title: The Influence of Clinical Experience and Photographic Presentation on Age Assessment of Women.
abstract: BACKGROUND
  Epidemiological studies have reported that a higher perceived age is associated with poor health and higher mortality. However, the method used for the assessment of perceived age differs between studies with regard to age, gender, the number and occupation of assessors as well as the presentation of participants.
  
  
  OBJECTIVE
  It is not known whether the clinical experience of the assessor or photographic presentation have an influence on the assessment of perceived age, which the present study aimed to investigate.
  
  
  METHODS
  In a cross-sectional study of 460 women aged 25-93 years, 10 consultants and 10 residents were asked to estimate the age of each participant using three different photographic presentations: facial photograph, whole-body photograph, and combined facial and whole-body photographs. Data were analyzed by means of summary statistics and linear mixed models.
  
  
  RESULTS
  The inter-class correlation coefficient within each assessor group and photographic presentation varied from 0.66 to 0.75. Limits of agreement were in a broad range but were similar in the two assessor groups. The best inter-assessor agreement was obtained from photographs of both the face and the whole body. Intra- and inter-assessor agreements between photographic presentations were similar among both assessor groups. The accuracy in age assessment was significantly influenced by the photographic presentation but not by the clinical experience of the assessor. The difference in the mean perceived age of a participant of average age was estimated as +0.40 years (95% CI: -1.80; 2.59) for consultants versus residents, -2.05 years (95% CI: -2.90; -1.19) for facial photographs versus both facial and whole-body photographs, and -1.44 years (95% CI: -2.30; -0.58) for whole-body photographs versus both facial and whole-body photographs. A regression towards the mean age was seen.
  
  
  CONCLUSIONS
  The assessment of perceived age was influenced by the photographic presentation but not by the clinical experience of the assessor.
authors.affiliation: Research Centre of Ageing and Osteoporosis, Departments of Endocrinology PE and Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark.
authors.forename: Barbara Rubek
authors.initials: BR
authors.lastname: Nielsen
authors.forename: Allan
authors.initials: A
authors.lastname: Linneberg
authors.forename: Kaare
authors.initials: K
authors.lastname: Christensen
authors.forename: Julie Lyng
authors.initials: JL
authors.lastname: Forman
authors.forename: Peter
authors.initials: P
authors.lastname: Schwarz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D016014:Linear Models; D008875:Middle Aged; D015588:Observer Variation; D010465:Perception; D010781:Photography; D010820:Physicians; D015203:Reproducibility of Results