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Photo by Rene DeAnda on Unsplash.

We heard this over and over again when Joe Biden was in the race. Biden stumbled. He tripped on a stair. He spoke coherently but quietly and he occasionally fluffed a word. He had a terrible debate appearance.

Then there was Donald Trump, running at 78. He forgets what state he’s in. He has trouble forming coherent thoughts. He rambles more than he used to. He rants and raves. He seems to have energy, although he’s looked tired often. He’s overweight but we don’t know much else about him and his health. He won’t release his medical records, beyond a page from a physician.

But is he too old to be president? Was Biden?

The issue should never be about age. It should be about individual competence. Not everyone forgets what state they’re in as soon as they turn 75. Not every “aging” person rants about “They’re eating the dogs! They’re eating the cats!”

As one observer wrote (I forget where), when someone starts behaving this way, you call a geriatric neurologist. You don’t give them the nuclear codes.

But we should be looking at behavior, not age, no matter what our political affiliation.

Some people show signs of age when they’re 60 or 70. Some are active into their 90s. Olga Kotelko was competing in age-appropriate track and field events until she died in her early 90s. Ruth Bader Ginsburg died of cancer at age 87, still active on the Supreme Court. Willie Nelson, the country singer, is still onstage at 91. I’d vote for him in a heartbeat.

It’s possible that in the future we’ll see a younger candidate with disturbing mental and physical illness symptoms.

There are three issues.

First, politicians are more open and more visible, and we the audience are more health-conscious.

Franklin Roosevelt was able to hide his wheelchair from the press and journalists helped him keep his secret.

Winston Churchill was happily obese, smoking cigars continuously; today I think we’d raise more concerns about his health. I can’t imagine a cigar-smoking politician in any country today.  Churchill died when he was 90.

Disclosures about mental illness are becoming much more common. John Fetterman, one of our Pennsylvania senators, became clinically depressed after a stroke. At least one other senator suffered from depression years ago. We have no idea how many past senators — and US Presidents — were mentally ill. Some researchers speculate that half our past presidents showed signs of mental illness; there’s a possibility they might have been better presidents as a result.

And a person’s condition can change overnight. One day you’re a healthy athletic high-functioning adult, and the next you’re a victim of cancer, a heart attack, or a stroke. It can happen at any age, but the probability is higher as you age.

Second, we should never be talking about age. We should. talk about medical conditions.

Of course, there are two caveats to this. As people age, they become more susceptible to deterioration. The risk of a heart attack at 75 is much greater than the risk at 35, although bad things do happen to young people. The odds that an 80-year-old will die of illness are much greater than the odds of a 40-year-old dying of illness.

And third, those of us who are not medical specialists do not know how to interpret new reports about someone’s health.

Even with complete and accurate information (which can be hard to get), we rarely know how to make predictions.

What can a depressed person do in a high-pressure role? Do the meds to control mental illness have side effects that would cause problems? If someone has a heart attack, how much are they likely to have another one? Is high cholesterol a true predictor of heart disease? How much forgetting is normal and how much is predictive of cognitive impairment? (Anyone who’s had a high-travel job can tell you it’s all too easy to mix up your locations.) How much does a confident walk predict overall general health?

I can’t say this too often. Some people remain high-functioning through their 90s. Some lose cognitive and physical functioning much earlier.

What is true is this. We need some way to stop someone who’s dangerously mentally ill from gaining access to the Oval Office. For that matter, we need to stop them from accessing guns and maybe cars.

I’m not sure how we can do this. But I know one thing for sure. It’s not about a simple measure like age.