updated 11/18/2010 11:51:32 AM ET 2010-11-18T16:51:32

Early wrinkles, premature balding and gray hairs before you feel middle-aged can be distressing signs of time's relentless march. But looking older than you really are doesn't necessarily signal an early death, found a new study.

You need to reliably look at least 10 years more mature than your true age before your appearance is a sign of ailing health, according to the study. The finding raises questions about the long-standing practice among doctors to consider how old their patients look as part of routine physical exams.

"This has been passed on from generation to generation of physicians without any explicit explanation of exactly why we are doing it," said lead researcher Stephen Hwang, a physician and researcher at St. Michael's Hospital in Toronto and at the University of Toronto.

"It's implied by doing this that you are getting a sense of a person's overall level of health," he added. "It's interesting to think that it's probably not a really strong indicator of whether someone is healthy or not."

To find out how useful the practice may or may not be, Hwang and colleagues surveyed people who were waiting in clinics to see their doctors. Ranging in age from 30 to 70, patients answered questions about their mental and physical health. The researchers collected more than 125 surveys, along with photos of each patient.

Next, more than 50 internal medicine physicians looked at each photo. They learned how old each patient was, just as they would in a real exam. Then, they judged how old each patient looked.

Overall, results showed that discrepancies between a physician's assessment and a patient's age didn't mean much until the doctor's judgment was at least 10 years older than the patient's true age. Among those patients, Hwang and colleagues reported in the Journal of General Internal Medicine, 99 percent had real health problems.

"The bottom line is that looking slightly older than one's actual age is not necessarily an ominous health sign," Hwang said.

On the other hand, the researchers identified quite a few health issues in people with an age-appropriate appearance. So even if you look youthful, you are not necessarily problem-free.

Also worth noting is that physicians varied widely in their assessments of patient age, said Peter Pompei, an internist and geriatric specialist at Stanford University School of Medicine in Palo Alto, Calif. And medical residents performed worse than more experienced doctors did.

"I think it's an important cautionary note," Pompei said. "It helps us realize we're not always very good at this. When we have an impression that someone is either older or younger than their stated age, that should prompt us to reflect on what about them has made us so inaccurate in terms of assessment."

Nevertheless, he added, observation will always be a powerful tool for doctors as they evaluate the health of their patients. Assessing age is just one form of looking closely at how someone is doing.

"I don't think anyone will ever be able to take away from us this notion of the impression that we get when we first encounter a person," Pompei said. "It's important."

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