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US presidential candidates over 70: does age affect the ability to govern

The age of the leading candidates in the 2020 presidential election is pretty solid. US President Donald Trump is already 73 years old, and his main opponent, Joe Biden, is 77. In other areas, people in the top ten usually retire. Throughout most of human history (and still in much of the modern world), people often do not even live up to this age. Writes about it The Atlantic.

Photo: Shutterstock

In March, 95-year-old Jimmy Carter, the 39th president of the United States, said that the presidency requires a person to “have a flexible mind,” and that by the age of 80 he did not feel able to do such a job.

He joined the growing ranks of those who support the setting of an upper age limit for nomination for presidency, either in order to destroy the gerontocracy, or to ensure that a person has the physical and cognitive abilities to rule the country.

“You must be able to move from one business to another and adequately concentrate on each of them, and then integrate them comprehensively,” Carter said.

The relevance of this issue for the current political moment is significant. Many neurologists and psychologists have expressed concern about Donald Trump's inability to hold the line of conversation. Compared to his public appearances in previous decades, his speech shows a decrease in the ability to reason and give arguments. Ten years ago, he was capable of delivering the same persuasive speech as Carter, but now he is not.

Joe Biden remains focused on individual topics and ideas much more consistently than Trump, but he is slower than before, finding the right words. At the same time, Biden sometimes deviates from the topic of conversation and says meaningless things. In September, answering a question about racism, he said: “Turn on the radio, make sure that the television - sorry, make sure you have the player turned on at night ... make sure the children hear the words.”

Ronald Reagan was re-elected for a second term in 73 years, and according to some reports, the end of his second presidential term was marked by early linguistic signs of Alzheimer's disease, the discovery of which he announced five years after leaving the presidency.

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Concerns about the age of politicians are not limited to presidential candidates. The average age of senators is 62 years. Mitch McConnell, the 78-year-old Senate majority leader, has already lived longer than the average male life expectancy in the United States (76,1 years) suggests. If a country considered, say, an official retirement age of 66 years as a prerequisite for ending a career in politics, this would mean a complete revision of power. This would exclude from politics not only presidential candidates, but also most of Congress.

At the conceptual level, any severe constraint creates many problems. In addition to allegations of ageism, age restrictions can raise a number of other objections that are very difficult to confront. The establishment of a minimum age can be justified by the lack of experience and competence in political matters, but, hypothetically, a 110-year-old person can rule the country.

At the same time, despite the development of modern science in the field of combating aging, it is impossible to base the assessment of candidates' abilities to perform official duties on their words that they are okay. Although they do not get tired of reminding us of this. For example, Joe Biden has repeatedly told the public that wisdom comes with his age, and Donald Trump once said: “I'm so young! I can't believe it - I'm the youngest. "

In addition to such first-person assurances regarding his state of health, the process of external evaluation of the president’s cognitive and physical abilities is opaque, optional and arbitrary.

The concept of "suitability for office" arose after the assassination of 35th US President John F. Kennedy. The transfer of power to Lyndon Johnson posed hypothetical questions: what if Kennedy survived, but was in a weakened state? What if the bullet only touched his frontal lobes, and after a short hospitalization he would have lost the ability to keep his train of thought? What if he began to make strange comments and deny the existence of the moon? Such gray areas in the law served as the basis for the ratification of the twenty-fifth amendment to the US Constitution in 1967. She created a way to remove from power a person who has lost the ability to fully serve the state.

But this amendment has never been applied. Instead, the idea of ​​being fit for the office boils down to an annual medical examination of the president with a public announcement of its results. This process, however, is formal at best. After Trump's election, his then-physician Harold Bornstein said that "the president showed excellent health" and that was it.

“From the very beginning it was obvious that this test was not credible,” said Mark Fisher, a professor of neurology at the University of California, Irvine. “It was unprofessional and unacceptable as an assessment of the president’s health.”

What citizens really need to know about their president’s health

A physical examination by a doctor is aimed at identifying diseases, but the real question of suitability for the presidency does not boil down to whether a person has a disease or not. Most Americans live with certain chronic diseases, which does not prevent them from working fully. Compared to the times of Kennedy, modern medicine, communication and transportation opportunities allow people with a wide variety of diseases and medical features to climb the political ladder. For example, Vice President Dick Cheney suffered from an incurable heart disease, then received a completely new heart from a donor and continued to work in the political environment.

According to Katherine Bales, professor emeritus at the University of Arizona, the essence of assessing a person’s suitability for political activity lies not in age or physical health, but in cognitive abilities. And they only very roughly correlate with age: the cognitive abilities of each person decrease at different ages and at different speeds.

Mild cognitive impairment often begins around the age of 60, but many people remain keen on mind until death.

“People over 65 are the most cognitively diverse part of the population,” says Bales, who studies speech, language and hearing. “Look at Nancy Pelosi, who is 80 years old.” She speaks clearly, measuredly and perfectly holds the subject. ”

According to Fisher’s estimates, simply based on average population figures, we can assume that a significant proportion of political leaders have some degree of cognitive impairment that may affect their ability to make decisions. But standard medical approaches (such as blood tests, MRIs, or CT scans) are not effective ways to detect cognitive problems.

In 2014, Fisher and his colleagues noted that a decrease in cognitive functions among political leaders can only be assumed, but it is almost impossible to identify or prove their presence. They suggested that the newer “highly sensitive brain imaging” could increase the efficiency of the abnormality detection process, but there are no such technologies yet.

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In 2019, ophthalmologists at Northwestern University Feinberg School of Medicine suggested that better detection of cognitive impairment could be improved by examining the eyes. At the back of the eye is a thin nest of capillaries, the status of which may be a reflection of what is happening to the blood supply to the brain. However, the retina and brain are indirect indicators of what really matters - the ability to think soberly.

Currently, the most widely used neurological test for cognitive impairment is the basic screening test, known as the Montreal Cognitive Assessment, or the MoCA, a five-minute test of 30 questions that includes knowing where you are, drawing a clock, and determining the image of a tiger. The hardest part is remembering the five words you were told to remember at the beginning of the exam. The test is designed to identify people who will be difficult to conduct "daily activities."

Trump passed this test last year. At a press conference, his doctor, Ronnie Jackson, said the president had "dealt with him." But the test used to test the population for dementia does not necessarily test the ability to serve as president more than, say, passing the driver's license test. Anything less than the ideal score is a cause for concern, but the ideal score tells the public little about the actual cognitive ability of a presidential candidate.

But the best tests exist. Simple and transparent in administration, they can help the public know what the cognitive status of people who seek access to nuclear codes really is.

Cognitive testing in the selection for administrative positions has long been introduced in the army. During World War I, psychologists developed tests, known as Alpha and Beta, to measure a person’s ability to follow orders and process information. Even during a period of great demand for military personnel, the US military considered it necessary to know whether a person was able to comply with basic orders. The testing process has grown into the currently used ASVAB test, which all beginners pass. It is not intended to disqualify anyone; it is used to determine what kind of work a person can do.

Of course, the testing process becomes more complex for more responsible roles. The president must be good at many things, but it is not necessary to be an expert in everything.

Problems in the testing process were recently clarified by the US Department of Defense. In 2016, a working group was developed to develop a cognitive assessment process for soldiers fighting in hot spots. The attempt failed, and the group reported the following: “The goal of determining the military’s cognitive state and predicting its performance under training and assignment conditions cannot be achieved.” The reason for the failure of the group indicated a lack of evidence linking the successful passage of tests with field performance.

However, for leadership roles, the most important skills can be tested through testing. Kim McCullough, a professor of communication sciences and disorders at Appalachian State University, says that certain tests can help evaluate the president’s potential abilities.

While neurologists are only developing tools to detect cognitive impairment in the early stages, speech pathologies have long been successfully identified using language tests.

"There are many tests that can be provided to candidates," says McCullough, whose work is aimed at detecting mild cognitive impairments. "The most relevant to the presidency can be tested by testing the cognitive processing ability, which shows whether a person is able to synthesize complex ideas and identify key points."

“Language is cognition in action,” says Bales. “Simple tests can be effective.”

According to her, if you had the opportunity to conduct only one test to assess a person’s cognitive state, then you would have to act like this: first you need to tell a simple story (in her example, this is a story about a woman who went to the grocery store and lost her wallet, but then someone found it and returned it); then you ask simple questions about what the person just heard. You ask questions immediately after the story, and then repeat them again after 30 minutes. Most young people with normal cognitive abilities give at least 15 correct answers to 17 questions. Elderly people with normal cognitive abilities for their age - one or two correct answers are less in the second round of questions.

In people with cognitive impairment, the results differ strikingly. People with mild Alzheimer's disease correctly answer only half the questions immediately after the story, and only one question a second time. People with more advanced Alzheimer's disease first answer correctly 2 questions, and then none.

Loss of thinking or forgetfulness of words does not necessarily indicate cognitive impairment. Some people know how to process and synthesize information, and the only difficulty is to quickly translate the result of processing into words.

Supporters of older politicians can ignore examples of their forgetfulness, arguing that a person does not have to be eloquent in order to function optimally as president. They are ready to argue that the president can be trusted with decision-making, even if they cannot justify them verbally.

But that kind of trust becomes harder to justify when the president makes decisions that have no obvious connection with US interests. The appeal of functional cognitive testing is that it would help the public know if the president can clearly understand the consequences of his decisions and their alternatives.

“There is no gold standard for a single assessment where you can test everything,” says Bales.

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But she suggests that some tests, such as the Cambridge Neurological, Wexler's Memory Scale, and the Edinburgh Social Cognition Test, may be useful. Based on two decades of research, she and her colleagues developed a test that they proved to be sensitive enough to detect cognitive impairment in the early stages. Known as the Arizona Communication Abnormality Test, or ABCD, it tests speech understanding and memory. This test lasts about 90 minutes, and concentrates on things such as reading comprehension, defining a concept, and retelling stories some time after reading them.

The test was able to detect cognitive impairment in 55-year-olds before they began to progress to overt dementia. The test does not test a person’s ability to make decisions, but can be an effective complement to other tests aimed at assessing a person’s managerial abilities. The whole process takes several hours and gives a clear picture of cognitive suitability for working in politics.

No process will be perfect. But if suitability for work will continue to be the principle of the electoral process, then an effective and transparent assessment of the candidate’s cognitive abilities is simply necessary. Without such a process, the problems of politicization and bias in medical assessments can only aggravate, and not improve, the situation, as age-related factors become more and more noticeable in politics from year to year.

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