Age alone shouldn’t determine who runs for political office
It was Robert Neil Butler, a psychiatrist and the first director of the National Institute on Aging, a branch of the National Institutes of Health, who first coined the term “ageism” in 1968.
Butler, who was one of the pioneers in American geriatrics and gerontology, used the term to describe prejudice by one age group toward other age groups, most notably toward older age groups. He considered it a form of bigotry comparable to racism and social class discrimination. While ageism is a construct that applies across the life span, the term “older adult” typically refers to people older than 65.
Ageism has been characterized as one of the last socially acceptable prejudices and is pervasive across all domains including housing, job opportunities and, of course, health care. Negative stereotypes of the elderly are often widely promoted by the news media, and the elderly are frequently portrayed as frail, lonely, isolated and cognitively impaired. Ageism has a deleterious impact on the physical and mental health of the elderly and more broadly a corrosive impact on society at large, including policymaking and allocation of resources.
In the U.S., the number of people older than 65 in 2019 was approximately 55 million; the total is projected to reach 95 million in 2060. People 65 and older represented 16% of the population in 2019, a percentage that is expected to grow to about 22% by 2040. These are striking demographic changes, and we can ill afford to ignore the challenges posed by this rapidly growing group.
Contrary to popular stereotypes, the elderly are a heterogeneous group, and individuals age very differently across time. In 1987, the scholars John Rowe and Robert Kahn introduced the term “successful aging” to the medical lexicon. They defined successful aging as a multidimensional construct requiring three critical components: low probability of disease, high cognitive and physical functioning, and active engagement with life. It embraces medical, behavioral and social functioning as central to the successful aging process. It is estimated that about 10% of individuals meet these criteria for successful aging.
Another 15% are severely frail, meaning that they are physically weak and lose their ability to respond to stressors, mostly physical. This leaves the vast majority of older individuals somewhere in the middle where they face multiple challenges but are able to cope and function relatively well, albeit with some assistance. Cognitive trajectories vary widely across the elderly, and a subgroup of elderly are “cognitive super agers” — people who approach the end of their life span functioning as if they were 30 years younger. The heterogeneity observed in the clinical and social spaces matches the heterogeneity in molecular and cellular processes.
Age alone is therefore not a reliable marker of inevitable physical or mental decline and loss of autonomy.
Life expectancy at birth in the U.S. is approximately 76 years when both sexes are combined. In 1900, the life expectancy for Americans of all races and both sexes was 47 years. We have changed rapidly over time as a society, and older norms and expectations regarding retirement age, cognitive and other mental faculties, and functional ability are obsolete.
We are also in an election cycle, the so-called funny season in political life. Most polls show that a majority of Americans believe that old age hurts elected officials by making it more difficult to do the work their position requires. Presidential candidate Nikki Haley recently called the Senate “the most privileged nursing home in the country.” While this may provide for a catchy sound bite, it does not reflect either the science or the social reality of the aging process.
More precisely, Haley’s remark amplifies the prejudices of yesteryear and weaponizes aging without grasping or acknowledging the demographic and social realities of our time.
Increasing age is an important risk factor for dementia and Alzheimer’s disease. Most patients with Alzheimer’s are older than 65. However, most people who are more than 65 years old do not have Alzheimer’s disease. Aging is associated with cognitive changes such as slow reaction time, difficulty with names and subjective complaints of memory loss.
These issues do not inevitably lead to progressive memory loss and cognitive impairment over time. That interpretation would be a vivid extrapolation of the science.
However, if there is a noticeable functional decline in the mental-cognitive space — meaning an individual is unable to perform at the intellectual level they were able to a few months to a year ago — it would provide a basis for a thorough medical exam that should include a physician exam, relevant laboratory tests and a cognitive exam.
Age alone should not be automatically disqualifying for leadership roles, even to the nation’s highest offices. The critical element is whether individuals have or lack the capacity to meet the challenges of the position they aspire to. That is the relevant question in this debate.
Everything else is a cacophony of background noise.