Age estimation in General: In the male, at about fourteen years, fine hair begins to appear on pubis, the testes become larger and firmer and the penis begins to enlarge. At about fifteen years, hair is moderately grown on pubis, and hair begins to grow in axilla. At about 16 years, hair on pubis is well grown and the external genitals have an adult appearance. Hair begins to appear on the face between 16 to 18 years and voice becomes hoarse.
In the female, the breasts begin to develop about thirteen years, the vulva becomes more horizontal due to forward tilting of the pelvis, the labia minora develop and some fine, pale, downy hair appears on mons veneris two months later. The labia develop and menstruation starts. At about 14 to 25 years the pubic hair is well grown and hair appears in the axilla.
Age estimation AS A WHOLE
For the approximate age estimation, the following paragraphs should be correlated with what has already been described. DOCTOR’S ESTIMATE ABOUT AGE IS NOT PROOF BUT MERELY AN OPINION.
FIRST FORTNIGHT: The changes in the umbilical cord and the skin.
FIRST SIX MONTHS: Weight and height, partial closure of anterior fontanelle and fusion of the two halves of the mandible. Ossification centres in capitate appears during second month after birth.
SIX MONTHS TO TWO YEARS: The eruption and calcification of temporary teeth is the best guide and the appearance of certain ossific centres and their size in heads of humerus, femur, tarsus and carpus.
TWO TO SIX YEARS: Ossification of tarsus and carpus and appearance of centres in epiphyses of long bones. The number of carpal bones seen on X-ray indicates the approximate age in years.
SIX TO THIRTEEN YEARS: Eruption and calcification of permanent teeth is very helpful. Alterations occur in the centres that have already appeared and additional centres appear.
THIRTEEN TO 16 YEARS: The changes of puberty and ossification of bones, especially in the region of the elbow joint.
SIXTEEN TO 25 YEARS: The union of epiphyses of most of the long bones with the shafts takes place.
The union of epiphyses of clavicles, ends of ribs and iliac crest occur during this period. Between 20 to 30 years, incisors, tips of canines and cusps of premolars show slight to moderate wear. In the early twenties, the sternal rib shows a scalloped rim around a deepening V-shaped pit in both sexes.
25 TO 35 YEARS: The coronal, sagittal and lambdoid sutures of the skull start to close. The changes in the symphysis pubis are very important.
35 TO 50 YEARS: There is further progress in the changes in the symphysis pubis. Between 30 to 40 years, tooth cusp wear may be moderate to severe. The medullary cavity of the humerus may have increased upward to the level of the lower end of the tuberosity. Wrinkles about the eyes, eyebrows and in front of ears appear about 35 to 40 years. Xiphoid process unites with the sternum at about forty years.
Between 40 to 50 years, the vault sutures are all united both endocranially and ectocranially. The cortex of the long bones becomes thinner and less dense. In the humerus, the medullary cavity may extend upward to almost the surgical neck. Atrophic areas in the scapula and iliac fossa are of moderate to almost large size.
Later, it becomes more marked here and in the joints of the extremities. By the end of fifth decade, bony projections from the superior and/or inferior margins of the rib are fairly well marked in males, and the pit deepens and widens.
In females, the pit is relatively shallow and the bone itself is thinner. Ossification of laryngeal and costal cartilages and hyoid bone usually begin. Early changes in the articular surfaces of many bones may appear; they include lipping, reduction of joint space, and the presence of punched-out areas of osteoporosis on Xray examination. The skull bones gradually change from an ivory-like to granular appearance and feel.
An Arcus Senilis (a grey opaque ring surrounding the margin of the cornea, due to degenerative changes), but separated from the margin by an area of clear cornea, may appear as a result of lipoid degeneration about fifty years or later, but is not complete before sixty years. When it occurs in young adults due to hyperlipidaemia, it is called arcus juveniles.
GREYING of the hair is variable and not of much value. Head hair may become grey after forty years, first at the temples. Later it involves the beard and chest hair and eyebrows, but pubic hair, does not become grey before 50 to 55 years.
50 TO 60 YEARS: The external tables of the vault become slightly thinner. The molar crowns of the teeth are usually worn flat to a single plane. If all molar cusps are so worn that the crown is a flat plane, an age of fifty plus may be concluded.
AFTER SIXTY YEARS: Further sutural closure of skull occurs. The linea and tuberosities of muscle attachment may show small osteophytic “spurs” or ‘spikes” in the fifties and sixties and are well advanced in the seventies. Joint changes become more extreme in character and osteoporosis is more marked.
The joint between the manubrium and the body of the sternum may fuse, and calcification of the laryngeal and costal cartilages becomes more visible. The predominant features of this period are pathological skeletal changes. The hair may become silvery-white. A completely edentulous upper and lower jaw usually indicates an age of over 70 years.
Loss of collagenous stroma occurs in old age due to which the bone becomes lighter. The stroma is lost first in the outer cortex and the zone around the marrow cavity. The ends of long bones adjacent to the joints are the first to appear fragile and brittle.
Radiological thinning of the cortex and progressive rarefaction of the apex of the medullary cavity in the head of the humerus and femur are helpful in the age estimation. Microradiographs of bone are useful. It is based on the correlation between increasing age and loss of bone through natural remodelling processes.
Loss of elasticity of skin, wrinkling and discolouration of the skin of buttocks and abdomen, atrophy of uterus and ovaries, brown atrophy of the heart, and atherosclerotic change in the arteries give an indication of old age.
The age estimation becomes more uncertain after the age of 25 years. It is difficult to achieve an accuracy of even five years. A careful examination of all factors may enable the doctor to make a fair approximation to the decade within which a person may be. Any closer approximation must be made with considerable reservation.
Premature ageing may be produced due to illness, malnutrition, suffering, anxiety or worry. White hair may be produced in quite young people from grief or shock.
