As President Biden careened between economic and global crises last year, his aides began to grapple privately with a more personal issue.
Questions about Biden’s physical and mental fitness have hung over him since he began his presidential run in 2019 and have persisted throughout the first two years of his term. But as Biden prepares to turn 80 on Nov. 20 — potentially announcing a reelection bid shortly thereafter — the United States is entering unmapped territory: an octogenarian in the Oval Office.
The previous oldest president, Ronald Reagan, left office at age 77, and he was widely considered at the time to be pushing the boundaries of age for a chief executive. If Biden runs for and wins a second term, he would be 82 years old at his inauguration in 2025 and 86 at the end of a second term.
The Democrats’ better-than-expected performance in the midterms has eased Biden’s path to a reelection run, though aides say no decision has been made. That has left White House officials searching urgently, if quietly, for the best ways to fend off attacks and neutralize the age issue in voters’ minds, according to people inside and outside the White House.
Republicans often circulate videos of Biden looking confused or seeming to stumble over his words or his feet; while the videos are often taken out of context, aides in the West Wing immediately share them among themselves to keep tabs on the attacks and consider responses, said the people, who spoke on the condition of anonymity to describe internal operations.
The nascent White House strategy includes showcasing Biden’s ability to be quick on his feet when interacting with voters, increasing his travel to demonstrate his vigor and pointing to his accomplishments as evidence he can do the job. Some allies are pushing the White House to do more, like showing video of Biden running meetings behind the scenes, where they say his sharpness is more apparent.
Aside from minor physical changes, Biden has shown few, if any, signs of decline, according to medical records and interviews with more than a dozen people who regularly interact with him. Kevin O’Connor, Biden’s physician, observed last year that the president’s gait had become “stiffer and less fluid” since the 2020 election, highlighting a case of spinal arthritis and the lingering effects of a foot fracture.
In medical examination records released almost a year ago, O’Connor said Biden was “fit for duty” and capable of executing his responsibilities without complication. The report noted that Biden has a history of atrial fibrillation, takes blood thinners, and is on medication for cholesterol, seasonal allergies and reflux that has caused persistent coughing and throat-clearing.
“President Biden remains a healthy, vigorous, 78-year-old male, who is fit to successfully execute the duties of the Presidency, to include those as Chief Executive, Head of State and Commander in Chief,” O’Connor wrote in a November 2021 letter.
Former president Donald Trump, who was 70 when he took office, also faced regular questions about his age and mental fitness, particularly because he was prone to erratic statements and diatribes. Trump also maintained an unhealthy diet and seldom exercised. Trump has strongly hinted at another run for president, and if he is elected in 2024 he would be 78 years old at his 2025 inauguration and 82 years old when he completes his second term.
Biden is attuned to — and at times irritated by — the issue, according to several aides, who spoke on the condition of anonymity to discuss a sensitive matter. He has said it is fair for people to ask about his age, but he also seeks to downplay the concerns by pointing to his record of legislative wins and encouraging voters to “watch me.”
Biden takes steps to protect his fitness, exercising daily and maintaining a healthy weight. His schedule is noticeably lighter after a stretch of foreign travel, and he spends most weekends at his family home in Delaware, though aides say that is unrelated to age. Other presidents also had lighter schedules after foreign trips, they say, to catch up on domestic matters.
Broad statistics shed little light on particular individuals, but in general, health risks increase sharply after 80. Aging individuals are less resilient to accidents, falls and other unexpected events. Recovering from an episode that requires hospitalization takes longer for a person in their 80s than someone in their 60s, doctors say.
The odds of acquiring three diseases simultaneously rise tenfold between 70 and 80, then tenfold again during the following decade, said Nir Barzilai, the director of the Institute for Aging Research at the Albert Einstein College of Medicine. The risk of Alzheimer’s disease doubles every five years after 65, said Steven Austad, senior scientific director at the American Federation for Aging Research (and 32 percent of those 85 or older have Alzheimer’s dementia).
“Aging makes us more vulnerable to pretty much everything,” said Austad, who chairs the biology department at the University of Alabama at Birmingham. “Someone at that age would need to be monitored very carefully.” Still, he added, “I don’t see that age by itself would disqualify him.”
Stuart Jay Olshansky, a professor of public health at the University of Illinois at Chicago, said Biden’s staffers need to ensure that he does not fall and must protect him from even minor physical risks. “The fact is that once you get out to those ages, things go wrong,” said Olshansky, who studies the longevity of presidents. “And when they go wrong, they can go wrong very rapidly.”
For Biden, the challenge is political as well as medical. As he nears his ninth decade, he faces the uncomfortable reality that a growing number of younger Democrats and independents are calling for “generational change,” in addition to the Republicans portraying him, far less politely, as too weak or addled to lead.
Some Democrats concede the critiques may be effective.
“Republicans should be congratulated for continuing to raise an issue that I think has no grounding in reality but may have political advantage for Republicans,” said Sen. Chris Murphy (D-Conn.), who has encouraged the White House to confront the aging issue by letting voters see how the president operates behind the scenes.
Since taking office, Biden has provided a steady supply of missteps that his opponents call “senior moments,” though his self-described penchant for gaffes stretches back decades.
In the most striking example, Biden at a White House conference in September called out for the late Rep. Jackie Walorski (R-Ind.), appearing to forget that she had died the previous month in a car accident. “Jackie, are you here? Where’s Jackie?” Biden said, peering into the crowd.
Almost immediately, video clips of Biden asking “Where’s Jackie?” began to circulate on right-wing media channels. Conservative outlets such as National Review sent push alerts, and conservative commentators suggested invoking the 25th Amendment to remove Biden from office.
White House staffers struggled to respond; press secretary Karine Jean-Pierre kept repeating that Walorski had been “top of mind” for the president. Biden later apologized to the congresswoman’s family at a closed-door ceremony, according to people familiar with the episode who spoke on the condition of anonymity to discuss a private meeting. Aides contend that the sensitive apology was a better reflection of the president’s mental and emotional state than the on-camera gaffe.
But surveys suggest the age issue is breaking through.
A February 2022 Washington Post-ABC News poll found that 54 percent of Americans said Biden does not have the mental sharpness to serve effectively as president, up from 43 percent in May 2020. While 83 percent of Democrats said Biden was mentally sharp, that dropped to 34 percent among independents and 7 percent among Republicans.
Voters, meanwhile, are drawing their own conclusions. “Sometimes he’s there, sometimes he’s not,” said Howard Walker, a 54-year-old Democrat from New York who voted for Biden in 2020. “Sometimes he tells long grandma stories that go nowhere, which is what old people do. And that’s okay, but that’s not what we need in a president.”
When Biden began a speech this past month by saying, “Let me start with two words: ‘Made in America,’ ” it set off a cycle of derisive Republican responses. Sen. Ted Cruz (R-Tex.) took to Twitter to quip, “Two words: ‘dementia.’ ”
Biden’s aides are operating without an established game plan, and they are under pressure to develop one. Some allies suggest ignoring the attacks, describing them as a retread of a strategy that failed in 2020. Others urge Biden to address the issue head-on, using humor or highlighting the experience that comes with years.
Reagan, then 73, famously joked during a 1984 debate against Democrat Walter Mondale, 56, that he would not “exploit for political purposes my opponent’s youth and inexperience.” The quip carried the moment, but it did not dispel questions about Reagan’s age that persisted into his second term.
While Biden has said his health will be a key consideration as he decides on reelection, he has told advisers that he feels great and is energized by a job he sought for decades.
Biden understands that as the oldest president he will face scrutiny, but he feels equipped to do the job, a senior White House official said. The official is one of more than a dozen aides, lawmakers, strategists, medical professionals and others familiar with the president’s health interviewed for this story, many speaking on the condition of anonymity to discuss the highly sensitive topic.
At the deepest level, the White House argument is stark: Trump, Biden’s potential opponent, is 76 himself, exercises less and eats worse than Biden, and is given to public bouts of rage and incoherence. Biden’s allies also say that Trump is an overwhelming threat to democracy and that Biden has the best chance of beating him, making Biden the indispensable candidate whatever his age.
“I think generational power shifts are really important, but to me, this is an existential moment for our democracy,” said Murphy, 49, adding that his interactions with Biden have shown the president to be sharp. “We’re literally fighting for democracy’s survival.”
Trump, for his part, started attacking Biden’s physical and mental capacity in 2020 with the epithet “Sleepy Joe” and has continued to do so. “You’d blow on him and he’d fall over,” he said in a recent interview with Salem News Channel.
Lifestyle and environmental factors play a far larger role than genetics in how people age, said Eric Verdin, the president and chief executive of the Buck Institute for Research and Aging. “It seems [Biden] is doing all of the things one would expect him to do to maximize his health span and life span,” Verdin said. “Being very active mentally is a protective factor against Alzheimer’s and other neurodegenerative conditions. Obviously he has access to the very best medical care.”
Austad, of the American Federation for Aging Research, added that medical advances in recent years have significantly reduced the vulnerabilities of older people. “An 80-year-old today is not the same as an 80-year-old in the 1950s or 1960s,” he said.
In a 2020 paper reviewing Biden’s medical and family history, Olshansky described Biden as a “super ager,” noting that his parents both lived past 85 and that he had fewer medical issues and took fewer medications than the majority of his cohort.
Biden had his closest brush with death more than three decades ago, when he suffered from two brain aneurysms and had to undergo surgery to fix the balloon-shaped bulges on an artery wall.
Neal Kassell, one of two doctors who operated on Biden in 1988, said he had been “cured” and faces lower prospects of a recurrence than the average person. There have been no lingering complications, said Kassell, who has kept in touch with Biden since the operation.
“He’s not gotten any younger in the last two years, but one thing I can say is that he’s become more knowledgeable and informed and wiser than he was two years ago,” Kassell said. “I don’t see him particularly slipping.”
Still, for many Americans, the signs of Biden’s aging are evident. The president speaks with a fainter, more gravelly voice than he did earlier in his career, and his hair has gone white and sparse.
White House aides insist they never lighten Biden’s schedule on account of his age. “There isn’t any risk-averseness,” said Jen O’Malley Dillon, the White House deputy chief of staff. “He just doesn’t live his life that way.”
Biden has not suffered serious injury, despite a few tumbles in recent years. He fell and broke his foot playing with his dog Major at his home in November 2020, an injury that required him to wear a medical boot. He also tripped last year while walking up the stairs of Air Force One on a windy day. In June, Biden toppled off his bike near his Delaware vacation home after his shoe got caught in the toe cage as he was coming to a stop.
He had no visible scrapes, and such mishaps are not uncommon among cyclists using toe cages. But Biden was notably frustrated as video of the spill sparked a wave of media coverage of his fitness, two White House aides said.
Biden later made light of the incident; he rode his bike again a couple of weeks later and joked with reporters that he had taken the toe cages off. Still, he knew the image made him look old, the aides said.
But those close to Biden say he sees no health obstacles to pursuing a second term.
When Jim Messina, the campaign manager for President Barack Obama’s reelection, recently tried to congratulate Biden on a string of legislative victories, the president immediately mentioned the other things he wants to accomplish before leaving office. The exchange left Messina convinced that Biden is determined to seek reelection.
“There’s just no chance he’s not going to run unless there’s some health issue,” Messina said. “If you’re not fully with it, or you don’t know if you’re going to run, you start to think about burnishing your own legacy. And that’s just not where he was.”
At times, Biden has grown prickly over the regular scrutiny of his age, but he has taken to responding with a combination of light humor and an emphasis on his accomplishments. “How’d an old guy do that?” he joked on CBS’s “60 Minutes” after outlining his legislative record.
“They’ve been saying this about my age since I began to run,” he told CNN’s Jake Tapper this past month. “You can come work out with me in the morning.”
Aides generally echo that sentiment, saying that even on days with few official events and weekends spent in Wilmington, Biden is working long hours speaking to lawmakers and reading briefing books. With his 80th birthday approaching, Biden has set off on a week-long trip to Egypt, Cambodia and Indonesia.
But the prospect of a reelection bid continues to be a source of angst for some Democratic lawmakers. Several — including Reps. Elissa Slotkin (D-Mich.), Tim Ryan (D-Ohio), Dean Phillips (D-Minn.) and Angie Craig (D-Minn.) — have called for a fresher, younger standard-bearer to lead the Democratic ticket in 2024, using phrases like “new blood” and “generational change.”
Rep. Ro Khanna (D-Calif.), who supports Biden’s reelection, disagreed, saying a grandfatherly figure who conveys that “I’m here to tell you things are going to be okay” is a political asset because so many people are worried about the future. Khanna said he has urged the White House to let Biden be himself, even if that occasionally leads to uncomfortable moments on camera.
Biden’s aides believe that being president is significantly more demanding than running for it, said one senior White House official who was intimately involved in Biden’s campaign, and that showing him as an active, engaged president is the best way to push back on age concerns.
So when Republicans shared a clip of Biden saying, “No one f---s with a Biden,” during a trip to Florida after Hurricane Ian, apparently unaware he was being recorded, Democrats were happy to share it as well, believing it showed Biden as an animated, caring figure.
“By and large, the American people are pretty fair, and they understand that someone at the age of 80 is not going to be the same as someone at the age of 60,” Khanna said. “People get it. But that doesn’t mean that they don’t also realize a lot of the benefits — of wisdom, of life experience — that come with that.”
Scott Clement and Tyler Pager contributed to this report.