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    The Army Sees Mortars as Safe. Troops Report Signs of Brain Injury.

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    After firing about 10,000 mortar rounds during four years of training, one soldier who joined the Army with near-perfect scores on the military aptitude test was struggling to read or do basic math.Another soldier started having unexplained fits in which his internal sense of time would suddenly come unmoored, sending everything around him whirling in fast-forward.A third, Sgt. Michael Devaul, drove home from a day of mortar training in such a daze that he pulled into a driveway, only to realize that he was not at his house but at his parents’ house an hour away. He had no idea how he got there.“Guys are getting destroyed,” said Sergeant Devaul, who has fired mortars in the Missouri National Guard for more than 10 years. “Heads pounding, not being able to think straight or walk straight. You go to the medic. They say you are just dehydrated, drink water.”All three soldiers fired the 120-millimeter heavy mortar — a steel tube about the height of a man, used widely in training and combat, that unleashes enough explosive force to hurl a 31-pound bomb four miles. The heads of the soldiers who fire it are just inches from the blast.The military says that those blasts are not powerful enough to cause brain injuries. But soldiers say that the Army is not seeing the evidence sitting in its own hospital waiting rooms.In more than two dozen interviews, soldiers who served at different bases and in different eras said that over the course of firing thousands of mortar rounds in training, they developed symptoms that match those of traumatic brain injury, including headaches, insomnia, confusion, frayed memory, bad balance, racing hearts, paranoia, depression and random eruptions of rage or tears.Troops of the First Armored Division fire rounds from a carrier-mounted mortar during a training exercise in New Mexico in 2017.Killo Gibson/U.S. Army, via Department of DefenseThe military is confronting growing evidence that the blasts from firing weapons can cause brain injuries. So far, though, the Pentagon has identified a potential danger only in a few unusual circumstances, like firing powerful antitank weapons or an abnormally high number of artillery shells. The military still knows little about whether routine exposure to lower-strength blasts from more common weapons like mortars can cause similar injuries.Answering that question definitively would take a large-scale study that follows hundreds of soldiers for years, and it is impossible to draw sweeping conclusions from a handful of cases. But the soldiers interviewed by The New York Times have experienced problems similar enough to suggest a disturbing pattern.Most soldiers said they had fired at least 1,000 rounds a year in training, often in bursts of hundreds over a few days. When they were new at firing, they said, they felt no lasting effects. But with each subsequent training session, headaches, mental fogginess and nausea seemed to come on quicker and last longer. After years of firing, the soldiers experienced problems so severe that they interfered with daily life.Nearly all of the soldiers interviewed for this article never saw combat, but they were nonetheless haunted by nightmares, anxiety, panic attacks and other symptoms usually attributed to post-traumatic stress disorder. Nearly all sought medical help from the Army or the Department of Veterans Affairs and were screened for traumatic brain injury, but did not get a diagnosis. Instead, doctors treated individual symptoms, prescribing headache medicine, antidepressants and sleeping pills.That is in part because of how traumatic brain injuries, known as T.B.I.s, are diagnosed. There is no imaging scan or blood test that can detect the swarms of microscopic tears that repeated blast exposure can cause in a living brain. The damage can be seen only postmortem.So, doctors screening for T.B.I.s ask three questions: Did the patient experience an identifiable, physically traumatic event, like a roadside bomb blast or car crash? Did the patient get knocked unconscious, see stars or experience other altered state of consciousness at the time? And is the patient still experiencing symptoms?For a T.B.I. diagnosis, the answer has to be yes to all three.U.S. Army paratroopers fire a mortar barrage at a training area in Germany in 2022. Kevin Payne/Department of DefenseThe problem is that people who are repeatedly exposed to weapons blasts often cannot pinpoint a specific traumatic event or altered state of consciousness, according to Stuart W. Hoffman, who directs brain injury research for the V.A. With career mortar soldiers, he said, “if you’re not feeling the effects at the time, but you’re being repeatedly exposed to it, it would be difficult to diagnose that condition with today’s current standards.”That means injuries that seem obvious to soldiers go unrecorded in official records and become invisible to commanders and policymakers at the top. As a result, weapons design, training protocols and other key aspects of military readiness may fail to account for the physical limits of human brain tissue.An Army spokesman, Lt. Col. Rob Lodewick, said in a statement that for decades the Army has been studying how to make weapons safer to fire and is “committed to understanding how brain health is affected, and to implementing evidence-based risk mitigation and treatment.”Asked if the Army plans to phase out the use of the 120-millimeter mortar, a mobile weapon that nearly all infantry units use to rain down bombs on enemy positions, Colonel Lodewick said no.Still, there are signs that the Army sees problems with the mortar. It is developing a cone for the muzzle to deflect blast pressure away from soldiers’ heads. And in January, the Army issued an internal safety warning, drastically limiting the number of rounds that soldiers fire in training to no more than 33 rounds a day using the weakest charge, and no more than three rounds a day using the strongest.That warning, though, makes no mention of brain injury; the stated purpose is to protect troops’ hearing.The military measures the force of blast waves in pounds of pressure per square inch, and the current safety guidelines say that anything below 4 PSI is safe for the brain. The blast from firing a 120-millimeter mortar officially measures at 2.5 PSI. But the guidelines do not take account of whether a soldier is exposed to a single blast or to a thousand.There are roughly 9,000 mortar soldiers in the Army — and, in all service branches, there are thousands more troops who regularly use weapons that deliver a similar punch: artillery, rockets, tanks, heavy machine guns, even large-caliber sniper rifles.Justin Andes, 34, launched about 10,000 mortar rounds in Army training at Fort Johnson, La., between 2018 and 2021.He began to experience migraines, dizziness and confusion, to such a degree that his job of keeping accurate counts of weapons in his unit’s armory became a struggle. Eventually he had an emotional breakdown with thoughts of suicide, and he left the Army in dismay when his enlistment ended.Justin Andes launched about 10,000 mortar rounds in Army training at Fort Johnson, La., between 2018 and 2021.Chase Castor for The New York Times“We had to keep a count of every round we fired, and get the mortar tubes inspected each year, because all those blasts can take a toll on the weapons system,” he said in an interview. “But no one was doing that for us.”Mr. Andes joined the Army with a college degree and top scores on the military aptitude test. He had planned to get a graduate degree in political science, but after firing so many mortar rounds, he had trouble reading. Today, Mr. Andes, who now lives in Jefferson City, Mo., speaks with a slight slur, sometimes puts the milk in the kitchen cupboard instead of the refrigerator, and spends much of his time in his basement.“His voice is different, he acts different, he is a different person from the man I married,” his wife, Kristyn Andes, said. “I didn’t start to connect the dots that this might be mortars until some of the other wives said they were having the same issues.”The first sergeant in charge of Mr. Andes’ platoon, she said, was having trouble, too. He was forgetting words, struggling to remember his responsibilities and had a stammer in his speech and a tremor in his hand.Another soldier in his platoon, James Davis, 33, started having near-daily panic attacks in uniform, as well as balance problems, migraines and sensitivity to light. He went to a specialty clinic for traumatic brain injury at Fort Johnson in 2022. “I was told that with time, the symptoms would disappear,” said Mr. Davis, who now lives in Colorado Springs, in an interview. “I am still waiting for that to happen.”The 120-millimeter mortar is a widely used weapon among American combat troops. Marines fired mortar rounds in Afghanistan in 2017.Lucas Hopkins/U.S. Marines, via Department of DefenseMr. Andes, Mr. Davis and their first sergeant all left the Army without any official record that their brains may have been injured by mortar blasts. All three went to the V.A. for help. All three were found to be substantially disabled by issues that can be caused by traumatic brain injury, like vertigo, headaches, anxiety and sleep apnea. But not one was diagnosed with a brain injury.Former soldiers who fired mortars in the 1980s and 1990s say their experiences show that the problems are not new and may not improve with time.“It’s hard for me to piece together, because my memory has gotten so bad, but things are definitely getting worse,” said Jordan Merkel, 55, who joined the Army in 1987 and fired an estimated 10,000 mortar rounds over four years.In uniform, Mr. Merkel started experiencing strange fugue states, where he would be awake but barely responsive and would retain little memory afterward of what had happened.After the Army, he tried college but spent most of the time struggling through remedial classes. He married and divorced three times and said that he remembers very little about those relationships.For years he worked testing security software — a job with a predictable routine that allowed him to get by. But in 2016, he forgot how to do his work: Procedures he’d been following for years drew a blank.He was soon laid off, got a similar job and was laid off again. He has recently noticed trouble reading an analog clock.“I’m really concerned,” said Mr. Merkel, who now lives in Harrisburg, Pa. “This is not normal aging, this is something else.”He went to the V.A. this spring seeking help. The medical staff asked whether he had ever hit his head or been knocked unconscious, but they seemed dismissive when he brought up mortars, he said.“They weren’t the least bit interested in discussing anything related to blast concussion,” he said.Todd Strader had a similar experience. He fired mortars in the 1980s and 1990s at a U.S. base in Germany, and he developed headaches so severe that he would collapse on the ground and vomit. He was hospitalized in the Army for unexplained intestinal problems — a common issue among people with traumatic brain injuries. As a civilian, he struggled with fractured concentration, fatigue and anxiety.Todd Strader fired mortars in the 1980s and 1990s at a U.S. base in Germany. He developed headaches so severe that he would collapse on the ground and vomit.Matthew Callahan for The New York Times“I had plans for myself after the Army,” said Mr. Strader, 54, who now lives in Hampton, Va. “I wanted to travel the world but just ended up working a string of dead-end jobs.”He went to the V.A. in 2019 and was told that there was nothing in his record to suggest a military service-associated brain injury. Instead he was diagnosed with PTSD, even though he had never been in combat.Frustrated that the V.A. would not recognize what seemed obvious to him, he started a Facebook group, hoping to find other mortar soldiers with the same symptoms. The group now has nearly 2,500 members.The Pentagon has repeatedly assured Congress that the military is giving new attention to blast exposure, but ordinary soldiers say they have seen little change.Sergeant Devaul, who drove home to the wrong house, is now trying to get the Army to recognize that years of firing mortars injured his brain. He hasn’t had much luck.At his kitchen table in Kansas City, Mo., on a recent morning, he described how for 18 years he fired mortars, and how his life slowly fell apart.He started in the active-duty Army in 2006 and transferred to the National Guard in 2010. He deployed twice but never saw combat.After years of firing, he started to have trouble thinking. He had a civilian job doing carpentry but struggled with the math and organizational skills and left in frustration. He worked as a security guard for several years, but he developed headaches and concentration problems, and had outbursts of rage.Then he got a break from firing. For much of 2017 and 2018 he was in Qatar on a mission with no mortars and then in training away from the mortar range. He began feeling clearer and calmer. He studied to become an emergency medical technician and, in 2019, got a job with his local fire department.A slow-motion video provided by Sgt. Michael Devaul shows the training in 2021 that left him so dazed that he drove home to the wrong house.But that summer he resumed firing mortars. He started struggling to remember where supplies were kept in his ambulance. Other firefighters told him that he seemed to spend much of his time staring at nothing. The department asked him to learn to drive a fire truck, but he doubted that he could pass the test.In the fall of 2021 he was firing mortars in a training exercise and suddenly felt as though a seam had split in his head. He was dizzy and sick. For weeks afterward, he said, his skull was throbbing, and he was confused and angry.“I felt worthless and stupid,” he said. “I was so exhausted I could barely get off the couch. I didn’t see it getting better.”His wife filed for divorce. He became suicidal and spent five days in a program for PTSD.At his next National Guard training, it took only a few blasts to put him on the ground with the world spinning.The Guard now lists him as temporarily disabled by what it calls “post-concussion syndrome.” He is not allowed to fire mortars or even rifles.Since Sergeant Devaul can’t do his military job, the Guard has begun the process of discharging him. If it decides his injuries are service-related, he’ll be medically retired with lifetime benefits. If not, he’ll be forced out with next to nothing.Sergeant Devaul met recently with his brigade’s surgeon to be evaluated for traumatic brain injury. He said the doctor seemed skeptical that firing mortars could cause his symptoms.“I kept asking, ‘What else could have caused it?’ He didn’t have an answer,” he said. “I’ve got every single symptom of a traumatic brain injury. I just don’t have a diagnosis.” More

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      My Father, Ronald Reagan, Would Weep for America

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      The night before my father died, Ronald Reagan, I listened to his breathing — ragged, thin. Nothing like that of the athletic man who rode horses, built fences at the ranch, constructed jumps from old phone poles, cut back shrubs along riding trails. Or of the man who lifted his voice to the overcast sky and said, “Mr. Gorbachev, tear down this wall.”Time and history folded over themselves inside me, distant memories somersaulting with more recent realities — the 10 years of his journey into the murky world of Alzheimer’s and my determination to abandon the well-worn trail of childhood complaints and forge a new path. To be blunt, I had resolved to grow the hell up.I can still remember how it felt to be his child, though, and how the attention he paid to America and its issues made me jealous.Long before my father ran for office, politics sat between us at the dinner table. The conversations were predictable: Big government was the problem, the demon, the thing America had to be wary of. I hated those conversations. I wanted to talk about the boy who bullied me on the school bus, not government overreach.In time I came to resent this country for claiming so much of him. Yet today, it’s his love for America that I miss most. His eyes often welled with tears when “America the Beautiful” was played, but it wasn’t just sentiment. He knew how fragile democracy is, how easily it can be destroyed. He used to tell me about how Germany slid into dictatorship, the biggest form of government of all.I wish so deeply that I could ask him about the edge we are teetering on now, and how America might move out of its quagmire of anger, its explosions of hatred. How do we break the cycle of violence, both actual and verbal? How do we cross the muddy divides that separate us, overcome the partisan rancor that drives elected officials to heckle the president in his State of the Union address? When my father was shot, Tip O’Neill, then speaker of the House and always one of his most devoted political opponents, came into his hospital room and knelt down to pray with him, reciting the 23rd Psalm. Today a gesture like that seems impossible.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Yes, Biden’s Age Matters

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      One of the most difficult conversations you can have in life is with a parent or peer who is becoming too old and infirm to work. Whether the infirmity is physical or mental, often your loved one is the last person to realize his own deficiencies, so he may interpret respectful, genuine concern as a personal attack.This conversation is difficult enough when it’s conducted entirely in private with friends and family. It’s infinitely more difficult when it plays out in public and involves the president of the United States.The top-line conclusion of the special counsel Robert Hur’s report regarding the discovery of classified information at Joe Biden’s home is good for the president. It found, in no uncertain terms, that “no criminal charges are warranted in this matter.” It said prosecution would be inappropriate “even if Department of Justice policy did not foreclose criminal charges against a sitting president.” The report even did the president the favor of clearly and unequivocally distinguishing his treatment of classified materials from Donald Trump’s vastly worse misconduct in his own retention-of-documents case.But the report presented what may be a worse assessment for Biden than the matter of guilt, which is its description of one reason he won’t be prosecuted: The special counsel found that Biden lacked the requisite degree of criminal willfulness in part because of his fading memory. The report characterized him as a “well-meaning, elderly man with a poor memory” and said he had “diminished faculties in advancing age.” To bolster this assertion, the report provided some damaging details, including claims that Biden couldn’t remember the dates when he was vice president and couldn’t remember “even within several years” when his son Beau died.The report understandably angered Biden, but in a fiery news conference after the report was released, he confused the president of Egypt with the president of Mexico. In isolation, the gaffe was minor — less serious, for instance, than Donald Trump recently confusing Nikki Haley with Nancy Pelosi — but the timing was terrible. The mistake, coming on the heels of two incidents in recent days in which Biden confused French and German leaders with their deceased predecessors, only served to bolster the special counsel’s conclusions.Democratic partisans may be furious that the special counsel was so blunt about Biden’s memory. But willfulness and intent are necessary elements of the underlying crimes, so Hur had to explore Biden’s mental state, and include illustrative details.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Mr. President, Ditch the Stealth About Health

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      Once, when my father was in West Virginia on police business, a man approached him and demanded to know about “rumors” that President Franklin Roosevelt was “crippled.” The man threatened to beat up my father or anyone who said F.D.R. was in a wheelchair.My dad, a D.C. police detective, served on F.D.R.’s protective detail. (I have a picture of my father, in a fedora, guarding Roosevelt at a Senators baseball game, with the president standing up with the help of his braces to throw out the first pitch.)Like others around Roosevelt, my dad kept a tight lip about the paralysis of the president, who did not want to seem weak. Dad assured the West Virginia ruffian that Roosevelt was “a fine, athletic man.”In the days before TV and social media, the White House could suppress the fact that Roosevelt, who contracted polio when he was 39, could barely walk. With the help of a complicit press corps, a censoring Secret Service and a variety of ruses, F.D.R. was even able to campaign giving the impression that he was mobile.But stealth about health is no longer possible, and the sooner President Biden’s team stops being in denial about that, the better off Democrats will be.Jill Biden and his other advisers come up with ways to obscure signs of senescence — from shorter news conferences to almost zero print interviews to TV interviews mainly with fawning MSNBC anchors.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Memory Loss Requires Careful Diagnosis, Scientists Say

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      A federal investigator said that President Biden had “poor memory” and “diminished faculties.” But such a diagnosis would require close medical assessment, experts said.A lengthy report by the Department of Justice on President Biden’s handling of classified documents contained some astonishing assessments of his well-being and mental health.Mr. Biden, 81, was an “elderly man with a poor memory” and “diminished faculties” who “did not remember when he was vice president,” the special counsel Robert K. Hur said.In conversations recorded in 2017, Mr. Biden was “often painfully slow” and “struggling to remember events and straining at times to read and relay his own notebook entries.” So impaired was Mr. Biden that a jury was unlikely to convict him, Mr. Hur said.Republicans were quick to pounce, some calling the president unfit for office and demanding his removal.But while the report disparaged Mr. Biden’s mental health, medical experts on Friday noted that its judgments were not based on science and that its methods bore no resemblance to those that doctors use to assess possible cognitive impairment.In its simplest form, the issue is one that doctors and family members have been dealing with for decades: How do you know when an episode of confusion or a memory lapse is part of a serious decline?We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Biden Wants to Be President Into His 80s. How Might Age Affect His Health?

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      Experts weigh in on octogenarian health.President Biden has announced his plans to run for re-election in 2024. If he wins, he will be 82 when he takes office and 86 when his term ends — which would establish him, for a second time, as the oldest person to assume the U.S. presidency. (Donald Trump is not far behind; he will be 78 during the 2024 election and would enter octogenarian territory during another presidential term.)President Biden is “a healthy, vigorous 80-year-old male,” according to a February report from the White House physician, Dr. Kevin C. O’Connor. Although he was recently treated for basal cell carcinoma, a common and slow-growing skin cancer, Mr. Biden has no major medical problems, doesn’t smoke or drink and exercises at least five days a week.“The spectrum of health at older ages varies so widely,” said Dr. Holly Holmes, a professor and the chair in gerontology at the University of Texas Health Science Center at Houston. “As we get older, we are more and more unlike our peers, and it becomes harder to generalize what a ‘typical’ 80-year-old would be like.”Dr. R. Sean Morrison, a professor and the chair in geriatrics at the Icahn School of Medicine at Mount Sinai in New York, added that the changes that occur during aging happen to different people at different times. Some 85-year-olds have healthier bodies than some 65-year-olds, and much of the variation comes down to genes and a person’s lifestyle before the age of 60.Yet, as people enter their 80s, and even their mid-to-late 70s, some standard age-related shifts tend to occur, like muscle loss and a drop in bone strength, that make people more prone to disease and injury.Here’s a head-to-toe snapshot of the body and mind of an octogenarian and the potential problems doctors look out for.BrainMost healthy people in their 80s don’t have trouble performing complex cognitive tasks such as problem-solving and planning, Dr. Morrison said, but they may find it harder to multitask and learn new things. Some may struggle to remember words. Reaction time can also slow, but usually only slightly — on the order of fractions of a millisecond, Dr. Morrison said.Scientists don’t know exactly why these changes happen, but the brain does get slightly smaller with age because of brain cell loss, so that could be playing a role, said Dr. Scott Kaiser, director of geriatric cognitive health at Pacific Neuroscience Institute in Santa Monica, Calif. Interestingly, certain cognitive skills — such as vocabulary and abstract reasoning — may stay constant or even improve with age, also for unknown reasons, he said.Dementia does become more common with age, but it still only affects a minority of adults in their 80s. According to the National Health and Aging Trends Study, 10.9 percent of adults ages 80 to 84, and 18.7 percent of adults ages 85 to 89, dealt with dementia in 2019. “These conditions are not a normal or inevitable part of aging,” Dr. Kaiser said.Eyes and earsVision tends to worsen over time. Octogenarians often need reading glasses and become more sensitive to glare, Dr. Morrison said. Nearly 70 percent of adults over 80 have cataracts, a clouding of the lens of the eye, but the condition can be treated effectively with surgery, he said.Age-related hearing loss is another common problem. First, people lose the ability to hear high-frequency sounds such as bird chirps and alarm clocks; this can start early, even in a person’s 30s or 40s. Low-frequency changes, affecting the ability to hear men’s voices and bass sounds in music, come later. Hearing loss can be treated with hearing aids — now available over the counter — or other devices, and it’s crucial to do so: “We have increasing data now that suggests that people who go longer with untreated hearing loss and don’t get hearing correction are more likely to develop dementia or diseases like Alzheimer’s disease,” Dr. Morrison said.Heart and lungsAs a person ages, heart rate slows slightly, and the heart can’t beat as fast during physical activity, which can make aerobic exercise more challenging. That said, an aging healthy heart typically “functions quite well,” said Dr. Lona Mody, a geriatrician at Michigan Medicine.Doctors monitor for heart disease in their octogenarian patients. “Blood vessels become stiffer with age, and this leads to higher blood pressure,” Dr. Mody said, which can increase the risk of hypertension and heart disease. According to the American Heart Association, 83 percent of men and 87 percent of women age 80 and older have heart disease, sometimes requiring the use of medications or surgery. Mr. Biden has asymptomatic atrial fibrillation — an irregular heartbeat — and takes apixaban (Eliquis), an anticoagulant drug that is often prescribed to help prevent blood clots and strokes. He also takes rosuvastatin (Crestor) to lower his cholesterol.Lung capacity often slightly drops with age because of changes in the strength and elasticity of the lung tissue and diaphragm, which can make breathing a bit harder, Dr. Mody said. One disease doctors look out for is chronic obstructive pulmonary disease, an inflammatory lung disease seen in just under 11 percent of people 65 and over.Digestive systemPeople in their 80s tend to eat less than they used to, in part because “food doesn’t taste quite the same,” Dr. Morrison said. Over time, people lose taste buds and their sense of smell, he said, both of which affect how much they enjoy eating. This helps to explain why older adults have an increased risk of nutritional deficiencies.But seniors also need fewer calories than younger people because of losses in lean muscle mass and slowing metabolism. According to the government’s Dietary Guidelines for Americans, women age 60 and older should consume a minimum of 1,600 calories a day, and men age 60 and older a minimum of 2,000 calories a day (as opposed to a minimum of 1,800 for women and 2,400 for men ages 19 to 30).Older people are at greater risk for heartburn and gastrointestinal reflux. Mr. Biden’s occasional coughing and throat-clearing are tied to gastroesophageal reflux, and he takes famotidine (Pepcid) as needed to treat his symptoms.Octogenarians digest food more slowly, too. Research suggests that 34 percent of women and 26 percent of men age 84 or older experience constipation.Bones and jointsBones become more brittle with age. The body starts to reabsorb the minerals that strengthen them, such as calcium and phosphate, in part because the intestines can’t absorb what is needed from food as effectively as they used to. For women, this degeneration is accelerated by the drop in estrogen after menopause, which reduces bone density.Decreased bone density puts older people at an increased risk for bone fractures and osteoporosis. In 2020, when Mr. Biden was the president-elect, he had a hairline fracture in his foot, requiring him to wear a walking boot as he healed. The bone injuries that doctors worry about most are hip fractures, which hospitalize more than 300,000 Americans over the age of 65 every year. “Hip fractures are one of the most common reasons for hospitalization among people 85 and over,” said Dr. Susan Wehry, a geriatrician at the University of New England. Recovery is often difficult because of complications such as infections, sometimes picked up at the hospital, and internal bleeding, or because conditions such as heart disease slow healing.Joints can also become more painful because the bones and cartilage that make up the joints start to wear down. According to the Centers for Disease Control and Prevention, nearly half of all Americans over 65 have been diagnosed with osteoarthritis, which causes joint pain and stiffness. President Biden has been diagnosed with osteoarthritis of the spine, which has stiffened his gait.SkinThe risk of skin cancer increases as people get older. The average age at which Americans are diagnosed with melanoma, a potentially deadly skin cancer, is 65. Men are at higher risk for melanoma than women. Dr. Holmes recommends that people in their 80s see a doctor or dermatologist once a year for a skin check.Non-melanoma forms of skin cancer, such as basal cell carcinoma and squamous cell carcinoma, affect more than three million Americans a year. These cancers grow slower than melanomas and are highly treatable when detected and removed early. In February, President Biden, who has said he spent a lot of time in the sun during his youth, had a basal cell carcinoma removed from his chest. He also had several other non-melanoma skin cancers removed before his presidency.Strength and balanceMost healthy people in their mid-80s can and should engage in physical activity, and many remain strong and agile, Dr. Holmes said. She encourages patients to participate in aerobic exercise and weight training a couple of days a week and to stretch at least once a week, but sometimes recommends modifications for patients with pain, orthopedic problems or cardiac issues.Adults “start to lose muscle mass and start to gain fat” as they get older, Dr. Morrison said. Between 42 and 62 percent of people in their mid-80s have sarcopenia, a disease characterized by loss of muscle mass and strength. Common symptoms include difficulty walking, ascending stairs and holding shopping bags.In addition, the spaces between the spinal vertebrae dry and compress, causing people to lean forward, which can affect their balance, Dr. Morrison said. People in their 80s tend to walk slowly and have a short gait, which also worsens balance, he added.In some older adults, the insulating layer that surrounds nerves and helps them communicate with one another, called myelin, starts to break down. This can slow reflexes and make people clumsy, Dr. Kaiser said.“One important consequence of these age-related changes to the brain and overall nervous system — along with changes to other systems and a broad range of other factors — is an increased risk of falls,” Dr. Kaiser said, which in turn can become more dangerous because bones are weaker and break more easily.Stress, stamina and sleepPeople in their mid-80s tend to have lower energy than younger people, so they fatigue more easily, Dr. Morrison said.Dr. Mody added that stress and changes to routine can be “harder to bounce back from” because older people’s tissues and organs take a longer time to recover after stresses or injuries. People may also take longer to recover from colds, Covid-19 and other infections, as the immune system becomes less responsive with age.Many older adults don’t sleep well, in part because they spend less time in deep slow-wave sleep, which makes them more prone to middle-of-the-night wake-ups. “Eighty-year-olds tend to sleep about an hour less than younger adults,” Dr. Morrison said.Still, it’s important to remember that everybody ages differently, and that age does not define a person’s health. Many people in their 80s are healthier than people 20 years younger, Dr. Mody said, and the choices they make late in life matter, too: Research suggests that adopting healthy behaviors even in the ninth decade can extend one’s life.Many octogenarians, Dr. Holmes said, are “quite resilient.” More

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      in World Politics

      The Right to Fair Recollection

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      The Fair Observer website uses digital cookies so it can collect statistics on how many visitors come to the site, what content is viewed and for how long, and the general location of the computer network of the visitor. These statistics are collected and processed using the Google Analytics service. Fair Observer uses these aggregate statistics from website visits to help improve the content of the website and to provide regular reports to our current and future donors and funding organizations. The type of digital cookie information collected during your visit and any derived data cannot be used or combined with other information to personally identify you. Fair Observer does not use personal data collected from its website for advertising purposes or to market to you.As a convenience to you, Fair Observer provides buttons that link to popular social media sites, called social sharing buttons, to help you share Fair Observer content and your comments and opinions about it on these social media sites. These social sharing buttons are provided by and are part of these social media sites. They may collect and use personal data as described in their respective policies. Fair Observer does not receive personal data from your use of these social sharing buttons. It is not necessary that you use these buttons to read Fair Observer content or to share on social media. More