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A geriatrician on the difference between Trump and Biden

A geriatrician on the difference between Trump and Biden

 


Nearly 50 years ago, I wrote a published letter objecting to the publication of Gerald Ford's complete medical examination, including genital and rectal examination. I thought this was inappropriate and that expecting such a level of disclosure would make it more difficult for women and men with an irrelevant abnormality to run for office. But I expected continued disclosure of conditions that actually affected job performance or survival.

This year's presidential campaigns have been a quagmire of misdirected attention and misleading communications. Kamala Harris gets off easy, since she has disclosed enough medical information, and neither this report nor her behavior shows any particular health problems. However, President Joe Biden and former President Donald Trump were both caught in the whirlwind, albeit differently. In my half century as a geriatric physician, I have served thousands of older adults. From my perspective, the public debate about the effects of aging on political leaders has been exasperating.

Biden has been widely criticized for being slow to walk and talk, and for having difficulty finding words quickly, including names. Although he has always had a problem with stuttering, which causes some slowing of speech, his command of English this year was clearly worse. Experts have attributed this to age, and some have suggested that it is a sign of insufficient intellectual skills, which are subject to progression and are likely associated with reduced life expectancy.

In my opinion, all this is irrelevant. What we need most in a president is a set of skills often called executive functions. These include the ability to sort through conflicting information, recognize important facts and differentiate them from unreliable information, judge the skills and temperament of others and build a functional team, give coherent reasons for decisions firm and thoughtful and able to develop strategies. and implement a plan. News reports have focused on word searches and slowed speech and walking, which are easily alleviated by aids, teleprompters, and tolerance, while ignoring those hard-to-complete executive skills that every citizen would want. at its leader.

Forcing presidents and candidates to share their medical histories is a terrible idea

Particularly infuriating was the desire to place older people in reduced capacities due to their age. Old age often brings experience, relationships, wisdom, and serenity, characteristics that are often lacking in young adults. Some syndromes become more common with age, but each older person faces their own unique challenges. To date, I am not aware of any deficiencies in Biden's executive functioning.

Trump is a much tougher case. Its current operation is based on a lifetime of skillful speeches and successful authoritarianism. He shows little interest in consistency or verifiable facts. He often launches into a bewildering array of topics and thoughts that are, at best, loosely connected. Many sentences are incomplete. His showmanship surpasses any serious consideration of his current leadership abilities. Certainly, his past performance leaves substantial doubt about his ability to build and lead a successful team, and he shows no willingness to take the facts and rules into account. However, these are long-standing problems.

The question of whether he exhibits new or worsened mental deficits is made difficult by his ubiquitous dramatic performances. One would need to know, for example, whether his public persona is an act he understands and strategizes to carry out, or whether it is genuine. In short, is there a different, more private Donald Trump who carefully examines the facts, thinks in full sentences, strategizes coherently, and builds a strong, competent leadership team? It would be impossible to truly understand this problem at this point in the campaign, but the available evidence does not support the belief that he has an inner Machiavelli who rationally plots a convincing charade. His former associates report that much of his behavior is consistent, particularly his insistence on long-contradicted facts and his willingness to act on an ill-considered whim. It is very likely that Trump has serious, long-standing deficiencies in his executive functions: he appears incapable of evaluating new information and acting on it, disinclined to ensure consistency and clarity, and limited in his ability to recognize and value skills beyond loyalty within one's management team. .

Age does not explain these gaps, and they are not particularly likely to worsen with age unless encouraged by life experience, such as gaining support from influential people, including voters . He may have age-related difficulties in processing information, but this would be difficult to distinguish using only the content of his public speeches.

Trump and Harris' vitriolic attacks on everyone's mental health are shameful

Disinhibition is a fairly common syndrome among advanced elderly people. Affected people say or do things they would normally repress, such as uttering profanity in a religious context or angrily expressing a harsh, long-repressed opinion toward a family member. One could argue that Trump has been affected for a long time, but perhaps he is increasingly inclined to say what he thinks in that moment, without filtering out random thoughts and inappropriate words. Still, focusing on aging is convenient for headlines, but less revealing than focusing on long-term behavior.

Trump also has remarkable physical conditions. He is obese, famously eats an unhealthy diet, has a history of high cholesterol, and doesn't exercise much. In 2018, his coronary calcium score was 131, indicating a moderate risk of a cardiovascular event such as a heart attack or stroke. This score is likely to get worse, even with medication. So, Trump probably has at least a moderate risk of disabling chronic illness or death over the next four years, but estimating this risk with confidence requires much more information. The fact that he hasn't been forthcoming about his health should weigh on voters' minds.

Strangely, the public discourse has not focused on the health of the vice presidential candidates. With violence becoming more and more common, we should know if they are fit.

Presidential campaigns are extended job interviews for a very important and demanding job. Our president must manage the executive agencies and appoint strong, competent, and thoughtful leaders. The president must manage foreign affairs and propose policy approaches that are both visionary and pragmatic. The president must earn the trust and respect of our people, our other leaders, and the leaders of other countries. These and many more are based on character traits, skills and experience. Physical health is important for endurance and survival. Deficits in brain function, especially if progressive, should be serious concerns. Biden has been criticized in the press, mostly for the wrong reasons. Until recently, Trump almost got a pass, with headlines mostly expressing tepid concerns focused on his age, rather than his long-standing deficits in skills, wisdom and character. The public and our journalists must learn to question and highlight the character and skills of each candidate, and refuse to rely on the overused and under-explained emphasis on age.

Joanne Lynn, MD, is a clinical professor of geriatrics and palliative care at George Washington University. She is the author of hundreds of articles and books, including The Mortal Handbook, and now works to improve long-term care funding through federal long-term care disaster insurance.

Sources

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2/ https://www.statnews.com/2024/10/30/trump-cognitive-health-executive-function-biden-aging-president/

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