In contrast to his aging predecessor, President Trump appears robust and energetic. Yet, like Joe Biden, Donald Trump is an elderly man, and he will become the oldest sitting president in U.S. history by the end of his second term. In light of recent revelations about Biden’s declining health, as a doctor and an expert in aging, I have been thinking about the responsibilities of Trump’s doctors to him and to the American public. If the way we care for elderly people is distinct because their bodies and risks are distinct, perhaps the care of an elderly president should be, too.
Presidents are getting older—which is to be expected, given the doubling of the average human lifespan across the 20th century. As we age, the likelihood of disease goes up significantly each decade (which makes sense because human mortality is holding steady at 100 percent). An elevated risk of disease shouldn’t exclude a person from any job—even one as important as the U.S. presidency—but in elderhood, certain diseases become more prevalent, such as heart disease and cancer, the leading causes of death for adults. After age 70, a person is also at increased risk for one or more health conditions in a category unique to old age, the so-called geriatric syndromes, which include cognitive impairment, functional decline, falls, and frailty.
On the surface, Trump seems stronger and less vulnerable than Biden did. Yet looks do not necessarily reflect risk for illness and disability. A hallmark of advanced age is its variability: One person may be physically powerful but have dementia; another might have hearing loss but no cognitive changes; a third could have heart disease, diabetes, high blood pressure, and high cholesterol—physiologic time bombs that increase a person’s risk of major events such as heart attacks, strokes, and death.
And Donald Trump has lived in a way that raises his risk for heart and other serious diseases as he ages. For years, he has been overweight or obese, as measured by his BMI—which doesn’t distinguish between lean, muscular weight, and fat, meaning he is likely even less healthy than his abnormal BMI suggests. His gait, though better than Biden’s, demonstrates the same weakness of many lower extremity muscle groups, and his history of eschewing formal, particularly muscle-building, exercise means that his risk for falls and frailty is increasing more quickly than they would with resistance and balance training—recent signs that he might be adopting healthier habits notwithstanding. Equally important, fat on a body indicates fat in and around the body’s critical organs and blood vessels, including the brain and heart.
To truly understand our current president’s health, as a doctor I would want to know and follow not just his BMI but also his percentages of fat and muscle, and to track his strength, hand grip, and walking speed. His doctors should be discussing those predictive measures with him, as well as the negative effects his lifestyle might have on his heart health and cancer risk.
That would be true for any older patient, but the president’s crucial role may well change which additional tests his doctors should consider. For example, routine screening for prostate cancer—which Biden reportedly did not undergo—is not recommended for men over age 70 because most, even if they develop prostate cancer, will die of something else. But these tests might make sense for a president over age 70 because the risks of a serious form of the cancer would affect not just the man but the country and the wider world. Other tests that fall into this category might include functional heart and brain scans, additional cancer screenings beyond usual age cutoffs, and certain biomarkers.
More aggressive screening would still have trade-offs for both the president and the nation. It could subject the president to unnecessary procedures and psychological stress. Opponents might use even a clinically insignificant diagnosis to their advantage. But more aggressive screening might also enable earlier diagnosis or, if a potentially disabling or lethal condition is found, succession planning.
Because the risk of adverse health events increases throughout the last third of life, we geriatricians recommend discussing what’s known as “goals of care” with each patient—to get a sense of their values and their fears. We ask about what matters most to them in their life, which situations seem worth some suffering and which do not, and how they have handled and experienced past health events. Programs proven to help people clarify their priorities and plan ahead can help patients, families, and doctors choose a course most consistent with their values and goals.
For a president, such conversations are even more essential. First, they could help the president, as an individual, think through how to separate political pressures from personal needs and family responsibilities. Second, having a plan that protects the country should be a core responsibility for anyone in high office, and an elderly president in particular should think ahead of time about how to best serve the United States in the event of a majorly debilitating health event or general decline.
Goals-of-care conversations are difficult for some people—and some doctors. If Trump’s doctors are not skilled at this sort of conversation, they should engage a consultant who is able to push him to reflect on how his answers to these questions would affect his ability to do his job, or the functioning of the country. Just as it’s the president’s responsibility to answer these difficult questions, so too is it his doctors’ responsibility to pose them.
When asked to comment, the White House did not address questions about Trump’s risk, mitigation strategies, or contingency planning, but Liz Huston, a spokesperson, said over email that Trump “receives the highest-quality medical care” from his doctors and “is in great health as evidenced by the results of his comprehensive annual physical exam.” (Huston also said the White House was not going to accept the unsolicited advice of “an activist Democrat doctor,” referencing a 2023 article on aging politicians in which I wrote, based on what reporters had told me, that journalists decades younger than Nancy Pelosi had trouble keeping up with her.)
Trump’s physicians face another challenge that most clinicians do not: Which information about their patient’s health should they share with the public? In both Trump terms, many physicians have struggled to believe the information provided by the president’s medical team and have suspected that his risks are being substantially downplayed. And now we know the problem exists in both major political parties. Biden’s team seemingly withheld information that would have made clear that he did not have the physical or cognitive ability to govern for a second term. Surely, with such high stakes, the president’s health is an exception to the usual rules of patient privacy. When a person signs up for “public office,” by definition they forfeit some of the privacy protections the rest of us are entitled to by law. Their health and ability to do their job affect hundreds of millions of lives.
The U.S. could consider imposing a maximum age limit on the presidency. But that one-size-fits-all approach risks eliminating potentially fit and favored candidates. In its absence, the person leading the country should receive station-specific, evidence-based, and person-centered care—that attends to their role, medical conditions, functional abilities, and preferences. And the American public deserves transparency about the president’s health.
