are quite highly likely to live through a second term if elected. But, of course, “not dying” is only one measure of performance. Let’s say Biden gets elected next year for a second term. He’d be 86 by the end of it. How do you view the odds of something serious going wrong with his physical or mental health, even if it’s not fatal?
Well, there’s no dementia in his family, which is one indicator, but stuff happens quickly. The older people get, the chances of being diagnosed with Alzheimer’s disease double about every five or six years. So it’s not something that you can completely discount, but you would hope that if something like that happened that there would be methods in place to deal with it.
But it wasn’t long ago that I actually read the clinical report on Biden from his last physical. I forget if it was last year or the year before, but it was very thorough. It was very thorough, and it didn’t hesitate to mention what medications he was on and all. I think that kind of transparency is increasingly important but probably less likely depending on who actually is the president.
I think one of these two contenders is a little more transparent than the other one.
Yeah, I agree.
As far as I can tell, neither of these guys have major health problems over the course of their lives. Neither of them drink or smoke. As you mentioned, Trump’s diet cannot be described as healthy. But all four of their parents lived to between 86 and 93. And, of course, they both have access to the best medical care that money can buy. How much does your and other people’s optimism about their longevity come from genetic factors alone and how much all environmental ones like their wealth?
I think it’s both. The genetic factors in aging are typically greatly overrated in terms of longevity for most of us.
Really? That’s disappointing, because my grandparents all lived past 90, and I was hoping I could just sort of coast from here on out.
The effect of genetics becomes stronger the later in life you look. So for all of us, the odds that you’re going to live to a certain age are about 25 percent genetic, but if you talk about people that live to 100, it’s a totally different thing. That really exceptionally long life is heavily genetic. Trump’s father had Alzheimer’s disease, but it was in his 90s, I think, that he was diagnosed with it.
But the other thing that plays into this is education and high SES, socioeconomic status. Those things are associated with better health and longer life. I think it’s pretty safe to say that both of them are well educated and they’re of high SES status. The odds are they’re going to be healthy through those years, but you never can be sure.
Running for president and being president are uniquely grueling tasks, as you were saying. I wonder if performing at that kind of intense level at an advanced age also has a salutary effect on life span.
I think that depends on the personality of the person doing it. In really stressful situations, some people are unflappable — they’re calm. Like astronauts, you think they’d be going absolutely crazy, and then you look at their pulse and it’s 75. So people respond differently to pressure. I think it could be good for the health of people or this could be bad. It depends on really how they respond to what most of us would consider to be highly stressful situations.
When Biden started his primary campaign in 2019, I thought, Whoa, he seems much worse than he used to. And then he actually got a bit better as the campaign picked up. Maybe it was just getting back into practice, but maybe he was also reinvigorated by what he was doing.
I think that’s true. The really old people that I’ve interacted with have really had this sort of calm about them and this unflappability no matter what happened. And I think that’s probably a very useful psychological attitude. And Biden, given all the personal hell that he’s been through … he’s got to have a very robust psychology, from my perspective.
Is there an age you would be uncomfortable with for somebody to run for public office? Or does it really just entirely depend on the person?
I think it depends on the person. People have talked about this for a long time — should there be a maximum age? And in fact, one of the early pioneers in aging research, a guy named Raymond Pearl in the 1920s, thought that voting rights ought to be taken away from anybody over 50 because they’d be too foolish.
Oh boy.
I can’t see having a hard, fast rule, but like I say, I think the nature of presidential campaigns is going to be pretty good at sorting out the ones that are just no longer capable of it. People do get better at decision-making, assuming they’re not demented. And Biden has 50 years of experience in how to deal with Congress.
Do you really think it’s that linear — that people get better as they get older?
Yeah, there’s actually objective data on what’s called wisdom. This is not surprising for most of human history.
Maybe not, but I don’t think it’s how most people view getting a lot older. They might think, You’ve learned some things by 60, but 80? You’re on the decline by then.
Right, but in ancient Sparta, you had to be 60 years old to be part of the governing council. And 2,500 years ago, 60 years old was probably more like 80 years old today. But there’s certainly a limit to that. And then as soon as dementia starts setting in, senility, then all bets are off.
You mentioned some things that people get wrong about aging earlier. What are the other popular misconceptions that you deal with?
Well, there’s this tremendous amount of ageism. It’s kind of the last respectable form of bigotry. So that people just assume that older people are less competent at just about everything. And certainly some things, they are. You’re not going to be a professional athlete if you’re 80 years old, and you’re not going to be a champion gamer, something that requires split-second decision-making. But on the other hand, people are generally more deliberate, they’re less impulsive, they make less spur-of-the-moment decisions. The thing I guess is that people just assume that age is associated with incompetence.
For some people, that’s true. Confidence men, scammers — they go after older people. And they go after older people because there’s more older people that they can take advantage of, and that’s because I think there’s a lot of subclinical dementia out there. But on the other hand, there are people that are writing their best books when they’re in their 80s. One of my old colleagues at Harvard, E.O. Wilson, wrote 11 books after the age of 80. That’s just incredible.
It is, although isn’t it rare for somebody to be doing their absolute best work at that age?
Yeah, it is rare. In some fields, like mathematics, it’s pretty much nonexistent. But there are people like Wilson. And a historian that I’m very fond of, Jacques Barzun, published his best book, From Dawn to Decadence, at the age of 90. And again, these are rare individuals, but people running for president are pretty rare individuals, too.
Some octogenarian politicians have not been doing so well lately. Mitch McConnell, for instance, seemed to have a medical episode in the middle of his speech the other day.
Yeah.
He’s had a number of falls recently.
Right, and he broke some ribs on one. That’s the kind of fall that seems to me more worrisome, especially if it doesn’t have any obvious reason, like you slipped on ice or something like that.
And then someone like Dianne Feinstein.
Yep, exactly. But as you just pointed out — some of them are still sharp as a tack and others are not.
Yeah, Chuck Grassley is 89 and he seems with it.
Right, yeah.
To go back to one thing you said — that aging makes people more different from each other. Can you expand on that a little?
Yeah, it’s like that famous line from Tolstoy, “All happy families are the same.” The thing with age, all 20-year-olds from a medical perspective are pretty similar, but all 80-year-olds are very, very different. They’re all 80 in their own unique way. There are people that are running marathons at 80. And like I say, there are some people that can’t get out of a chair. And that’s what aging does. It’s a combination of genetics and lifetime experience and lifestyle habits and all those things. But we have to remember that people who get to the point where they run for president are exceptional in a number of ways, or they wouldn’t be where they are.
They can withstand our endless election process, for one thing. And all the questions about their age.
I expect these conversations will accelerate as we get closer to the election. I think they’re good conversations to have. The political parties are going to try to make hay out of this. And I think the more accurate information that we get out there about aging and the more information we get about the candidates, the better off we’re all going to be.
This interview has been edited for length and clarity.
