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.
Design
Cross-sectional.
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 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.
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Acknowledgments
The authors would like to thank Catharine Chambers for assistance with data analyses, and the faculty and staff of the Determinants of Community Health 2 Course, Faculty of Medicine, University of Toronto. The Centre for Research on Inner City Health gratefully acknowledges the support of the Ontario Ministry of Health and Long-term Care. The views expressed in this publication are the views of the authors and do not necessarily reflect the views of the Ontario Ministry of Health and Long-term Care.
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None.
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Appendix
Appendix
Examples of actual patient photographs, as displayed to physicians.
Figures 4, 5, 6, and 7
Actual patient photograph shown to physicians
Actual patient photograph shown to physicians
Actual patient photograph shown to physicians
Actual patient photograph shown to physicians
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Hwang, S.W., Atia, M., Nisenbaum, R. et al. Is Looking Older than One’s Actual Age a Sign of Poor Health?. J GEN INTERN MED 26, 136–141 (2011). https://doi.org/10.1007/s11606-010-1537-0
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DOI: https://doi.org/10.1007/s11606-010-1537-0