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Age and health concerns about Donald Trump

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At 78 years, 5 months and 26 days, Donald Trump, the 45th and president-elect of the United States, is the oldest president-elect in the history of the United States. He previously became the oldest major-party presidential nominee in history five weeks after his 78th birthday, after President Joe Biden withdrew from contention prior to becoming the nominee of his own party in the 2024 United States presidential election.[2][3] Should he live to the end of his second presidency in 2029, he will become the oldest person ever to hold the office at 82 years, seven months, and six days old, sparking renewed discussion of his fitness to assume the presidency.[2][4][5][6] Since the early days of Trump's 2016 presidential campaign, his physical and mental health have been a subject of public debate. Trump was 70 years old when he first took office, surpassing Ronald Reagan as the oldest person to assume the presidency to that date.[7] During Trump's presidency, comments on his age, weight, lifestyle, and history of heart disease raised questions about his physical health.[2] In addition, numerous public figures, media sources, and mental health professionals have speculated that Trump may have mental health impairments, ranging from narcissistic personality disorder to some form of dementia, which runs in his family.[8][9]

Trump in November 2024
Growth in concern around Trump's age[1]

In a 2022 interview, Trump "floated the possibility that his health could become an important factor in weighing whether he would run again in 2024".[10] During the 2024 United States presidential election, Nikki Haley "was an early observer of the public's dissatisfaction with both candidates' ages, going so far as to predict that fortune would favor the party that first dropped their elderly candidate."[11] Polling has shown a majority of Americans worry about whether he is fit to serve another four years.[12][13]

Trump has been criticized for his secrecy and lack of transparency around his medical records and health.[4][10][2] As of October 12, 2024, Trump had not released basic health information since 2015, when he first started running for president, despite a promise he had made in August 2024 to release records from a recent examination, as election opponent Kamala Harris had done, and as is typical of presidential candidates.[14][15][16]

Public opinion

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During his 2024 campaign, polls generally showed that a majority of Americans believed that Trump was too old to serve as president.[4] A February 2024 poll finding that Joe Biden's age and health were major or moderate concerns for 86% of voters generally also found that 59% similarly thought Trump was too old to hold the office.[17]

A July 2024 poll, taken shortly after the first presidential debate, found that 60% of voters saw Trump as too old for a second term.[13] This represented a steady and constant increase in voters polled by this pollster sharing this concern, and paralleled the progression of the larger number of voters who had the same concern about Biden.[13] An August 2024 Morning Consult poll found that the number of respondents who thought Trump was too old to run jumped by seven percent, to 51%, from their previous poll once Trump's opponent changed from Joe Biden to Kamala Harris, and the number of respondents who thought Trump was in good health correspondingly fell by six percent.[18][19] The poll further reported that nearly 80% of respondents "were unsure he'd be up for serving a full second term".[18] A Marquette University poll released the same day reported that 57% of respondents felt that Trump was too old.[20]

Incidents

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A number of incidents have contributed to the trend in public opinion. In a July 4, 2019, speech, Trump said in a gaffe that during the American Revolutionary War, the Continental Army "took over the airports" from the British.[21] In another gaffe in October 2023, Trump referred to Hungarian prime minister Viktor Orbán as "the leader of Turkey", and said that Orbán shares a border with Russia, which neither Turkey nor Hungary do.[22] During the course of the 2024 primary campaign, it was noted that Trump confused Nikki Haley for Nancy Pelosi and "repeatedly said he is running against Barack Obama, and not Biden, and that he feared that the nation may soon enter World War II, a conflict that has been over for nearly 80 years".[23]

In June 2024, while bragging about his performance on a cognitive test administered in 2018, Trump "confused the name of his former White House physician" who had administered that test.[24] That same month, he said that his longtime acquaintance Joan Rivers had told him that she had voted for him in the 2016 election, though Rivers had died in September 2014.[25] Following an August 2024 interview, media reports indicated that Trump had acquired a pronounced lisp, prompting further public speculation about his health.[26][27] Trump released a statement the following day explaining that this was caused by technical issues with the broadcast.[28] In September 2024, Trump "claimed that the crowd went crazy for him" at the presidential debate the preceding week, even though there had been no audience at the debate.[29][4] Later that month, NPR reported that Trump's "non sequiturs are more pronounced" than they have been before, stating that in 2016 "he was all over the place but, to some extent, structured", while now "there's no structure anymore".[30]

Mental health

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Allegations of mental illness by medical professionals

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The "Duty to Warn" movement was founded by medical professionals concerned about Trump's cognitive health in his first year in office.[31] In 2017, psychologist John Gartner collected more than 41,000 signatures of mental health professionals on a petition, directed to the national opposition leader, Democratic Senator Chuck Schumer.[32][33] The core of the petition stated: My professional judgement is that Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States. And I respectfully request him [sic] be removed from office, according to article 3 of the 25th Amendment, and so on. Gartner asserted that Trump's mental handicaps are a mix of narcissism, paranoia, sociopathy, and sadism.[32] Mary L. Trump, his niece and a clinical psychologist, wrote a book in 2020 identifying the disorders she believed him to have.[34][35]

Narcissistic personality disorder

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As early as November 2015, Vanity Fair reported the opinion of a number of mental health experts that Trump had "textbook narcissistic personality disorder".[36] Bornstein's letter of December 2015, drafted in response to questions about the health of presidential candidates, did not address Trump's mental health,[37] while claiming that he would be "the healthiest individual ever elected to the presidency".[38] Bornstein disclosed in 2018 that Trump had dictated this letter over the telephone.[39] He said: "Mr. Trump dictated the letter and I would tell him what he couldn't put in there."[40] In August 2016, Bornstein stated that Trump's "health is excellent, especially his mental health."[41]

In April 2017, forensic psychiatrist Bandy X. Lee hosted a meeting at Yale University medical school regarding the ethics of discussing Trump's mental health.[42][43] In October 2017, Lee published The Dangerous Case of Donald Trump, containing essays from 27 psychologists, psychiatrists, and mental health professionals on the "clear and present danger" that Trump's mental health poses to the "nation and individual well being". They argued that the president's issues affected the mental health of the United States population,[44] and that he placed the country at grave risk of war because of his pathological traits.[45] They defined Trump's behavior in terms of mental disorder, such as narcissistic personality disorder, 'extreme present hedonism' and bullying.[9] Carlos Lozada, writing for The Washington Post, considered these conclusions "compelling", but also noted that the book contributors were writing from their own political perspective, as other mental health professionals differ.[9] Lee and others contended that Trump's presidency represented an emergency allowing, or even requiring, psychiatrists to take exception from the APA's Goldwater rule, which holds that it is unethical for members of the APA to give a professional opinion about public figures without having examined them in person and without their consent.[46][45] Proponents of such expression have asserted that there is precedent in allowing psychiatrists to speak out when someone presents a clear and present danger.[9]

In 2017, journalist Bill Moyers interviewed psychiatrist Robert Jay Lifton and said that Trump "makes increasingly bizarre statements that are contradicted by irrefutable evidence to the contrary". Lifton replied, "He doesn't have clear contact with reality, though I'm not sure it qualifies as a bona fide delusion." As an example, Lifton said, when Trump claimed that former president Barack Obama was born in Kenya, "he was manipulating that lie as well as undoubtedly believing it in part."[47]

In 2019, amid continued speculation, the American Psychiatric Association and Alzheimer's Society requested that people should not armchair diagnose Trump, or diagnose him with any disorder without being his doctor, in accordance with the Goldwater rule.[48][49]

Cognitive decline

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Experts for the science publication STAT who analyzed changes in Trump's speeches between 2015 and 2024 noted shorter sentences, more tangents, more repetition and more confusion of words and phrases. The doctors suggested it could just be due to changes in mood or it could indicate the beginning of Alzheimer's.[50][4] The sharp rise in all-or-nothing thinking is linked to cognitive decline.[50]

Coverage of Trump's mental acuity has generated discussion of whether the media has been 'sanewashing' Trump by selecting more coherent clips or quotes from his speeches that give a false impression of mental acuity without balancing that coverage by also focusing on the parts of his speeches that might raise concerns about his mental fitness to be President.[51][52][53][54]

Family history of dementia

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Medical experts have also advised the Washington Post that Trump likely has an elevated genetic risk of dementia.[2] Nephew Fred Trump III sees signs of the dementia that he saw in Trump's father, Fred Trump Sr.[8] Fred Trump Sr. was diagnosed with Alzheimer's in October 1991, at the age of 86, eight years before he passed.[8]

Responses by political opponents

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During the 2016 Republican Party presidential primaries, presidential candidate and primary opponent Jeb Bush speculated in February 2016 that Trump had mental health issues, stating "I'm not a psychiatrist or a psychologist, but the guy needs therapy".[55][56]

On April 14, 2017, Representatives Jamie Raskin and Earl Blumenauer introduced the Oversight Commission on Presidential Capacity Act.[57] The bill, if passed, would have allowed Congress, by a concurrent resolution, to require an 11-member commission to conduct an examination of the president and report the findings.[58][59] Blumenauer stated:

It is hard to imagine a better group to work with the vice president to examine whether the president is able to discharge the duties of the office. When there are questions about the president's ability to fulfill his or her constitutional responsibilities, it is in the country's best interest to have a mechanism in place that works effectively.[58]

In September 2017, Jeanne Suk Gerson wrote in The New Yorker: "A strange consensus does appear to be forming around Trump's mental state," including Democrats and Republicans who doubt Trump's fitness for office.[45]

Donald J. Trump
@realDonaldTrump
  

North Korean Leader Kim Jong Un just stated that the "Nuclear Button is on his desk at all times." Will someone from his depleted and food starved regime please inform him that I too have a Nuclear Button, but it is a much bigger & more powerful one than his, and my Button works!

January 3, 2018[60]

In January 2018, after North Korea's leader Kim Jong Un and Trump publicly exchanged claims about their respective "nuclear buttons", Richard Painter, a former adviser to President George W. Bush, deemed Trump "psychologically unfit" and supported transferring his powers to Vice President Pence under the 25th Amendment.[61] In April 2018, Vanity Fair reported that Trump's advisers "worry about his mental health" when he is outside the controls available in the White House environment.[62]

Trump's responses

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In 2018, Trump dismissed then-prevalent questions regarding his mental health, stating that he is a "very stable genius".[61] As evidence of his mental capacities, he pointed to his business success, his victory over Republican competitors, and his election to the presidency against Hillary Clinton.[63] Trump has also pushed back on claims he couldn't remember the name of a fallen soldier while talking to the widow by stating he has "one of the great memories of all time".[64]

2018 cognitive test

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In response to speculation about his cognitive abilities, Trump was administered the Montreal Cognitive Assessment (MoCA) at his own request as part of his January 2018 health checkup. He claims he received a score of 30/30, indicating a normal level of cognitive function, though the results have never been released.[2] Critics have contended that the MoCA test is too basic to diagnose the problems asserted.[65][66] Trump used the phrase "Person, woman, man, camera, TV" several times during a July 2020 Fox News interview with Marc Siegel, a professor of medicine at New York University,[67][68] while boasting about his performance on and describing part of the 2018 MoCA test.[69] Trump has not publicly revealed the results of any subsequent cognitive tests, but as late as 2024 continues to brag of his performance in the 2018 cognitive test.[24] Ziad Nasreddine, the neurologist who created the test Trump took, noted that 2018 results would be too outdated to be relevant in 2024.[2]

Physical health

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Medical reports and records controversies

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In December 2015, Trump's personal physician, Harold Bornstein, released a superlative-laden letter of health praising Trump for "extraordinary physical strength and stamina", saying he was the "healthiest individual ever elected to the presidency", and said that a recent medical exam yielded "only positive results".[70] Before Bornstein's death in 2021, he told CNN that Trump had dictated the entire letter.[2][71] The language used was in Trump's style and not that typical of a medical doctor; in particular, the American journalist Kurt Eichenwald noted that positive test results often do not mean a positive (favorable) outcome for the patient.[72] A follow-up medical report by Bornstein claimed Trump's blood pressure, liver and thyroid functions to be in normal ranges, and that he takes a statin. At 6 ft 3 in (1.91 m) and 236 lb (107 kg), Trump's body mass index of 29.5 registered as overweight which is on the higher end of overweight BMIs.[73][74][75]

In January 2018, Trump was examined by White House physician Ronny Jackson, who stated that he was in excellent health, although his weight and cholesterol level were higher than recommended,[76] and that his cardiac assessment revealed no medical issues.[77] Several outside cardiologists commented that Trump's weight, lifestyle and LDL cholesterol ought to have raised serious concerns about his cardiac health.[78] Trump's 2018 coronary CT calcium scan score indicates he has a form of heart disease called coronary artery disease, which is common for white males at his age.[79]

On May 1, 2018, Bornstein told NBC News that three Trump representatives had "raided" his office on February 3, 2017, taking all of Trump's medical records. He identified two of the men as Trump's longtime bodyguard Keith Schiller and the Trump Organization's chief legal officer Alan Garten.[80] Two days earlier, Bornstein had told a reporter that Trump took a prescription hair growth medicine, Propecia, after which Trump cut ties with him.[80][81] In February 2019, Trump was examined by White House physician Sean Conley. Conley stated Trump was in "very good health overall", although Trump was now slightly clinically obese, at 243 lb (110 kg) with a BMI of 30.4.[82] In 2022, MSNBC described Trump as "notoriously secretive about sharing his health records with the public" and "deliberately misleading and even dishonest about his health".[10]

As of 2018 it was reported that Trump does not drink alcohol;[76] this decision arose in part from watching his older brother Fred Jr. suffer from alcoholism that contributed to his early death in 1981.[83][84] He also said that he has never smoked cigarettes or consumed drugs, including marijuana.[85]

2020 COVID-19 infection

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Main article: White House COVID-19 outbreak
 
Trump boards Marine One for COVID-19 treatment on October 2, 2020

On September 26, 2020, an event was held in the White House Rose Garden announcing Amy Coney Barrett's nomination to the Supreme Court following the death of Ruth Bader Ginsburg.[86] Hours after the ceremony, Trump tested positive for COVID-19, although the public would not learn of this result until late 2021.[87] His chief of staff recalled that Trump looked "a little tired" and was suspected of having a "slight cold".[87]

Despite testing positive, Trump traveled in Air Force One to a rally at the Harrisburg International Airport in Pennsylvania, which was attended by thousands.[88] The governor opposed the rally, arguing: "It is gravely concerning that the president would insist on holding this event with blatant disregard for social distancing and masking requirements. His decision to bring thousands of people together in a tight space in the midst of a global pandemic caused by an airborne virus is flat out wrong."[89] After Trump's diagnosis was made public, Pennsylvania health officials advised attendees to participate in the state's contact tracing program.[90] In the wake of the rally, the county saw a surge in COVID-19.[91]

After returning from Bedminster, Trump received a positive test result[92] on a rapid test and was waiting to get results of a PCR test when he did a live phone interview on Hannity.[93] Sean Hannity of Fox News brought up Bloomberg's report about Hicks and asked for an update, whereupon Trump publicly mentioned Hicks' diagnosis for the first time, saying, "I just heard about this. She tested positive."[94][95] Trump stated, "It is very, very hard when you are with people from the military, or from law enforcement, and they come over to you, and they want to hug you, and they want to kiss you because we really have done a good job for them."[96][97] Without disclosing that he had already tested positive, he announced that he and the first lady were being tested for SARS-CoV-2.[93][98][99] He repeated this via Twitter after the interview. Later that night, the result of the PCR test also came in positive.[93] On October 2, 2020, Trump tweeted that he had tested positive for COVID-19,[100][101] part of a White House outbreak.[102][103]

Later that day Trump was hospitalized at Walter Reed National Military Medical Center,[104] reportedly due to fever and labored breathing. He was treated with antiviral and experimental antibody drugs and a steroid. He returned to the White House on October 5, still infectious and unwell.[102][105] During and after his treatment he continued to downplay the virus.[102] In 2021, it was revealed that his condition had been far more serious; he had dangerously low blood oxygen levels, a high fever, and lung infiltrates, indicating a severe case.[103]

2024 election

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The shift in Trump's speeches by 2024 towards shorter sentences, more tangents, more repetition, more all-or-nothing thinking and more confusion of words and phrases could indicate cognitive decline.[50][8][20][2] Basil Smikle of Columbia argued in January that one reason Trump has not seen as much of the age criticism as Biden because his rallies seem loud and vibrant whereas Biden has a more old-school approach to politics.[31]

An article in The Conversation by finance professor Brandon Cline showed that around half of the 1500 largest public companies in the U.S. force their CEOs to retire when they turn 65 or so because of declining performance, with nearly 70% of S&P 500 companies having mandatory retirement ages for their boards in the mid-70s. Cline noted that a similar rule would have made both Trump and Biden ineligible to run in 2024 and argues that the evidence supporting a mandatory retirement age is strong. He cited studies showing that CEOs over 65 hired and fired fewer people, made fewer deals, were less active overall and that age-related changes impair judgment.[106]

As of October 12, 2024, Trump has yet to release even the most basic health information going back to 2015 when he first started running for president, despite a promise he made in August 2024 to release records from a recent examination.[14][15] Releasing detailed medical reports is typical of presidential candidates.[16] Kamala Harris released her detailed medical report on October 12, 2024.[107]

The New York Times published an analysis of Trump's speeches on October 6, 2024, writing "with the passage of time, the 78-year-old former president's speeches have grown darker, harsher, longer, angrier, less focused, more profane and increasingly fixated on the past, according to a review of his public appearances over the years." The paper commented that Trump has lately seemed "confused, forgetful, incoherent or disconnected from reality" but that it does not get covered much because it is so common. It highlighted an average rally length of 82 minutes compared with 45 minutes in 2016, and a 13% increase in use of all-or-nothing terms like "always" and "never". It also found 32% more negative words than positive words compared with 21% in 2016, and a 69% increase in swearwords. It cited that experts considered this increase in tangential speech and behavioral disinhibition potential results of advancing age and cognitive decline.[4] The paper also found that Trump has appeared tired at times and has maintained a far less active campaign schedule this time around, holding only 61 rallies so far in 2024, compared with 283 through all of 2016.[4] The authors also highlight how he is more easily distracted and not open to correction.[4]

Bob Woodward described Trump as "the most reckless and impulsive president in American history."[108]

Longevity

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In January 2024, Dr. Jay Olshansky gave Donald Trump less than a 75% chance of living through a second term based on publicly available information about his health.[109][110]

2024 assassination attempt

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Main article: Attempted assassination of Donald Trump in Pennsylvania

On July 13, 2024, Trump survived an assassination attempt while addressing a campaign rally near Butler, Pennsylvania.[111] Trump was shot at[112] by Thomas Matthew Crooks, a 20-year-old man from Bethel Park, Pennsylvania,[113][114] who fired eight rounds with an AR-15–style rifle from the roof of a building located approximately 400 feet (120 meters) from the stage.

According to the FBI, Trump was hit by a bullet or shrapnel,[115] and injured in his upper right ear.[116] He raised a hand to his ear before dropping down on his podium behind the lectern for cover.[117][118][119][120] Secret Service agents lunged toward Trump and shielded him. After the assailant was declared "down", agents helped Trump get up. Blood was visible on his ear and face. He asked the Secret Service agents to let him get his shoes.[121] According to Trump, the agents "hit me so hard that my shoes fell off, and my shoes are tight".[122] None of the medical records, as of October 12, 2024, from the wounds have been released.[123]

Psychologist Simon McCarthy-Jones of Trinity College Dublin said in The Conversation in July 2024 that "the potential effect of these events on his mental health – whether negligible, negative or positive – cannot be ignored", and that Trump being an extrovert might improve his ability to deal with the psychological impact of the event, while "other personality traits, including low agreeableness, low conscientiousness and low emotional stability, also attributed to Trump, are associated with greater levels of PTSD", as are "high levels of narcissism", which can also "cause people to react to even limited threats with aggression".[124] In August 2024, Vanity Fair reported that Trump was in fact "experiencing trauma from his near-death experience", with a campaign insider reportedly claiming that Trump was "watching that seven-second clip of how close he was to getting shot right in the head – over and over and over again", saying that Trump "may actually legit have PTSD".[125]

See also

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References

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