First, a couple of facts. The average life expectancy for a 75-year-old male in the United States is currently 11.2 additional years, with seven to 10 of those years considered “active,” meaning without disability. Those numbers are higher for white men and college graduates.
Our general view of aging in the United States is filled with myths about how old age equates to disease, disability and dementia. Nothing could be further from the truth. While increasing age carries increasing risk of disease and disability, the effect is surprisingly modest: A generally healthy 60-year-old man has a 4 percent risk of stroke or heart attack in the next 10 years, a risk that increases only to 15 percent for a similarly healthy 75-year-old man.
Another myth about aging is that it is all about loss. There are well-documented positives, as well, including increases in some aspects of intelligence, managing conflicts (might come in handy in the Oval Office) and handling our emotions.
The older people become, the less like each other they become. While many physical and mental functions might decline with advancing age on average, for most measures there are many older persons who perform as well as the average young adult, and well-educated, financially secure individuals are especially likely to be among them.
In the current era of multiple televised debates, we have ample opportunity to evaluate candidates’ intellectual performance and logic. Nonetheless, there is, of course, concern regarding the likelihood of an older president developing cognitive impairment. Here again, the general public view may exaggerate the risks. If we exclude individuals with clear evidence of dementia that would be obvious in a debate, the next concern is mild cognitive impairment (MCI), which is much less severe but can impair some functions. For individuals in their 70s, the overall prevalence of MCI is 10 percent, and it is lower among those with a college education.
Since diseases vary dramatically in their severity and effect, simple lists of diagnoses are often not helpful. For instance, telling you that a 75-year-old man has a past history of diabetes, high blood pressure or heart attack does not help you decide whether he should be in a nursing home or on the Supreme Court.
As heart disease and stroke are very common causes of death and disability for those in their 70s, the American College of Cardiology and the American Heart Association provide a risk calculator based on gender, race, total cholesterol, HDL cholesterol, systolic and diastolic blood pressure, current use of medications to treat high blood pressure, presence of diabetes and smoking history. While we hardly need, nor would likely ever see, all this information, it might be useful for each of them to disclose their overall risk score.
I should note that this risk scale is valid only for individuals without a prior history of heart attack or stroke. Obviously such a history would carry higher risk.
What about stamina? Aren’t old people always dozing off? No. Obviously, successful service as president (as well as enduring a presidential election campaign) requires a sustained high level of functioning, though we should not exaggerate the negative impact of physical limitations or discomfort. Remember, Franklin D. Roosevelt was disabled and John F. Kennedy suffered from severe chronic back pain. Also note that one of the myths about aging is that older persons require less sleep: They still need a good seven to eight hours to maintain optimal alertness.
Other lifestyle issues are also important. Being physically active is an ingredient in successful aging, but the requirements are often exaggerated and more is not always better. In general, 30 minutes of exercise five times a week provides ample preventive health care value. As for diet, individual issues (cholesterol, diabetes, weight) are more important than age. And a little extra weight in old age carries little risk.
What else should we know?
Again, purely diagnostic labels (such as arthritis, diabetes, history of depression), as well as family history, are of little value in folks this age. Functional impairments and chronic health issues that require active management are generally more informative. And it would be nice to know whether we’re being asked to vote for a non-recovering alcoholic or drug addict.
In sum, advancing age should not be a disqualifying criterion for suitability to the presidency. While it carries some modest health risks compared with younger individuals, let’s not overlook that it can also bring some advantages, including experience and wisdom.