Facing Cognitive Decline: Lessons from Family Care to Presidential Politics

After watching Biden’s performance in the first 2024 presidential debate, I have been thinking about how families approach aging. About 20 years ago, both my grandmother and father showed signs of no longer being able to manage their affairs. At the relatively young age of 36, I found myself helping to plan for their long-term care, and I’ve observed other families in this situation since.

The questions in these cases have some similarities to those now being asked about Joe Biden: How consistent is the presentation of cognitive changes? If someone was inconsistent in their cognitive abilities, what was the best way to maintain their dignity as the news was broken to them and more capable family members took over?

My grandmother at the age of 92 was still lucid enough to take part in the decision-making for assisted living. That was the good news, but the wait list required that she live with family members until she was offered an apartment, something no one was prepared for. While my mother was happy to care for my grandmother over the next six months, my stepfather was less prepared to welcome someone into the home. My father was a different story. His decline began in his early 60s. He faced many health issues besides dementia, and it seemed like out of the blue — although it really wasn’t out of the blue — that we needed to find a nursing home.

As uncomfortable as it is to admit, the family just didn’t bother to plan for the inevitable. Perhaps we took my grandmother and my father at their word when they said everything was fine, and they could manage by themselves. This approach in hindsight was highly problematic. Many people often aren’t aware of their own cognitive decline. They sense things are becoming more difficult, but may not be fully aware of their developing limitations.

I witnessed other families make the same mistakes we made. I used to live in a building with a large elderly population. There was the couple in their mid-eighties who repeatedly left the gas stove on. The super had to go up to their apartment regularly to put out the fires, something that put the whole building in danger. A neighbor down the hall was fine until her early nineties. She rapidly developed dementia and told her children that she didn’t need their help because she could rely on the woman next door. The next-door neighbor gradually took on more and more responsibilities and only learned later that the family had turned her into a surrogate daughter.

In a culture that prizes individualism and self-sufficiency, it’s hard for parents to admit to themselves and their children that they may no longer be able to take care of themselves. And it’s hard for the children to see their parents in decline.

Nevertheless, there may be more going on here than just difficult emotions. Perhaps we’re dealing with a cognitive distortion that sounds something like this: if we acknowledge aging, plan for elder care in advance, and regularly monitor our loved ones, we will hasten or cause their eventual demise — and our own.

These are dangerous beliefs. For all the left’s fear of Trump, we could end up with a shadow government, if we don’t have one already. In 1919, Woodrow Wilson suffered a stroke that left him with poor judgment and impaired emotional difficulties. His wife, Edith, took over. She acted as gatekeeper, made decisions in his name, and hid his condition from the public, something that included overly optimistic reports from his doctors.

In 1920, the Democrats had the good sense to nominate someone else, but today, we are somehow debating inconsistencies in behavior that are documented signs of decline. Attempting to rope the nation into a dangerous exercise in futility is not conducive to democracy. Using fear to manipulate the electorate into voting for someone not capable of holding office is not conducive to democracy. On the contrary, it is decidedly anti-democratic because it erodes trust in the political establishment.

Joe Biden needs to be told the truth to preserve his dignity and to preserve the country. Unlike my 90-year-old neighbor, who had no say in her fate, Biden may still be well enough to comprehend his position and have a voice in his future. Full transparency on the part of the Biden family would allow the electorate to have a say in their fate as well.