President Joe Biden turned 81 on Monday as concerns about his age and mental acuity continue to be a major issue for his re-election campaign.

Voters have been uneasy with Biden’s age ever since he joined the 2020 presidential race, and that unease has yet to subside. At 78, he was already the oldest person to be sworn in as president. If re-elected, Biden would be 86 by the end of his second term.

The president’s team has often attempted to focus on his accomplishments and his political experience. Biden himself has tried to downplay fears by joking about his age, but the right-wing fixation on his gaffes and occasional tumbles hasn’t helped.

Polls have found that many Americans — including Biden’s own supporters — say he is already too old for the presidency, let alone for a second term. A recent poll by The New York Times and Siena College found that 71% of registered voters agreed that Biden is “just too old to be an effective president.” In a Reuters/Ipsos poll in September, 77% of respondents said Biden is too old to be president.

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The president’s age also appears to take precedence over his platform and accomplishments: Americans tend to associate Biden with being old, while they associate his likely 2024 rival, Donald Trump — who, at 77, is just four years Biden’s junior — with crime, according to an AP-NORC poll.

Of course, you barely even need a poll to know that Biden’s age is clearly a significant concern for voters — and his campaign would do well to address it head-on.