title: Is looking older than one's actual age a sign of poor health?
abstract: 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.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  A total of 126 outpatients (ages 30-70) from four primary care clinics and one general internal medicine clinic at an academic medical institution.
  
  
  METHODS
  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 health scores.
  
  
  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.
authors.affiliation: Centre for Research on Inner City Health, The Keenan Research Centre in Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. hwangs@smh.ca
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.forename: Mina
authors.initials: M
authors.lastname: Atia
authors.forename: Rosane
authors.initials: R
authors.lastname: Nisenbaum
authors.forename: Dwayne E
authors.initials: DE
authors.lastname: Pare
authors.forename: Steve
authors.initials: S
authors.lastname: Joordens
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000473:pathology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods*; D010819:Physician's Role / Q000523:psychology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity