The debate about Biden's age and mental fitness

President Biden has finally formally announced his bid for re-election in 2024 after months of reiterating his intentions to run again without making it official. Now that he has launched his campaign, Biden will once again have to face questions about his advanced age.

The president enters the race amid lukewarm support for his re-election bid in polls. An NBC News poll released earlier this month indicated that a Biden-Trump rematch in 2024 remains unpopular among most voters. Biden's announcement may have clarified questions about his candidacy, but questions about his mental competency and advanced age still loom. The president's age remains a significant issue for nearly half of the respondents against him running for a second term. 

Biden says he respects that voters have questioned his health and mental faculties due to his age and insisted he took that into account when considering whether to run again. "I took a hard look at it before I decided to run, and I feel good, I feel excited about the prospects," Biden said when asked about his age days after announcing his campaign. The most recent report from the president's physician, Dr. Kevin O'Connor, said he was "fit for duty" and "fully executes all of his responsibilities without any exemptions or accommodations."

Why is Biden's age so noteworthy?

President Biden is 80 years old — at age 78, he became the oldest person to assume the presidency in U.S. history. By the end of his term, he'll be 82. Now that Biden has officially confirmed that he is running for re-election, that means he'd be 86 by the end of his second term, eight years older than the average life expectancy for an American male. Ronald Reagan began his second term at the age of 73 and is widely believed to have suffered from Alzheimer's toward the end of his presidency.

The median age of American presidents on Inauguration Day is 55.

Is he showing signs of cognitive decline?

Not necessarily. Biden frequently stumbles over his words, but that could be at least partially because of his history with a stutter. Journalist John Hendrickson described Biden's stutter — and his lifelong struggle to control it — as the president's "most visible weakness" but also "the main source of his grit and determination." Senior care experts note that some forms of dementia can lead to stuttering and that childhood stutters sometimes re-emerge among elderly people, especially if they experience an increase in confusion or anxiety.

Last year, in an op-ed for The Hill, Marc Siegel noted that "at least 15 percent of those over the age of 75 have some cognitive impairment," that the president has several risk factors that could increase the likelihood of cognitive issues, and that the doctor's report following Biden's physical in Nov. 2022 found "a significant worsening in the president's gait, which in some cases can be related to degenerative disease in the brain or the spinal cord." That report also concluded that Biden was "fit to successfully execute the duties of the Presidency."

What are commentators saying about Biden's age? 

It might be "deeply unfair" to make assumptions about Biden's capacity to do his job because of his age. In his case, "it's impossible to deny that politics and conspiracy theories, rather than facts, fuel at least some of the concern," The New York Times editorial board opines. Still, Biden and other candidates shouldn't pretend that "advanced age isn't an issue." As Biden runs for re-election, he "will need to provide explicit reassurance to voters; many of them have seen family members decline rapidly in their 80s." 

Democrats should see Biden's advanced age "as a not ideal situation but one that's better than the likely alternatives," Matthew Cooper writes in the Washington Monthly. While Biden's satisfactory health reports have been "less than reassuring," Cooper says he has "been able to do the job well, and he's done it in better physical shape than previous presidents who overcame worse infirmities," such as Franklin D. Roosevelt, Woodrow Wilson, and Ronald Reagan. "Barring a cataclysmic health decline," Cooper adds, "Biden will be in better shape in a second term than Reagan, FDR, and certainly Wilson." Biden's age may be "unprecedented," but so would losing with his record, Cooper concludes.  

Based on his unpopularity in recent polls, The Wall Street Journal's editorial board believes the public understands "that electing an octogenarian in obvious decline for another four years could be a historic mistake." Asking people to elect a man who is already the oldest president to hold office "is a risky act that borders on selfish." While the Journal contends that the White House hides Biden's "real physical and mental state," the editorial board says, "his decline is clear to anyone who isn't willfully blind. "

What does polling show?

When Biden was a candidate in the 2020 race, his relatively strong debate performances and pandemic-driven minimalist campaigning strategy inspired confidence that, despite his age, Biden was still in full command of his faculties. Just before the 2020 election, voters "believed [Biden] was mentally fit by a 21-point margin," Politico reported.

That confidence didn't last. By Nov. 2021, 48 percent of voters said Biden was mentally unfit for office. Three months later, that number was up to 54 percent.

In the recent NBC poll, 70 percent of the Americans surveyed said Biden should not run for a second term in office, while just 26 percent said he should. 51 percent of Democrats voted against Biden seeking a second term. 48 percent of those against Biden running said his age was a major factor in that stance. Former President Donald Trump, who has also officially put in his bid, didn't fare much better with the poll respondents, with 60 percent against him running again. The survey was taken from Apr. 14-18, with 1,000 respondents and a margin of error of +/- 3.1.

About 3 in 4 Americans surveyed in the latest Associated Press-NORC Center for Public Affairs Research poll would prefer Biden didn't run again. Only 47 percent of Democrats polled want to see Biden on the ballot, yet 41 percent said they would support him if he ran, and another 40 percent said they might. "Interviews with poll respondents suggest that the gap reflects concerns about Biden's age," AP explains, "as well as a clamoring from a younger generation of Democrats who say they want leadership that reflects their demographic and their values." 

Update April 27, 2023: This article has been updated throughout to reflect the latest developments