Joe Biden was filmed snapping at staffers after an awkward gaffe during a final meeting with a group of world leaders.

The president, 81, barked 'Who's next?' while introducing a leader from the 'Quad' nations of Australia, India and Japan at his home in Wilmington, Delaware, on Saturday night.

Ending his introductory speech about the Quad's efforts to beat cancer, Biden said: 'So I want to thank you all for being here. And now, who am I introducing next?'

After an awkward second of silence, Biden demanded to know: 'Who's next?'.

An aide could then be seen making a hand gesture towards the stage, before a compere introduced Indian Prime Minister Narendra Modi. 

Biden appeared to relax and cracked a joke, before putting his arm around Modi.

The outgoing president is infamous for age-related gaffes - although Saturday night's issue appeared to be the result of a logistical error, rather than Biden's advancing years. 

Saturday's summit was intended to advance Biden's 'cancer moonshot,' which will see the US work with the other three regions in the Quad to try and beat the disease.

Also in attendance were Australian Prime Minister Anthony Albanese and Japanese PM Fumio Kishida.  

The Quad was initially established in 2007 to try and counter-balance China's rising power and influence in the Indo-Pacific region. 

It's next meeting will take place with whoever wins November's presidential election between Kamala Harris and Donald Trump.

Biden announced he was stepping down in July after a disastrous June debate against Donald Trump which saw him repeatedly lose his train of thought and spout nonsense on stage.

He is the oldest president in US history and faced growing concerns over mistakes made on stage.

Biden has also suffered a physical decline which saw him repeatedly trip while walking up the steps of Air Force One and walk with a noticeably stiff gait.

He was effectively forced out of office by senior Democrats including Nancy Pelosi who warned him he would not win against Donald Trump.

Vice President Kamala Harris' nomination as the new presidential contender has re-energized the Democrats and election campaign.

It also appears to have put Donald Trump on the back foot, with the 78 year-old GOP leader no longer able to take digs at his rival's lack of vitality.

Polls show the race remains on a knife edge ahead of the November 5 election date.