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John Kearney is a retired philosophy professor who taught at Saint Joseph’s University in Philadelphia, Pennsylvania. He has lived in Waterloo, Iowa for the past six years.

Is Joe Biden too old to be seeking a second term as president of the United States? Well, he clearly thinks he is not. He recently stated that he is the most qualified person in the country to hold that office.

Biden had his annual physical a few days ago. His personal physician, Dr. Kevin O’Connor, concluded his six-page summary of the president’s health by saying, “President Biden is a healthy, active, robust 81-year old male, who remains fit to successfully execute the duties of the Presidency, to include those of the Chief Executive, Head of State and Commander in Chief.”

Dr. O’Connor’s summary listed several medical issues the president is dealing with, including sleep apnea, persistent atrial fibrillation, hyperlipidemia, gastroesophageal reflux, seasonal allergies, spinal arthritis, and sensory peripheral neuropathy in both feet.

I can identify somewhat with President Biden’s medical profile. He is 81 years old. I am 84. He has atrial fibrillation, for which he takes the blood thinner apixaban (Eliquis). So do I. One third of the 2.7 million people in this country with a-fib are asymptomatic. No heart palpitations, dizziness, light headedness, etc. In that respect Biden and I are alike.

He has hyperlipidemia, for which he takes a statin drug on a daily basis. So do I. He exercises five times a week. Sorry, Mr. President, but I exercise seven times a week!

The president does not smoke or drink. Neither do I.

In the past year, he was diagnosed with sleep apnea, for which he uses a CPAP machine. I have mild sleep apnea, but I elected not to take the CPAP route after I studied the statistics on the number of individuals who quit using the device.

One notable difference between us is that I have a pacemaker. He does not. Biden has seasonal allergies, acid reflux, spinal arthritis, and neuropathy of the feet. Other than an occasional bout of acid reflux I do not suffer from those ailments.

It is not “ageism” to be concerned about Biden’s health. While “persistent” atrial fibrillation is not, in itself, life threatening, and taking Eliquis lowers the risk of stroke, it does not guarantee that a patient will never experience a stroke, especially a hemorrhagic stroke, when blood vessels in the brain leak or rupture.

My wife and I reside in an independent living retirement community of approximately 180 people where the median age is around eighty. I see some people living to a great age. But I see others who are otherwise healthy one day, sick the next, and then receive a depressing diagnosis. Every person in their 80s knows or should know that their health can “go south” very quickly.

Personally, I am doing reasonably well. But in the back of my mind, I know that, at age 84, while I could live another ten years, it is also the case that I could live another ten weeks or even ten days. Death is an ever-present possibility.

I have another major concern about Biden’s candidacy. I believe the American people have witnessed a dramatic decline in his communication skills. I am not talking about the stuttering, over which he has no control and for which he should not be criticized. But it is troubling when he confuses the President of Egypt with the President of Mexico, French President Macron with Francois Mitterrand (who died in 1996), and Ukrainian President Volodymyr Zelensky with Russian President Vladimir Putin.

Some people want to write off these gaffes as “Biden being Biden.” But when you are the most powerful and influential leader in the free world, it is incumbent upon you to have above average communication skills. Are these linguistic mistakes symptomatic of an underlying cognitive deficiency? I have no idea. I am not qualified to make such a judgment. But I do expect my president to be an effective communicator.

I am not saying, “Don’t vote for Biden, vote for Trump.” Just be aware of the risk that a vote for Biden poses. As regards Donald Trump, who also sometimes confuses names (Barack Obama for Biden, Nikki Haley for Nancy Pelosi), I believe the risk is even greater. I am persuaded that one needn’t be a psychiatrist to see that his behavior is symptomatic of a narcissistic personality disorder which, in my judgement, should be disqualifying in itself. MAGA Republicans would no doubt have a different view.