just asking questions

Talking to a Geriatrician About Age and the 2020 Race

Photo: Jim Watson/AFP/Getty Images

Representative Eric Swalwell wasn’t able to make much of an impression with just under five minutes of speaking time on night two of the first Democratic debates, but he did give voice to a growing concern within the party. “I was 6 years old when a presidential candidate came to the California Democratic convention and said it’s time to pass the torch to a new generation of Americans,” he said. “That candidate was then-Senator Joe Biden.”

Swalwell’s call to “pass the torch” isn’t the only evidence that Democrats have concerns about the age (76) of their leading candidate. “It’s the 78-year-old elephant in the room,” Fernand Amandi, an Obama-Biden pollster in 2008 and 2012, told Politico in June, referring to Biden’s age upon inauguration. Of course, Biden isn’t the only — or the oldest — septuagenarian going for the White House: Bernie Sanders is 77, Elizabeth Warren just turned 70, and President Trump is 73.

But how much stock should voters place in the age of their preferred candidate? And how does ageism affect the questions we have about 2020 contenders’ fitness for office? Dr. Louise Aronson, geriatrician and author of the recently released book, Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life, contends that the conversations around older candidates reflect changing ideas about aging in America — and that they could probably use a bias check. Intelligencer spoke with her about how politicians use ageism to undercut rivals, and when, if ever, a candidate’s age becomes a valid concern.

How do you feel about the way journalists and voters are talking about age in the 2020 race so far?

You do see things, like instead of saying, “I don’t like a candidate’s policies,” you’ll hear, “They’re too old.” I think old is a shortcut, and it probably sells, because most prejudice is inflammatory, and inflammatory things sell. We also know ageism is pervasive across industries, which means that it’s pervasive in the culture.

For older candidate’s competitors, it makes sense to push age, because it’s sort of a category dismissal of some of the people who are doing quite well. Age means they’ve been around longer, with experience and name recognition, which gives them an advantage. So ageism can be a way to try and undercut that.

I don’t see so much thoughtful discussion of the ways in which age could be a player. Which is what I tried to address a little bit in a Washington Post op-ed, talking about how, yes, your risks for certain things do increase with age, but so does your functional status and what you’re able to get done. From everything I understand, if you can survive a campaign, you should be able to govern. It seems pretty arduous.

Do you think that a race between two 70-year-olds could reframe how we think of older people in politics?

In some ways it’s a very visible manifestation of what’s happening in our society, where people in their 70s are the fastest-growing segment of the American workforce. There are two reasons for that. One is that Social Security and retirement benefits were set when we couldn’t live anywhere near as long, and now there are all these people retiring in their early to middle 60s. A huge percentage of them will live decades longer. So some people simply don’t have the money at that age to retire, they need to be making more money to survive.

Then other people find that it’s just boring or purposeless to be retired. A lot of people will take a year or two to recover from all the intensity of their adult job then ask, “Who am I, what am I doing?” We don’t actually know the number of older people working, because we only count work as paid things. All the people volunteering, all the care-giving that is done by older people — without which society falls apart — none of that is even in the counts that put them in the fastest-growing working group.

The election might help open our eyes as a society to the idea that what I’m calling elderhood is now decades long and has as many subphases as childhood and adulthood. So, let’s start talking about this. The leading candidates are in this “elder” category — look at what they’re doing.

When do you think the concerns about politicians’ age start to become valid? You wrote in your Post op-ed that “most healthy 70-somethings don’t die.” But on the other hand, most 70-somethings don’t have the hardest job in the world. There are also concerns about reelection: If Biden or Sanders were to win, they would be 81 and 82 in 2024.

Mortality curves are moving upward pretty steeply by the time people are in their 80s. The risk of a person, even a healthy person, getting something or dying does go up. And that’s not good for a country.

On the other hand, we say that if you’ve seen one 85-year-old, you’ve seen one 85-year-old. There are some who run marathons and some who run corporations and there are others that can’t really do anything. There’s such a range. What a person is doing now is the best predictor, but it’s not like clairvoyance.

But if somebody is going to be in their mid to late 80s, I am getting a little concerned at that point. The longer you live without cognitive impairment the more likely you are to go the distance, so that’s good. The more physically active you are the more likely you are to remain that way. I don’t know the answer for sure. Does it begin to make me a little more worried about whether the person would see through their term as they move into their 80s? It does. Do I think that should be the only criteria? No. But let’s say you have two candidates who are about equal — I might go for the one who’s in their earlier 70s compared to their later 70s, for the sake of the country having greater continuity. And that may or may not be fair.

Regarding our current septuagenarian president, how do you feel about the warnings from clinical psychologists who suggest his language — “Tim Apple,” claiming his father was born in Germany — are signs of “cognitive slippage”? The same psychologists stress that they can’t make the call from afar, but how do you feel about that trend of professionals carefully speculating about the president’s mental health related to aging?

Many mental health diagnoses are made based on behavior in conversations, unlike other diagnoses where you might need a blood test. So a few things: Is it theoretically possible to make a diagnosis by seeing a whole lot of a person’s behavior? Possibly, for a psychological diagnosis. On the other hand, there is some suggestion that some of this is him acting and doing a persona. So I don’t know from afar how to distinguish the roles he’s chosen to play from who he really is — aside from his long history of bankruptcy and sexual abuse, those appear to be pretty credible.

Is this about age slippage or just his personality? If you’re just looking at tapes from today, comparing them to older footage, I think it’s hard to say for sure. On the other hand, if somebody were behaving psychotic or truly impaired, I can relate to the argument that “I am professionally trained and have seen pretty consistently these behaviors that sound consistent with a diagnosis” — particularly when the person in question has the power to launch nuclear bombs, destroy the economy, and ruin the environment. I can see how a professional would think it’s ethically irresponsible not to at least weigh the issue and invite other people, perhaps behind closed doors, to do a more medical, personal, fair, and private evaluation.

It seems like there are two conversations about age in politics: One about the age of individual candidates, and the other about older political representation as a whole. According to one recent analysis, the average age of Democratic House leadership is around 72, which is 24 years older than the average age of GOP House leaders; the three leading House Democrats are 79, 78, and 79. Do you think it’s healthy for Americans, whose median age is 38, to have political representatives who tend to be much older?

I can see how the ideal might be a blend of both, which is what many industries are finding, that people of different generations bring different strengths and that the strongest teams have some of each. That often gets framed as, young people are unreliable and fly off the handle. Or on the positive side, young people think of things we haven’t thought of. For old people, they really understand the system and how it works and that’s why you get elected speaker.

Also, representation should be representation. Republicans may be younger, but they’re also heavily male and heavily white. I mean everything is heavily white still. So either we have representation or we don’t, and I think right now many important populations could argue that we do not.

How does older representation change the political conversation? I’m thinking in particular of the concerns younger Democrats have over leadership that will not be around to bear the brunt of climate change later this century.

I think each generation screws something up. Now we’re hearing the horrors of tech and what it’s doing to us, the rates of anxiety are crazy and people can’t have conversations anymore — a few generations down the line, they’re going to blame us for that. We need younger people and older people — only if you have those conversations can you really learn and get those right answers for everybody. Different generations have different priorities, and the only way to deal with problems created long ago and anticipate ones that are going to happen in the future is to get those different lenses.

But if the older generation of politicians is clearly not paying enough attention to something that is clearly a global crisis, then they should absolutely be held accountable. And if the younger people are doing better at that, they should be taking the reins. Ideally, they’d be doing that together.

Geriatrician Louise Aronson on Age and the 2020 Race