Even though most adults want to avoid looking older than their actual age, research led by St. Michael's Hospital shows that looking older does not necessarily point to poor health. The study found that a person needed to look at least 10 years older than their actual age before assumptions about their health could be made.
"Few people are aware that when physicians describe their patients to other physicians, they often include an assessment of whether the patient looks older than his or her actual age," says Dr. Stephen Hwang, a research scientist at St. Michael's Hospital and an associate professor at the University of Toronto. "This long standing medical practice assumes that people who look older than their actual age are likely to be in poor health, but our study shows this isn't always true."
For patients, it means looking a few years older than their age does not always indicate poor health status. The study found that when a physician rated an individual as looking up to five years older than their actual age, it had little value in predicting whether or not the person was in poor health. However, when a physician thought that a person looked 10 or more years older than their actual age, 99 per cent of these individuals had very poor physical or mental health.
"Physicians have simply assumed that their quick assessment of how old a person looks has diagnostic value," explains Dr. Hwang. "We were really surprised to find that people have to look a decade older than their actual age before it's a reliable sign that they're in poor health. It was also very interesting to discover that many people who look their age are in poor health. Doctors need to remember that even if patients look their age, we shouldn't assume that their health is fine."
The researchers studied 126 people between the ages of 30 to 70 who were visiting a doctor's office. Participants completed a survey that accurately determined whether they had poor physical or mental health. Each person was photographed, and the photographs were shown to 58 physicians who were told each person's actual age and asked to rate how old the person looked.
The study, published in the Journal of General Internal Medicine, provides new insights and questions into the value and limitations of a long standing medical practice of judging a person's health by how old they appear.
Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by St. Michael's Hospital, via EurekAlert!, a service of AAAS.
- Stephen W. Hwang, Mina Atia, Rosane Nisenbaum, Dwayne E. Pare, Steve Joordens. Is Looking Older than One’s Actual Age a Sign of Poor Health? Journal of General Internal Medicine, 2010; DOI: 10.1007/s11606-010-1537-0
BACKGROUND: Physicians often begin the physical examination
with an assessment of whether a patient looks
older than his or her actual age. This practice suggests an
implicit assumption that patients who appear older than
their actual age are more likely to be in poor health.
OBJECTIVE: To determine the sensitivity and specificity
of apparent age for the detection of poor health status.
PATIENTS: A total of 126 outpatients (ages 30–70) from
four primary care clinics and one general internal
medicine clinic at an academic medical institution.
MEASUREMENTS: With the patient’s actual age provided,
physicians (n=58 internal medicine residents and
general internal medicine faculty) viewed patient photographs
and assessed how old each patient looked. For
each physician, we examined the sensitivity and specificity
of the difference between how old the patient looked
and the patient’s actual age for the detection of poor
health, defined using SF-12 physical health and mental
RESULTS: Using the threshold of looking ≥5 years older
than actual age and with poor health defined as an SF-12
score≥2.0 SD below age group norms, median sensitivity
was 29%(IQR, 19%to 35%), median specificity 82% (IQR,
77%to 88%),median positive likelihood ratio 1.7 (IQR, 1.3
to 2.2), and median negative likelihood ratio 0.9 (IQR, 0.8
to 0.9). Using the threshold of looking ≥10 years older
than actual age, median sensitivity was 5% (IQR, 2% to
9%) and median specificity was 99% (IQR, 96% to 100%).
CONCLUSIONS: The diagnostic value of apparent age
depends on how many years older than his or her actual
age a patient looks. A physician’s assessment that a
patient looks ≥10 years older than his or her actual age
has very high specificity for the detection of poor health.