Missing: Healthcare/Gerontology Experts on the Debate Performance ?

President Biden and former President Trump are both elderly men. Both are subject to their more fragile systems related to such things as dehydration, stress, fatigue, infections, and even innocuous over-the-counter medications, as we all are as we age; but old age is not a disease, unlike personality and character disorders, aging is a normal biological process.

By all accounts, President Biden had a poor showing in his recent debate. That is indisputable. His opponent has also had numerous episodes of obvious confusion, compromised thinking, general disorientation, fact-based orientation, and wordfinding difficulties, yet the focus is primarily on just one of them, President Biden.

Politicians and political pundits on both sides of the aisle have weighed in on why President Biden did poorly in his debate, but one perspective on this has been glaringly missing. As a licensed and doctorate-prepared healthcare provider who has been practicing for over 55 years, and as a Masters prepared gerontologist since the 1980s, I was quickly struck by the President's altered demeanor. His affect was off. He was hoarse & coughing, and most strikingly I observed that prior to the debate as well as at the after-party that followed it, he was like two different men. this was just hours apart in time. My clinical assessment skills promptly kicked in causing me to wonder if he had taken what he might have thought was an innocuous cough or cold medication before the debate, or if an acute respiratory infection or dehydration might have resulted in a temporary delirium effect that is common in older people who become ill, dehydrated, or on certain types of medications, including cold medications. The impact of such an induced delirium would or could include side effects such as somnolence, confusion, mental and physical slowness, gait imbalances, etc. and these would not be uncommon in an older person.

The American Gerontological Society puts out updated versions of "The Beers List" every few years. This is a compilation of medications that are not advised for older (65+) people because of the high risk of side effects & interaction effects with other medications; (Please check out Medications on the Beers Criteria List ). Many of us have undoubtedly felt this ourselves. It was originally created by Dr. Mark Beers in 1991. This possibility immediately crossed my mind as I watched President Biden in this very uncharacteristic presentation for such an accomplished senior Statesman. My assessment skills immediately kicked in in response to what I was observing. It was especially of interest to me since, just a short time after the debate, as the president spoke at an after-party event, as well as during the following days, he was back to his former self as an animated and accomplished Statesman with his facts at his fingertips. I also considered the lifestyle and activity schedules of both men. One lives a carefree hedonistic life that focuses on him, while the other travels regularly across numerous time zones addressing and participating in world events of global importance that have impact for all of us.

I wondered about the impact of his obvious upper respiratory condition. When seniors become confused, the first things we health professionals assess for are signs of infections, especially those involving urinary tract and respiratory ailments. His upper respiratory symptoms were apparent. I wondered if anyone had inquired about whether or not he had taken any over the counter or prescription medications to control his cough, congestion, or sore throat symptoms? This alone could readily account for what we saw during those few hours? Delirium is a temporary response to things like infections, medications, dehydration, injuries, etc. & the effects are readily reversible. If he was dehydrated, which come from inadequate fluid intake as well as from decongestant and other medications, a resulting delirium could be a temporary outcome that would explain his 90-minutes of sub-optimal performance.

Let's support one of the most accomplished Presidents we have ever had in the United States. If dehydration or an attempt to control coughing, a sore throat, or upper respiratory symptoms is or was a factor, let's put that out before the public. Even young people who become ill, dehydrated, or who have used these types of cold preparation medications (OTC or Rx) have felt their temporary impact on physical and mental acuity. Such induced delirium symptoms are temporary and reversable, as was clearly the case with President Biden, as just a few hours of time demonstrated so clearly.

There was a time when being an Elder, especially such an accomplished one over decades of professional public service commanded respect. What has become of our respect for the wisdom that is accrued through decades of life and experiences.

Dr. Stephanie Paulmeno, DNP, MS, RN, NHA, CPH, CCM, CDP