ROME >> Pope Francis turned 87 today, closing out a year that saw big milestones in his efforts to reform the Catholic Church as well as health scares that raise questions about his future as pope.

Francis celebrated his birthday with cake during a festive audience with children Sunday morning, and there were “Happy Birthday” banners in St. Peter’s Square during his weekly noon blessing.

One early present came Saturday, when a Vatican tribunal handed down a mix of guilty verdicts and acquittals in a complicated trial that Francis had supported as evidence of his financial reforms. The biggest-name defendant, Cardinal Angelo Becciu, was convicted of embezzlement and sentenced to 5½ years in prison.

“It was quite a year for a pope who’s obviously thinking about legacy and finishing up,” said Christopher Bellitto, professor of history at Kean University in New Jersey.

Only seven popes are known to have been older than Francis at the time of their deaths, according to the online resource Catholic Hierarchy. Francis is fast closing in on one of them, Pope Gregory XII, perhaps best known for having been the most recent pope to resign until Pope Benedict XVI stepped down in 2013.

Gregory was 88½ when he voluntarily stepped down in 1415 in a bid to end the Western Schism, in which there were three rival claimants to the papacy. Francis has said he, too, would consider resigning if his health made him unable to carry on, but more recently he said the job of pope is for life.

Twice this year, however, Francis’ less-than-robust respiratory health forced him to cancel big events: In spring, a bout of acute bronchitis landed him in the hospital for three days and made him miss the Good Friday procession at the Colosseum.

More recently, a new case of bronchitis forced him to cancel a planned trip to Dubai to participate in the U.N. climate conference. Francis had part of one lung removed as a young man and seems to be increasingly prone to respiratory problems that make breathing difficult and speaking even more so.

In between those events, he was hospitalized again in June for nine days for surgeons to repair an abdominal hernia and remove scar tissue from previous intestinal surgeries.

The hospitalizations have raised questions about Francis’ ability to continue the globetrotting rigors of the modern-day papacy, which is increasingly dependent on the person of the pope, said David Gibson, director of the Center on Religion and Culture at Fordham University.

“It’s a great improvement from the time when the pope was just a king in his throne surrounded by a royal court,” he said. “But with such expectations can any pope govern into his 80s and even 90s and be effective?”

While Francis’ health scares punctuated his 87th year, perhaps the biggest milestone of all, and one that is likely to shape the remainder of Francis’ pontificate, was Benedict’s Dec. 31 death.

Benedict largely stuck to his promise to live “hidden to the world” and allow Francis to govern unimpeded. But his death after 10 years of retirement removed the shadow of a more conservative pope looking over Francis’ shoulder from the other side of the Vatican gardens.

His death has seemingly freed up Francis to accelerate his reform agenda and crack down on his right-wing opponents.

For starters, Francis presided over the first stage of his legacy-making meeting on the future of the Catholic Church. The synod aims to make the church more inclusive and reflective of and responsive to the needs of rank-and-file Catholics. The first session ended with “urgent” calls to include women in decision-making roles in the church. The next phase is scheduled for October 2024.

“The effort to change the rigidly top-down nature of governance in Catholicism is the main reform project of the Francis papacy and its success or failure will likely be his chief legacy,” said Fordham’s Gibson. He said the jury was still out on whether it would succeed, since the transition period is “messy and absolutely exhausting.”

“Will the sense of exhaustion overcome the inspiration that invigorates so many?” he asked.

Alongside the synod, Francis this year appointed an unusually progressive theologian as the Vatican’s chief doctrine watchdog, and he has already begun setting a very new tone for the church’s teachings that could have big effects on the church going forward.

Cardinal Victor Fernandez has issued decrees on everything from how to care for cremated ashes (in a defined and sacred place) to membership in Masonic lodges (forbidden) and whether transgender people can be godparents (they can).

At the same time, Francis has begun hitting back at his conservative critics, for whom Benedict was a point of reference for the past 10 years.

Francis exiled Benedict’s longtime secretary, Archbishop Georg Gaenswein, to his native Germany after a series of infractions culminating with a tell-all memoir published in the days after Benedict’s death that was highly critical of Francis.

Then, he forcibly removed the bishop of Tyler, Texas, Bishop Joseph Strickland, whose social media posts were highly critical of the pope. And most recently, he cut off the former Vatican high court judge, Cardinal Raymond Burke, after he warned that Francis’ reform-minded synod risked dividing the faithful.

Natalia Imperatori-Lee, professor of religious studies at Manhattan College, said the pushback against Burke was less of a “smackdown” and would have little tangible effect, since he has plenty of wealthy backers in the U.S.

But she said it was part of an important year that had as its high point the synod, the conclusion of which will drive Francis at least for another year.

“I think the Pope is thinking about his legacy in a way he hasn’t done before. Perhaps that has to do with Benedict’s death, maybe it’s more a matter of his own mortality becoming more real given his recent illnesses,” she said. “The synod is a huge part of that legacy, obviously, and you can see his investment in having it succeed. I’m willing to bet that seeing part 2 of the synod to fruition is a huge motivator for him right now.”