This study examines whether the aged and the middle aged differ in their self-appraisal of health. Data were obtained through interviews and medical records from a probability sample of 460 individuals aged 45 to 89 years old. The aged evaluated their health more pessimistically than the middle aged, after controlling for physical health, psychological distress, gender, and education. The aged's perception of health was significantly worse than the middle aged's for persons having diagnoses in each of the following diagnostic categories: rheumatism and musculoskeletal deformities, nervous system and sense disorders, and digestive problems. A stronger association was found between perceived poor health and depressive symptoms among the aged than the middle aged. The importance of psychological distress on the aged's health assessment and subsequent illness behaviors is discussed.