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A ghost's Horrifying Visage can age a creature as follows:

Horrifying Visage: Each non-undead creature within 60 feet of the ghost that can see it must succeed on a DC 13 Wisdom saving throw or be frightened for 1 minute. If the save fails by 5 or more, the target also ages 1d4 x 10 years. A frightened target can repeat the saving throw at the end of each of its turns, ending the frightened condition on itself on a success. If a target's saving throw is successful or the effect ends for it, the target is immune to this ghost's Horrifying Visage for the next 24 hours. The aging effect can be reversed with a greater restoration spell, but only within 24 hours of it occurring.

What's unclear is whether this can be fatal or if the effects are purely cosmetic. For elves, this is likely not an issue, but does a human simply go from a healthy young adult, to an elder who likely works out very regularly because there is no stat adjustments for age (that I know of)?

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It's up to the DM...But the DM has no Guide.

The effects of aging, from slowing down all the way up through death, are not currently listed in the 5th edition of D&D. It appears that the designers either forgot to include them, or, slightly more likely, that they left the issue up to each table to decide.

The Aging is Real

That said, the aging from the ghost's horrifying visage ability is real rather than cosmetic, because it specifies that the effect ages the creature, not just alters its appearance to look older. High level Monks (Player's Handbook p79) are immune to the aging portion of the effect, as are high level Oath of the Ancients Paladins (who don't appear to die of old age, by omission) (p87).

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  • \$\begingroup\$ I agree with the principle of this answer the most, because the bodily effects of the 'magical fear' is real consequence. I've judged this where the effects are semi-reversible, since they were magically induced. 'Plucking out the thorn' is a similar matter, up to the DM. e.g. perhaps the effects are only real-perm-aging if not reversed within 13 moons of the incident, where every moon seems to 'solidify' the aging as real — etc. That said, for game effect, I encourage leaving the Charisma part of the Visage, regardless of real-age related consequences. \$\endgroup\$
    – New Alexandria
    Commented Apr 29, 2017 at 16:39
  • \$\begingroup\$ @NewAlexandria Is this version better? \$\endgroup\$
    – Chemus
    Commented Apr 29, 2017 at 16:46
  • \$\begingroup\$ My upvote remains \$\endgroup\$
    – New Alexandria
    Commented May 1, 2017 at 0:58
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Age is nothing but a number

You don't die, you're just Frightened.

There is no absolute hard limit on the age of a human in D&D (well, humans are technically stated to live less than a century, but to be pedantic, it doesn't say they can't be older than a century).

The adventurer could be an 80 year old Wizard who suddenly becomes 120 years old, but still retain his mental acuity. The mechanical effect comes in the Frightened condition, which can be removed via succeeding the saving throws.

There are no mechanical effects of aging, and you will have to implement house rules to make it relevant.

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    \$\begingroup\$ Historical note: In earlier editions of D&D, ghosts could and did age characters to death. Some dungeon masters ruled that rapid aging was enough of a shock to the body that the player had to make a System Shock roll, and the consequence of failing that was instant death. \$\endgroup\$
    – GMJoe
    Commented Apr 29, 2017 at 22:26

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