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Special online feature to the Journal on Active Aging5DRAFTSeptember 2020
• Donald Trump and Joe Biden come
from family histories of exceptional
longevity (e.g., familial longevity). As
such, there is suggestive evidence that
both candidates are likely to be “super
agers”—a subgroup of people that
maintain their mental and physical
functioning into late life and tend to
live longer than the average person
their age.
• Both candidates have a higher than
average probability of surviving the
next four years relative to other men
their age (95.2% for Biden—average is
82.2%; 90.3% for Trump—average is
86.2%). The main force influencing
these favorable survival estimates is
familial longevity. Socioeconomic
factors contributing to this conclusion
are that both have access to excellent
health care, high income, they are
highly educated, and both are married.
• Both candidates are expected to have
higher than average healthspans
relative to other men their age in the
US (about 10 years more than
average).
• Biden is expected to outlive Trump,
even though he is three years older.
The reasons are that Biden has an
exceptional health profile for a man
his age (e.g., ideal Body Mass Index
[BMI], physically active, few
prescription medications, no
identifiable lethal conditions, excellent
cholesterol profile, low inflammation).
He also has a family history of
longevity. Trump also shares most of
this profile, except his obesity and
sedentary lifestyle work against his
familial longevity history and his
otherwise healthy biological profile.
Trump’s risk factors are significant but
modifiable—it is unknown whether
he has adhered to lifestyle recom-
mendations from his physicians.
However, this is not a longevity
competition—both have a high prob-
ability of surviving a full term in office
after the election.
• Trump does face an elevated familial risk
of late onset Alzheimer’s disease (AD)
as this was a major contributor to his
father’s death (died of pneumonia, a
common immediate cause of death in AD
patients); and he also faces an elevated risk
of heart disease due to verified risk factors
publicly revealed by his personal physician.
• There is no evidence available in the public
record to indicate that either candidate is
facing a major cognitive functioning
challenge—either now or during the next
four years. Trump does face an elevated
risk of Alzheimer’s disease due to a family
history of the disease on his father’s side.
It may be tempting to conclude that
evidence of cognitive decline does not
exist because extensive diagnostic assess-
ments of cognitive functioning have
not been completed, and if done, some-
thing significant might be revealed.
Presidential candidates are evaluated by
their personal physicians in much the same
way the rest of the population is assessed.
Diagnostic tests of cognitive function are
not done unless the physician suspects the
presence of a problem or if requested, and
even then, a dementia screening test like
the one completed by Trump (Montreal
Cognitive Assessment Test–MoCA) is
done first. There is no single diagnostic
test that can determine if someone has
Alzheimer’s disease. The decision not to
order an extended battery of medical,
neuropsychological and other diagnostic
tests during the candidates’ most recent
physicals is evidence for an absence of
issues involving cognitive functioning for
both Biden and Trump. It is unclear what
would occur if a candidate or sitting
president refused to undergo a screening
or diagnostic test—if recommended by
their physician.
• This review of inherited and acquired risk
factors combined with an assessment of
available medical records for both
candidates is not a guarantee of an
anticipated survival or health outcome.
Risk factors for health, longevity and
cognitive functioning are subject to
modification in either direction by
both candidates; random elements to
aging make it difficult to generate
forecasts with precision; and both
candidates are subject to health risks
due to Covid-19.* Nevertheless, the
familial, and personal health and
medical history information publicly
available from both candidates tend to
favor the projected outcomes discussed
here.
• Based on a personalized assessment that
includes an evaluation of inherited
and acquired risk factors for health and
longevity from a demographic and
actuarial perspective; and from inde-
pendent reviews of publicly available
medical record data on both candidates
by three independent physicians with
expertise in aging; it is our conclusion
that chronological age is not a relevant
factor for either candidate running for
president of the United States. Both
candidates face a lower than average risk
of experiencing significant health or
cognitive functioning challenges during
the next four years.
* Donald Trump has tested positive for
Covid-19 as this article is in production.
This diagnosis raises his immediate and
long-term risk of death by an undeter-
mined amount. If Trump is a super ager,
it’s possible that the same factors that lead
to decelerated aging, also offer added
protection from the harmful effects of
Covid-19 on his immune system. Initial
evidence from centenarians infected with
Covid-19 suggest that super agers weather
this challenge quite effectively.
Executive summary
Special online feature to the Journal on Active Aging6DRAFTSeptember 2020 population. Needing help with at least
one activity of daily living (ADL), such as
bathing and dressing, defined disability.
Healthspan corresponds to remaining life-
span without disability. The metric of
healthspan is a byproduct of decades of
research by scientists across the globe with
the goal of devising a summary measure of
population health that combines mortality
risk with non-fatal health conditions.
Healthspan was first measured in the late
1970s by Sullivan, and it is now a standard
reporting metric by the Global Burden of
Disease project, the World Health Organi-
zation, and in thousands of research articles
since first developed.16 Healthspan is a
standardized reliable health metric that is
reported annually for most countries.17
Results
Lifespan (independent of medical
history)
• Biden life expectancy estimate using a
combined risk factor approach = 96.8
years (average is 87.4 years)
• Biden probability of surviving a four-
year term as president = 95.2% (average
is 82.2%)
• Biden probability of surviving to age 85
years = 66% (average is 61.2%)
• Trump life expectancy estimate using a
combined risk factor approach = 88.6
years (average is 86.2 years)
• Trump probability of surviving a second
four-year term as president = 90.3%
(average is 86.2%)
• Trump probability of surviving to age
85 years = 60% (average is 55.0%)
Healthspan
In an earlier assessment of healthspan for
Biden and Trump,3 it was estimated that
men in the U.S. that are Biden’s age have,
on average, about 9 years of healthy life
remaining while men in the U.S. that are
Trump’s age have an average of 10.9 years of
healthy life remaining. Those assessments
were based on expectations for a white col-
lege-educated subgroup of men, so they are
consistent with what is expected for both
candidates—which is an estimated
healthspan that is higher than average.
Since there is no reason to believe that ei-
ther candidate has lost any of their activi-
ties of daily living (ADLs) or instrumental
activities of daily living (IADLs), there is
no basis for adjusting these healthspan esti-
mates. However, given the more favorable
overall health profile of Biden relative to
Trump, even in spite of being three years
older, it is safe to assume that the projected
healthspans of the two candidates are
roughly equal at approximately 10 years.
Both candidates are projected to have a
healthspan that extends beyond the end of
the next presidential term.
Physician reviews
(summary)
Dr. Nir Barzilai
Considering that over 90% of people over
65 in the U.S. have more than two morbid-
ities (obesity considered one), the available
medical records reveal an excellent overall
health status of Joe Biden—placing him in
the top 10% of his birth cohort for older
adults. His most challenging condition is
his atrial fibrillation that seems stable and
asymptomatic with treatment to prevent
thrombosis. There is nothing in his medical
record to suggest that he is at a higher than
normal risk for cardiovascular diseases, can-
cer, type 2 diabetes mellitus, cognitive de-
cline or death during a first term in office.
The aneurysms he experienced in 1990 are
no longer a significant health risk for him
given his healthy survival during the past
30 years. He’s on a limited number of pre-
scription medications—implying a bet-
ter-than-average set of health risks. The
best piece of evidence in the medical record
suggesting that Biden could be long-lived is
the exceptional longevity of his parents;
both of whom reached advanced ages for
their birth cohort—with his father surviv-
ing into his 80’s and mother into her 90s.
Having long-lived parents has independent
effects on the longevity of offspring, even
independent of risk factors and physical
dysfunction.18,19,20,21 For example, Alzhei-
mer’s disease and type 2 diabetes mellitus
can be significantly delayed for people
with long-lived parents. Overall, based
on Biden’s behavioral and medical risk
profiles and his family history of exception-
al longevity, there is a high probability
Biden will survive with his physical and
mental health intact through a first term in
office.
Based on the available data, Trump has two
major documented health issues, obesity
and a level of physical activity defined as
sedentary. There is suggestive evidence that
his dietary and sleep habits are unfavorable,
but in the absence of definitive evidence for
both of these covariates, it is assumed here
that these are non-issues. Aside from obesi-
ty and a lack of physical activity, the rest of
the data available on Trump reveals excel-
lent overall health prospects for a 74-year-
old male in the U.S. relative to other men
his age. Trump’s high LDL levels suggest a
risk for cardiovascular disease, especially
because these high levels are observed wSpecial online feature to the
Journal on Active Aging8DRAFTSeptember 2020
on cholesterol-reducing medication.
Trump’s level of obesity places him at risk
for type 2 diabetes mellitus. He has no
known risks for cancer, cognitive decline or
death during the next term. The best piece
of evidence suggesting that Trump could be
long-lived is the familial exceptional lon-
gevity of his parents; both of whom
reached advanced ages—with his father
surviving into his 90s and mother into her
late 80s. When familial longevity is consid-
ered together with his behavioral risk pro-
file, it is my conclusion that there is a high
probability Trump would survive with his
physical and mental health intact through a
second term in office.
Dr. Paola Rode
Recognizing that there are constraints on
publicly available medical records, available
data suggest that both candidates have a
high likelihood of surviving the next four
years. Biden may have a slight longevity ad-
vantage over Trump due to his lifestyle
choices such as exercise and diet regimen as
well as a Body Mass Index (BMI) within the
normal range. Both candidates take less than
the national average prescription medica-
tions for men their age in the U.S. A Nation-
al Center for Health Statistics investigation
reported that approximately a third of per-
sons over age 60 were on = 5 prescription
medications in 2007–2008 (see detailed
review below) As higher prescription medi-
cation use can be associated with worse
health status than those on less medication,
the fact that they are both taking fewer med-
ications than average makes them less vul-
nerable. Both candidates have access to ex-
cellent health care and are known to have a
higher income which correlates with an in-
creased life expectancy. This speaks to the
fact that despite the age difference, both
candidates are expected to survive a four-
year term with their mental and physical
capacities intact.
Dr. Bradley Willcox
Joe Biden is in excellent overall health for a
77-year-old American male. His primary
medical impairment is non-valvular atrial
fibrillation (AF). This is a common age-as-
sociated arrhythmia and does not appear to
be due to underlying coronary artery dis-
ease. He has never had any cardiovascular
disease (CVD) complications attributable
to AF, does not require rate or rhythm con-
trol, and it is considered fairly benign. Case
in point, he engages in vigorous physical
activity that might overly stress a typical
AF patient, without incident, and has done
so most of his life. He has no clear evidence
for CAD; he has a distant history of cere-
bral aneurysms, which were successfully
treated after discovery and are no longer a
risk; he has no other major age-related dis-
eases, and all physiological systems appear
to be functioning well. Biden’s laboratory
blood work is exceptional, particularly his
metabolic/lipid profile (excellent cholester-
ol, fasting blood sugar, hemoglobin A1C).
His C-reactive protein (CRP) is very low,
suggesting very low systemic inflammation,
which is a major driver of the aging process
known as “inflammaging”.22 His medica-
tions are low-risk and minimal. His father
and mother far outlived their birth cohort,
living into their 80s and 90s, respectively.
In addition to his family history of longevi-
ty, Biden has a healthy BMI, and practices
excellent health habits, particularly eating a
healthy diet and vigorous exercise. This
includes aerobic activity and strength train-
ing, which are very important for healthy
aging. Biden’s overall health profile suggests
that he has a very high probability of sur-
viving through his first term in office with
his physical and cognitive function intact.
Donald Trump’s overall health profile sug-
gests that he has been quite healthy over
the years, but he now is aging at an acceler-
ated pace. He has clear evidence (on several
Cardiac CT scans) for subclinical CAD,
the leading cause of mortality in the U.S.,
that has been worsening over the past de-
cade. His otherwise lack of major disease
and disability thus far may be largely genet-
ic since his parents lived into their octoge-
narian and nonagenarian years, although
his father had Alzheimer’s disease for ap-
proximately six years before his death.
However, family history is not destiny (two
of his brothers have died younger than ex-
pected) and Trump’s poor lifestyle (un-
healthy diet, lack of physical activity) may
be catching up with him. This is evident
from a worrisome increase in his coronary
artery calcium (CAC) score over the past
decade (2009–18), which has progressed
from a low CAC score to a moderately
high-risk score (approximately 7-fold in-
creased risk for a major cardiovascular
event [MI or sudden death] versus a score
of zero23). On the positive side, other than
obesity, he has a very good metabolic pro-
file, he appears to be on few prescription
medications for a man his age (less than a
half-dozen low risk medications), appears
to receive excellent medical care, practices
some preventive health behaviors (e.g. takes
a multivitamin, screening tests and immu-
nizations appear up to date) and is married.
In sum, based on these data, and assum-
ing there is no further comorbidity in
the limited medical records, he will likely
live longer than a typical 74-year-old
male.
Overall, the medical records and/or public-
ly available information suggest that Biden
maintains an edge over Trump in terms of
his chances of surviving, and surviving
healthfully, over the next four years—in
spite of the fact that Biden is three years
older than Trump. However, both Biden
and Trump are expected to survive the next
presidential term with their mental and
physical functioning intact

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