President Biden walked awkwardly and appeared frail and pale during his debate with former President Trump. As public health psychologists with expertise in aging and mental health, we recognize that there are many health-related explanations for President Biden’s inability to eloquently defend his own record or fact-check the flood of lies being spewed by his opponent.
Some of these explanations are less worrisome than others — recent medication changes, infection, poor sleep hygiene, jet lag — and only a clinician who has examined the president, reviewed his medical records, and interviewed his family and aides can offer a reliable opinion on his health.
Whatever the truth about President Biden’s health, one thing is certain: his illustrious political career is coming to an end, and in the very near future.
The end of life can be painful, difficult and unexpected. Scientists who study aging and clinicians who care for dying patients and their families have seen it all too often. There are good days and bad days, or good mornings and difficult nights. President Biden has done a bit better since that disastrous debate.
Last night’s distressing press conference reflected Mr Trump’s wisdom and mastery of international affairs, but also clear evidence of decline – gaffes, incoherent asides and “sudden outbursts of anger”.
Letting go is often painful and seldom enjoyable. Intoxicated by a dizzying whirlwind of emotions and encouraged by well-meaning but submissive and concerned relatives, many patients opt for futile treatments that make things worse rather than better. The play ends with harmful side effects, suffering and a painful death in the intensive care unit; most do not want to die that way because they believe it would rob them of their dignity.
It’s not just patients and their families who are driven by emotional confusion to consent to undignified treatments that do more harm than good: Even experienced physicians who have treated dying patients for decades often overestimate how long their patients will live and recommend futile treatments.
Despite overwhelming evidence to the contrary, the tendency to overestimate our future health is well known and two theories have been proposed to explain this tendency. The first has to do with the biology of aging and death, which is somewhat unpredictable. The second has to do with the psychology of precognition and how heartfelt empathic responses often lead to disastrous outcomes.
Overestimation and misplaced sympathy for future achievements have cast a long shadow over American politics. We have endured the consequences of Ruth Bader Ginsburg’s decision to remain on the Supreme Court. Senator Dianne Feinstein died last year after a long period of public decline. Less than two years before Strom Thurmond died at age 100, 79-year-old South Carolina congressman Ernest Hollings said, “He doesn’t have a home. Someone told me the best retirement home is the United States Senate.” None of these three elder statesmen decided to continue on this path alone. They received encouragement from well-meaning supporters.
This trend is also evident in higher education, with recent appointments to university and college leadership further highlighting the fact that the average age of a university president is 63 and 11% of university leaders are aged 71 or over.
In reality, many people overestimate their uniqueness and capabilities in life and in their careers, with no end in sight, forcing them to let go. This ultimately creates unnecessary burdens in their roles and hampers future generations waiting patiently to take up these positions. We say this as two people in their 60s preparing to let go of their careers.
The demand for an upper age limit or retirement age may seem reasonable. Some of the world’s leading organizations, such as Deloitte, mandate a retirement age of 63 to give opportunities to younger generations. But such restrictions can be seen as discriminatory and simply do not make sense. Many 85-year-olds are healthier than 55-year-olds. Moreover, gross inequalities and a breakdown in safety nets, including pensions, mean that too many people have to work into their 90s.
Rather, we need to carefully consider the lessons learned from the science of emotion and from clinical research on death and the aging transitions over the past few decades.
Humans are designed to nurture new life, but not to let it go. And when we let it go, we grieve. Emotions like pride and shame may hold President Biden back from redirecting his energy and passion from one course of action to another. He’s been playing this game for decades, and walking away would require a major shift in thinking.
When deciding whether to stay put or move on, we often underestimate our ability to adapt to changing circumstances. Too often, we become paralyzed by sadness and anticipated grief reactions: nostalgia, longing, regret. It’s heartbreaking.
Emotions like compassion and empathy may make it impossible for family members, staff, or trusted friends to offer wise counsel. Hospitals pay experts to teach clinicians how to have difficult conversations about aging and death. Perhaps similar efforts should be made in other areas, including politics and the media.
We must also create clear pathways for younger generations to take on leadership roles in politics, higher education, and all walks of life. The British Royal Family is bound by tradition, with a 96-year-old heir to the throne being handed over to an already frail 73-year-old. The rest of us should not emulate these artificial traditions from a bygone era.
Emotions around old age, retirement, and endings of all kinds, including death, are inevitable and universal. We can ignore them, allowing them to confuse and mislead us, or we can face them unashamedly with determination, courage, and dignity.
Paul R. Duberstein is professor and chair of the Department of Health Behavior, Society and Policy at the Rutgers University School of Public Health and professor of Family Medicine and Community Health at the Rutgers Robert Wood Johnson Medical School.
Perry N. Halkitis is Dean, Distinguished Professor, and Hunterdon Professor of Public Health and Health Equity at the Rutgers University School of Public Health, where he also serves as director of the Center for Health, Identity, Behavior, and Prevention Research (CHIBPS).
Our journalism needs your support. Subscribe now NJ.com.
This is How to submit Editorial or letter to the editor. Bookmark NJ.com/OpinionFollow us on Twitter translation: On Facebook NJ.com OpinionGet the latest news by email. Subscribe NJ.com Newsletter.
