President Joe Biden gives a speech in Dundalk, Ireland, on April 12, 2023. Photo / AP
Was it the way US President Joe Biden confused the Ukraine and Iraq wars twice in 24 hours, claiming “Putin is losing the war in Iraq”, that had the world worrying about his health again?
Or the horizontal indentations on both sides of the 80-year-old’s face, on show as he left the White House this week, which revealed he had slept wearing an air mask - a device to ease sleep apnea?
Either way, the wellbeing of octogenarian Biden is an inevitable source of interest and worry given his knowledge of the nuclear codes. Indeed he is the oldest person ever to hold the office, and, if his bid for a second term in 2024 is successful, Biden will be 86 at the end of his time at the White House.
To be fair, Biden has revealed his history of sleep apnea before, and his personal physician, Dr Kevin O’Connor, issued the president with a clean bill of health as recently as February.
But what are the health concerns that have beset him?
The sleep disorder, while common, can potentially be serious. Sleep apnea is when breathing can stop and start in the night. Left untreated, it may cause symptoms including forgetfulness and fatigue.
Age is one of several factors that increases the risk of developing sleep apnea. It can ultimately lead to cardiovascular disease because of the significant strain it can put on the heart, according to studies.
A CPAP (“continuous positive airway pressure”) machine pumps air through a tube to a mask strapped to the user’s nose. The pressure of the air being delivered keeps their airway open.
Geneticist and longevity expert Tony Pemberton says: “Sleep apnea is certainly a risk factor for cognitive decline. This is through two pathways; firstly your brain is starved of oxygen during your sleep, but on top of that typically it’s harder to get restorative sleep.
“This is due to the body secreting cortisol into your system, simply to avoid suffocating in your sleep. Sleep deprivation is one of the strongest causes of cognitive decline.”
Pronounced throat-clearing has become a hallmark of Biden’s public speaking. The cause, according to his team, is gastroesophageal reflux that is often brought about after he eats.
The acid reflux was first reported after Biden’s November 2021 physical examination. It was added that an examination of Biden’s lungs, a chest X-ray and a measurement of his oxygen saturation showed normal results, and noted that the president will continue to take Pepcid to treat the acid reflux.
“The main issues from acid reflux, if not controlled, is risk of gastric irritation and ulcers… if he’s on anti-reflux medication this reduces likelihood of ulcers,” says private GP Dr Suhail Hussain. “Acid reflux is not necessarily age-related.”
The president was recently treated for basal cell carcinoma, a common and slow-growing skin cancer. Doctors conducted a routine removal of a lesion from his chest that will be checked for skin cancer, according to a six-page summary of his examination.
“This is a non-malignant cancer which normally does not cause any problems with spreading elsewhere and is easily removed with no long-term adverse sequelae,” says Dr Hussain.
Cancer is strongly linked to ageing. “This is why scientists now describe ageing as a disease, as around 90 per cent of diseases are age-related,” says Pemberton. “In future our leaders might be judged more on their biological age rather than their chronological age.”
Biden’s mobility issues are attributed to degenerative “wear and tear” on his spine and the stiffness in his walk is a combination of arthritis in his back, a neuropathy in his feet and the long-term effects of breaking his foot in November 2020 while playing with his former dog Major.
“He has confirmed osteoarthritis of the foot and spine which impacts his mobility due to stiffness (and potentially pain),” says Dr Hussain. “If this worsens this could require increased pain medication, anti-inflammatory medication or even operative intervention in the worst-case scenario.
“This would necessitate time off work and long recuperation given his advanced age. And could require hip or knee replacements, if these joints are affected.”
Biden’s high cholesterol was also noted in his latest health summary, which is a risk factor for a heart attack, stroke or kidney disease. “According to the physician’s report Joe Biden has atrial fibrillation which is a condition that causes an irregular heart rate,” says Dr Hussain. “This is controlled by blood-thinning medications.”
High cholesterol is not inevitable with age, but age is a factor.
“His lipid level – lipids are fat-like substances found in your blood and body tissues – is controlled by statin tablets so there is no issue with his cholesterol profile.”
Mixing up the wars in Ukraine and Iraq is not the first time Biden has made gaffes.
“Biden has been open about having a stutter, which some say his adversaries mistakenly label as Alzheimer’s,” says Pemberton. However, he adds: “The increase in stumbles is certainly an indicator that his verbal fluency is on the decline, which can be an early sign of dementia, memory lapses being the strongest indicator.
“The saying ‘age is just a number’ is true to a level in meritocracy, but when the signs of a mental and physical decline are becoming more apparent, is it ageism?”
Dr Hussain agrees: “From the videos we’ve all seen of him on stage giving speeches, his cognitive functioning is below par and in my opinion he has some level of cognitive decline, possibly early-stage dementia – that’s absolutely clear from his clinical situation.”
In February, Biden stumbled up the stairs of Air Force One as he headed back to the United States after a three-day visit to Europe.
He fell up the same stairs just two months into his presidency in March 2021. In June, he also fell off his bike while spending a weekend away in Rehoboth Beach, Delaware.
“Ageing is a physiological process and as we age our functioning both physically and mentally diminishes - it is impossible to avoid,” says Dr Hussain. “We become less able both physically and mentally. Our ability to move and function at the level we did when we were younger diminishes. Equally, our cognitive abilities will decline.”
The aforementioned arthritis and foot issues, of course, contribute to the reduction in Biden’s mobility.
“There’s no doubt his health is deteriorating,” says Dr Hussain. “From a clinical point of view, I would not be advising him to run for re-election because the enormity of the role at his age and level of ability is likely to be too great – and his health from this point could deteriorate rapidly.
“It doesn’t mean ageism doesn’t exist and older people should be treated with respect – but older people also need to understand [that], while they should be treated with respect, they should gracefully step down from such high-profile roles.”
Clinton, the second-youngest living US president, has had a series of health issues.