Joe Biden has been given printed guides directing him where to walk on and off stage at events.

The printouts show large images of the entrance and exit to a stage with the words: “Walk to podium,” Axios reported.

The guides include a precise path to the podium for the US president to follow.

One five-page document seen by the publication showed large pictures of an event space taken from different angles, accompanied by the words “view from podium” and “view from audience”.

Republicans have drawn attention to videos showing Mr Biden occasionally appearing unsure of where to walk on and off stage, using clips of the moments to suggest he is not mentally fit enough for office.

The latest guide is reportedly from a White House events template sent to staffers. 

One unnamed person who staffed a Biden fundraiser in the last 18 months told Axios: “It surprised me that a seasoned political pro like the president would need detailed verbal and visual instructions on how to enter and exit a room.”

Andrew Bates, a White House spokesman, said high levels of detail and precision were critical to presidential advance work, regardless of who is president.

He added that “these are basic approaches that are used by any modern advance team, including the vice president’s office and agencies”.

Kirsten Allen, a spokesman for Kamala Harris, the vice president, added: “These documents are standard logistical briefing materials and photos for any principal, including the vice president.”

However, two former aides who worked with Biden during his vice presidency said his preparation documents were different at the time, and more often relied on site diagrams, according to Axios.

Questions surrounding Mr Biden’s fitness to lead the country have intensified since last month’s presidential debate, which was described as “disastrous” for the Democrats.

Mr Biden stumbled over his words and appeared confused at points, forgetting statistics and failing to conclude his thoughts.

The 81-year-old is the oldest person elected to the office of the president.

Last year it emerged he had used cue cards for a meeting with Rishi Sunak, the former prime minister. The cards included five prompts for conversation, including “Nato” in capitalised letters that were underscored for emphasis.