Journal of General Internal Medicine

, Volume 26, Issue 2, pp 136–141

Is Looking Older than One’s Actual Age a Sign of Poor Health?

  • Stephen W. Hwang
  • Mina Atia
  • Rosane Nisenbaum
  • Dwayne E. Pare
  • Steve Joordens
Original Research



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.


To determine the sensitivity and specificity of apparent age for the detection of poor health status.




A total of 126 outpatients (ages 30–70) from four primary care clinics and one general internal medicine clinic at an academic medical institution.


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.


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%).


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.


sensitivity and specificity physical examination diagnosis health status age factors 


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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Stephen W. Hwang
    • 1
    • 2
  • Mina Atia
    • 1
  • Rosane Nisenbaum
    • 1
  • Dwayne E. Pare
    • 3
  • Steve Joordens
    • 3
  1. 1.Centre for Research on Inner City HealthThe Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoCanada
  2. 2.Division of General Internal Medicine, Department of MedicineUniversity of TorontoTorontoCanada
  3. 3.Centre for Computational Cognitive NeuroscienceUniversity of Toronto ScarboroughTorontoCanada

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