What the speculation about Joe Biden’s health can teach us about aging

I’m a physician dedicated to caring for aging adults, many of whom are living with cognitive impairment.

After his struggles in the June 27 debate, many speculated that President Joe Biden was suffering from a form of cognitive impairment — changes that from time to time, interfere with a patient’s ability to perform daily activities.

While it is impossible to know exactly what the president is experiencing without examining him — and it would be irresponsible to speculate about his condition — those who are struggling with this aspect of aging tell me this transition is challenging. As it unfolds, their day-to-day lives are subject to constant scrutiny. Their capacity to perform everyday activities is questioned.

Patients with cognitive impairment experience preoccupying, sometimes demoralizing, feelings of frustration. Close relatives and friends worry their loved one is scared and embarrassed

The speculation about Biden’s health may offer important lessons for all aging Americans and their families.

Biden’s problems have been intermittent. The June 27 debate revealed an accomplished politician struggling to perform a demanding task: debating. He showed problems with word-finding, attention, concentration, and multitasking. The 2024 State of the Union address was a sharp reversal. On that Thursday evening in March, he came across as sharp, witty, and on point.

Biden isn’t denying his problems. Notably, he admitted to a gathering of governors that he struggled during the debate and proposed adjustments to his environment. Biden is already seeking out supports — such as teleprompters — and I hope that he continues to do this.

I’ve seen in my patients how emotionally and ethically complex life can become when these supports are other people. The heart of this complexity is finding the proper degree of support, the fulcrum between too much support that then robs the person of autonomy and dignity, or not enough, which causes the person to commit mistakes and suffer harms.

Finding this fulcrum is especially challenging when the task being supported carries notable responsibilities, especially to other people, such as managing finances, practicing medicine, or running for President of the United States.

The continued focus on Biden’s age seems out of balance now that he is no longer running for reelection. Curiously, many are not holding Donald Trump to the same standard, despite his frequent ramblings and confusion of names and events.

A second lesson we can learn from the conversation about the president’s health is primarily cultural. Here is Pennsylvania, I was barraged by ads with the tag line “Joe Biden: dishonesty or dementia?”

Crushing stigmas permeate the lives of aging people, especially those living with cognitive impairments. Words such as “memory loss,” “dementia,” and “Alzheimer’s disease” are conjoined to negative attitudes and emotions. A person with one of these labels is mistakenly assumed to be incapable of meaningful activity and someone to be avoided.

These stigmas spill over to the patient’s family. People often treat a person labeled a “caregiver” differently from that same person who, prior to their loved one’s diagnosis and labeling, was simply a loving wife or caring son. Friends offer pity, or they just stay away.

Stigma causes people not to seek support, or when the supports they’ve cobbled together don’t work, to avoid seeking more help. The families I see at the Penn Memory Center often recount months struggling to convince themselves and their relatives to seek out an evaluation. In that time, needless suffering ensues.

The events of the last few months have been instructive. The individuals who lead America are, just like the millions who vote for them, at risk for frailty and decline. Unlike those millions, these events are unfolding publicly.

Jason Karlawish is a physician and co-director of the Penn Memory Center at the University of Pennsylvania. The opinions expressed in this op-ed do not represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.