Measuring anxiety in late life: A psychometric examination of the Geriatric Anxiety Inventory and Geriatric Anxiety Scale
Abstract
We examined the psychometric properties, internal scale reliability and validity, of two geriatric anxiety measures: the Geriatric Anxiety Inventory (GAI) and Geriatric Anxiety Scale (GAS). We also determined the extent to which memory ability influenced the psychometric properties of these measures. Older adult participants (N=110; M age=75 years) completed self-report, clinician-rated and diagnostic psychiatric measures and a neuropsychiatric battery. GAI and GAS scores had good internal consistency, adequate reliability, and strong convergent validity. GAI scores had better discriminant validity than GAS scores relative to a health rating. Both measures had strong associations with depression scores. Psychometric properties were decreased in participants with average delayed memory recall compared with those with superior recall. Both measures had good psychometric support, particularly in those with strong memory abilities. Psychometric performance characteristics indicate that the GAI and GAS may be good alternatives to anxiety measures not designed specifically for older adults.
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Assessment of anxiety in older adults: a review of self-report measures
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“Anxiety measures typically used with younger adults have been criticized for the use with older people for being too long, including reversed scored items and relying too much on somatic symptom reporting (42).”
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Technology Use and Preferences for Mental Health Self-Management Interventions among Older Veterans
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“A score ≥ 16 maximizes sensitivity and specificity for the detection of anxiety disorders in older adults.(37) The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5)(38) is a 20-item measure of PTSD symptoms.”
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Psychometric properties of the French Canadian version of the Geriatric Anxiety Inventory
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“…have found adequate internal consistency (a D .71 to .97) and convergent validity indices (r D .36 to .70) with anxiety measures (Andrew & Dulin, 2007; Byrne et al., 2010; Gould et al., 2014; Johnco, Knight, Tadic, & Wuthrich, 2014; Pachana et al., 2007; Yochim, Mueller, June, & Segal, 2011).”
BackgroundResultGottschling, J., Segal, D., Häusele, C., Spinath, F., & Stoll, G. (2015) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-015-9504-z · Cited by 25 · see citing works
“A recent study by Gould et al. (2014) compared the psychometric properties of the GAI and the GAS in a sample of 110 older adults.”
InfluentialSelf-citationDevelopment of a video-delivered relaxation treatment of late-life anxiety for veterans
Gould, C. E., Zapata, A. M. L., Bruce, J., Bereknyei Merrell, S., Wetherell, J. L., O'Hara, R., Kuhn, E., Goldstein, M. K., & Beaudreau, S. A. (2017) · International Psychogeriatrics · doi:10.1017/s1041610217000928 · Cited by 23 · see citing works
“%) obtaining scores above the GAS cut-off (> 16) in community dwelling older adults (Gould et al., 2014).”
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Bandari, R., Heravi-Karimooi, M., Miremadi, M., Mohebbi, L., & Montazeri, A. (2019) · Health and Quality of Life Outcomes · doi:10.1186/s12955-019-1176-z · Cited by 22 · see citing works
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“However, previous studies have shown that the GAI is a valid instrument for anxiety disorder, which means that our results cannot be totally biased (Gould et al., 2014; M arquez-Gonz alez et al., 2012; Massena et al., 2015; Pachana & Byrne, 2012; Pachana et al., 2007).”
ResultChirico, A., Giovannetti, T., Neroni, P., Simone, S. M., Gallo, L., Galli, F., Giancamilli, F., Predazzi, M., Lucidi, F., Pietro, G. D., et al. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00123 · Cited by 20 · see citing works
Creighton, A., Davison, T., & Kissane, D. (2019) · Aging & Mental Health · doi:10.1080/13607863.2018.1439882 · Cited by 20 · see citing works
“Thus far, the GAI has been found to have sound psychometric properties in elderly community-dwelling samples (Gould et al., 2014), psychogeriatric patients (Johnco et al., 2015; Pachana et al., 2007), and in a sample of RACF residents (Gerolimatos et al., 2013).”
BackgroundGould, C., Kok, B. C., Ma, V. K., Wetherell, J., Sudheimer, K., & Beaudreau, S. (2018) · The American journal of geriatric psychiatry · doi:10.1016/j.jagp.2018.12.018 · Cited by 20 · see citing works
Self-citationZapata, A., Beaudreau, S., O'Hara, R., Merrell, S. B., Bruce, J. S., Garrison-Diehn, C., & Gould, C. (2017) · Clinical Gerontologist · doi:10.1080/07317115.2017.1359716 · Cited by 20 · see citing works
“The high-anxiety group scores fall above the recommended cut-point (> 16) for detecting anxiety in community-dwelling older adults (Gould et al., 2014).”
BackgroundSelf-citationGerolimatos, L., Ciliberti, C., Gregg, J. J., Nazem, S., Bamonti, P. M., Cavanagh, C. E., & Edelstein, B. (2015) · International Psychogeriatrics · doi:10.1017/s1041610215001027 · Cited by 19 · see citing works
“The GAI has been shown to have good internal consistency, along with strong concurrent and discriminant validity, in a sample of communitydwelling older adults (Gould et al., 2014).”
BackgroundA Systematic Review of the Psychometric Properties of the Geriatric Anxiety Inventory
Champagne, A., Landreville, P., & Gosselin, P. (2020) · Canadian Journal on Aging/La Revue canadienne du vieillissement · doi:10.1017/s0714980820000185 · Cited by 18 · see citing works
“For example, item 2 – “ I find it difficult to make a decision ” – was reported as being insufficiently precise and having low corrected item-total correlations (Gould et al., 2014; Yan et al., 2014).”
InfluentialPifer, M., & Segal, D. (2020) · Clinical Gerontologist · doi:10.1080/07317115.2020.1725793 · Cited by 18 · see citing works
“and Hau (2014) found that higher scores on the PRMQ reliably predicted greater dementia severity, identifying an optimal cut-score of 31.”
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“Studies performed on both community and clinical samples of older adults evidenced good psychometric properties of the GAS, with high internal consistency of scale scores and good internal and convergent validity (Gottschling et al., 2016; Gould et al., 2014; Segal et al., 2010; Yochim, Mueller, & Segal, 2013; Yochim,…”
BackgroundMethodResultInfluentialSelf-citationFactor structure of the Chinese version of the geriatric anxiety inventory
Guan, M. (2016) · Annals of General Psychiatry · doi:10.1186/s12991-016-0092-4 · Cited by 17 · see citing works
“Because another study indicates that the GAI and Geriatric Anxiety Scale may be good alternatives to anxiety measures not designed specifically for older adults [17].”
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“Prior research has shown GAS total scores have excellent internal consistency (α = .90) (Gould et al., 2014).”
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“There is limited data on the sensitivity and specificity of the GAS for a clinical cut-off score, but a score of 16 and above may be used [30].”
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“It has been validated in different clinical and community samples, and in various populations and countries (e.g. Gould et al., 2014).”
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Ferrari, S., Signorelli, M. S., Cerrato, F., Pingani, L., Massimino, M., Valente, S., Forlani, M., Bonasegla, P., Arcidiacono, E., Ronchi, D. D., et al. (2017) · Clinica Terapeutica · doi:10.7417/ct.2017.1992 · Cited by 13
“It was translated (25) and validated so far in 3 other languages (29-31) and a 5-item version was later developed (GAI Short-Form, GAI-SF) (32) for quicker administration.”
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“Scores greater than 16 indicate clinically significant anxiety (Gould et al., 2014).”
BackgroundCarlucci, L., Balestrieri, M., Maso, E., Marini, A., Conte, N., & Balsamo, M. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02350-3 · Cited by 11 · see citing works
“itional cut-off score in literature was applied (> 9) [70].”
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Distinctions between depression and anxiety with fear of being a burden in late life
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“Elevated anxiety symptoms were defined using the clinical cutoff score of 16 or more points (Gould et al., 2014).”
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“Despite its drawbacks, convenience sampling has found broad application in normative and psychometric studies based on neuropsychological tests [18, 19] or psychological questionnaires [20, 21].”
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Assessment of Anxiety in Long-Term Care Residents: Issues and Strategies
Pifer, M., Segal, D., Jester, D. J., & Molinari, V. (2020) · The International Journal of Aging & Human Development · doi:10.1177/0091415020943321 · Cited by 6 · see citing works
“Since its initial validation, the GAI has performed well and has been validated for use in various older adult populations (Gould et al., 2014; Johnco et al., 2015).”
MethodSelf-citationGuided Self-Management Targeting Anxiety and Activity Participation in Older Veterans
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“With the proposed cutoff score of 16 for the full-length original GAS (Gould et al., 2014), 54% of the individuals identified as having at least mild symptoms of anxiety indicated by the BAI were correctly classified, which matches the results reported by Gould et al. (2014).”
BackgroundResultInfluentialSelf-citationIs there anything to worry about?
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Self-citationTreating co-occurring chronic low back pain & generalized anxiety disorder.
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“The average levels of anxiety and depressive symptoms were higher than for the general population in studies done prior to COVID–19 (Charles et al., 2003; Gould et al., 2014).”
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Self-citationImpact of end-of-life planning on surrogate decision-maker anxiety in the US.
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Self-citationAnxiety in Later Life and Across the Lifespan
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Self-citationOlder Veterans’ Treatment Preferences: Psychotherapy and Self-Management Treatment Modalities
Ma, F., Carlson, C., Gomez, R., & Gould, C. (2022) · Clinical Gerontologist · doi:10.1080/07317115.2022.2079447 · Cited by 3 · see citing works
“A score ≥16 maximizes sensitivity and specificity for the detection of anxiety disorders in older adults (Gould et al., 2014).”
BackgroundSelf-citationPragmatic Screening of Anxiety, Depression, Suicidal Ideation, and Substance Misuse in Older Adults
Lauderdale, S., Martin, K., Oakes, K., Moore, J. M., & Balotti, R. J. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.06.003 · Cited by 3 · see citing works
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Association of anxiety symptoms with health care use and costs in people aged 85 and over
Hohls, J. K., König, H., Bussche, H., Eisele, M., Wiese, B., Oey, A., Weyerer, S., Werle, J., Fuchs, A., Pentzek, M., et al. (2019) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5089 · Cited by 3 · see citing works
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“, Beck Anxiety Inventory [BAI]), their heavy reliance on self-reported somatic symptoms is considered as a limitation when applying them to clinical and non-clinical older adult populations (Diefenbach et al., 2009; Gould et al., 2014).”
BackgroundMethodVito, A. N. D., Calamia, M. R., Weitzner, D. S., & Bernstein, J. P. K. (2019) · International Psychogeriatrics · doi:10.1017/s1041610219001145 · Cited by 2 · see citing works
“For example, likely due to the high number of items explicitly about worry, the GAI has been shown to have a stronger relationship with the PSWQ, while the greater emphasis on somatic content in the GAS likely contributes to its stronger association with self-reported health (Gould et al., 2014).”
ResultAnxiety About Aging in University Students Comparisons by Gender
Vásquez, S., Contreras, M., Delgado, J. C. G., Martell, G. J. A., & Pando, E. V. B. (2017) · Humanities and Social Sciences · doi:10.11648/j.hss.20170501.12 · Cited by 2 · see citing works
“Much is known about the negative effects of anxiety on this age group, however, dimensions and ramifications of anxiety toward aging are poorly understood; a large number of scales have been designed to assess attitudes towards aging and to the old people, however, many of these have not taken into account the multidi…”
BackgroundByrne, G. (2017) · Mental health and illness worldwide · doi:10.1007/978-981-10-0370-7_13-1 · Cited by 2 · see citing works
Self-citationGould, C., Beaudreau, S., Gullickson, G., Tenover, J., Bauer, E. A., & Huh, J. W. T. (2016) · Journal of rehabilitation research and development · doi:10.1682/jrrd.2014.10.0258 · Cited by 2 · see citing works
“Furthermore, the GAD-7 uses a four-point Likert-type scale, which may be confusing for some patients with cognitive impairment and visual memory deficits in particular [17].”
MethodSelf-citationLin, X.-L., Lu, D., Gottschling, J., Segal, D., & Tang, S. (2016) · Journal of Cross-Cultural Gerontology · doi:10.1007/s10823-016-9302-4 · Cited by 1 · see citing works
Self-citationSheffler, J., Meng, Z., Sims, T., Caimary, V. G., Nagpal, R. K., & Mompremier, G. (2026) · Nutrients · doi:10.3390/nu18050747 · Cited by 1 · see citing works
“The 10-item Geriatric Anxiety Scale (GAS-10) was utilized to assess anxiety symptoms among older adults [40,41].”
The Role of Family and Supporter Accommodation in Late-Life Anxiety
Muir, C., Wuthrich, V. M., & Johnco, C. (2025) · Clinical Gerontologist · doi:10.1080/07317115.2025.2492132 · Cited by 1 · see citing works
“The GAS has shown excellent internal consistency (α =.93; Gould et al., 2014), convergent validity with other measures of anxiety ( r =.61) and depression ( r = .59), and discriminant validity with measures of overall functioning ( r = −.39) and education ( r = −.01; Gould et al., 2014; Segal et…”
Tang, Q., Zhang, C., Zhao, Y.-F., Yang, M., Deng, R.-Y., Yan, S.-Y., & Yao, J. (2025) · Psychology, Health & Medicine · doi:10.1080/13548506.2025.2491038 · Cited by 1 · see citing works
“Third, self-report methods of using scales for anxiety and depression symptoms in older adults may reduce accuracy and they may not endorse absolute statements while responding, which can be interpreted as decreased reliability of items using words like “always” (Gould et al., 2014).”
Sibley, R. (2024) · FPOP Bulletin: Psychology of Older People · doi:10.53841/bpsfpop.2024.1.167.29 · Cited by 1 · see citing works
Anxiety Disorders, Hoarding Disorder, and Post-Traumatic Stress Disorder
Segal, D., Qualls, S., & Smyer, M. (2018) · doi:10.1002/9781119133186.ch11 · Cited by 1 · see citing works
Self-citationMental Health and Treatment Considerations for Older Adults
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Anxiety and its disorders in old age
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Self-citationAnxiety Disorders in Later Life
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Self-citation
- Authors
- Gould, C. E., Segal, D. L., Yochim, B. P., Pachana, N. A., Byrne, G. J., & Beaudreau, S. A.
- Affiliations
- VA Palo Alto Health Care System (US)
- University of Colorado Colorado Springs (US)
- The University of Queensland (AU)
- Corresponding author
- Beaudreau, Sherry A.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 28
- Issue
- 8
- Pages
- 804-811
- ISSN
- 0887-6185 (ISSN-L)
- OpenAlex
- W1982782535
- Cited by
- 84
- References
- 0
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 13 · 2020: 8 · 2019: 12 · 2018: 5 · 2017: 8 · 2016: 9 · 2015: 7
- FWCI
- 11.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- geriatric anxiety, Geriatric Anxiety Inventory, Geriatric Anxiety Scale, psychometric properties, internal consistency, convergent validity, discriminant validity, memory retrieval, older adults, depression, anxiety assessment
- MeSH terms
- Aged, Aged, 80 and over, Anxiety Disorders, Female, Humans, Male, Personality Inventory, Psychometrics, Reproducibility of Results, Geriatric Assessment, Self Report
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