Anxiety about Aging Scale (AAS)

Abstract

The Anxiety about Aging Scale (AAS) is a prominent multidimensional self-report psychometric instrument developed by Kathleen Patterson Lasher and Patricia J. Faulkender in 1987 and formally published in 1993. Formulated to address the theoretical and methodological limitations of unidimensional aging attitude measures, the AAS operationalizes aging anxiety as a multifaceted construct comprising affective, cognitive, social, and physiological apprehensions regarding one's own aging trajectory and interactions with older cohorts. The scale consists of 20 items evaluated along a five-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Through rigorous exploratory and confirmatory factor analyses, the instrument delineates four distinct empirical dimensions: Fear of Old People (5 items), Psychological Concerns (6 items), Physical Appearance (4 items), and Fear of Loss (5 items).

Across diverse adult populations spanning early adulthood through old age, the AAS has demonstrated robust psychometric properties. The overall scale exhibits solid internal consistency, with full-scale Cronbach’s alpha coefficients characteristically reported between .82 and .84, and subscale coefficients ranging from .69 to .78 across heterogeneous international cohorts. Construct validity has been established through meaningful convergent associations with generalized trait anxiety, death anxiety, hypochondriasis, ageism, and external locus of control, as well as divergent validity against unrelated personality traits such as openness to experience and social desirability. The AAS is widely employed within developmental psychology, social gerontology, behavioral medicine, clinical psychology, and professional healthcare education to quantify age-related apprehensions, evaluate educational interventions designed to combat ageist stereotypes, and identify psychosocial vulnerabilities across the adult lifespan.

Keywords

Anxiety about Aging Scale, AAS, aging anxiety, gerontophobia, fear of old people, psychological concerns, ageism, physical appearance anxiety, fear of loss, psychometrics, Lasher and Faulkender, social gerontology, terror management theory.

Authors

The Anxiety about Aging Scale was conceptualized and validated by Kathleen Patterson Lasher, Ph.D., and Patricia J. Faulkender, Ph.D. The scale originated from Dr. Lasher's doctoral dissertation in the Department of Psychology at the University of Southern Mississippi (1987), under the academic mentorship of Dr. Faulkender. Their collaborative validation research was subsequently published in the peer-reviewed journal International Journal of Aging and Human Development in 1993.

Dr. Lasher conducted primary foundational investigations into social perceptions of aging, developmental transitions in adulthood, and the emotional precursors to gerontological attitudes. Dr. Faulkender contributed expertise in life-span developmental psychology, psychometric modeling, and personality assessment. Subsequent international validation and cross-cultural adaptations have been spearheaded by diverse researchers, including Dr. Nicholas M. Wisdom at Oklahoma State University and clinical research teams investigating health professionals' aging attitudes across Europe, North America, the Middle East, and East Asia.

Purpose

The primary purpose of the Anxiety about Aging Scale is to provide an empirical, psychometrically sound, multidimensional assessment of the fears, apprehensions, and psychological distress that individuals experience when anticipating their own aging process and when engaging with older adults. Historically, early gerontological research assessed attitudes toward older individuals using broad, unidimensional bipolar semantic differentials or generalized ageism scales (such as the Kogan Attitudes Toward Old People Scale). However, these conventional instruments frequently conflated societal stereotyping with personal internal anxiety, masking critical qualitative distinctions between affective dread of personal bodily decline and behavioral avoidance of senior citizens.

Lasher and Faulkender recognized that aging anxiety represents an intricate interplay of personal mortality awareness, anticipation of biological deterioration, socioeconomic vulnerability, and social distancing behaviors. The AAS was designed to fulfill multiple clinical, empirical, and educational objectives:

• Lifespan Developmental Research: Tracking developmental shifts in personal aging expectations from young adulthood (college cohorts) through middle age and older adulthood, clarifying how chronological age, gender, and social status interact with existential aging distress.
• Healthcare Professional Training and Education: Evaluating baseline attitudes and intervention-induced attitudinal shifts among medical, nursing, dental, and clinical psychology students whose unexamined aging anxiety may inadvertently undermine clinical empathy and patient care quality for older adults.
• Clinical and Geropsychological Assessment: Identifying maladaptive cognitive schemas concerning personal competence, autonomy loss, and social isolation among middle-aged and older adults presenting with generalized anxiety, health anxiety, adjustment disorders, or somatic symptom distress.
• Organizational and Policy Evaluation: Assisting human resource departments and gerontological organizations in measuring implicit age-related biases, workplace age discrimination vulnerabilities, and intergenerational workplace tensions.

By dissecting aging anxiety into four separable factors, the AAS enables researchers and clinicians to identify whether an individual's anxiety stems predominantly from social aversion (Fear of Old People), existential despair (Psychological Concerns), aesthetic distress (Physical Appearance), or autonomic decline and social abandonment (Fear of Loss), thereby facilitating targeted educational and therapeutic interventions.

Psychological Construct

The psychological construct assessed by the AAS is aging anxiety, defined as a state of apprehensive anticipation, emotional discomfort, and dread surrounding the progressive biological, psychological, and social transitions associated with growing old. Rather than operating as an undifferentiated global phobia, aging anxiety manifests across four primary intercorrelated dimensions, grounded in empirical factor structures:

1. Fear of Old People

This social-affective dimension captures an individual's subjective discomfort, aversion, and avoidance when interacting with elderly persons. It measures whether one enjoys being around older adults, engaging in conversations with them, visiting older relatives, or performing altruistic acts for seniors. High scores indicate an implicit social distancing tendency, reflecting an internalized gerontophobic orientation wherein older individuals serve as tangible reminders of frailty, cognitive decline, and impending mortality.

2. Psychological Concerns

This intrapersonal, existential dimension assesses the cognitive expectations and anticipatory appraisals an individual holds regarding their personal psychological wellbeing, life satisfaction, and meaning in later life. Representative items measure whether a person expects to experience contentment, self-worth, and purposeful engagement as they age, or conversely, whether they anticipate existential boredom, purposelessness, and depressive despair. This dimension closely aligns with theoretical concepts of subjective wellbeing and emotional resilience in developmental transitions.

3. Physical Appearance

The physical appearance dimension reflects cosmetic, somatic, and body-image apprehensions tied to the visible signs of chronological aging. It operationalizes the distress evoked by physical markers such as graying hair, wrinkles, skin elasticity changes, and structural postural shifts, as well as behavioral manifestations such as concealing one's age. Societal pressures emphasizing youthful aesthetics—frequently intensified by gendered standards of beauty—render this subscale particularly sensitive to sociocultural conditioning, body dysmorphic concerns, and self-esteem contingencies linked to physical appearance.

4. Fear of Loss

This dimension evaluates apprehensions regarding tangible structural and functional decrements in later life. It encompasses multiple existential and ecological losses: the loss of autonomy (having others make personal decisions), the loss of health (escalating hypochondriacal and somatic anxiety), the loss of social networks through bereavement (fear that all friends will be deceased), and the loss of social visibility or relevance (worrying that others will ignore or dismiss them). Fear of Loss represents the individual's vulnerability to helplessness, social abandonment, and functional dependence.

Theoretical Framework

The conceptual structure of the Anxiety about Aging Scale is anchored in several foundational frameworks within developmental psychology, social psychology, and psychodynamics:

Erikson’s Epigenetic Theory of Psychosocial Development

The scale directly draws upon Erik Erikson’s life-stage paradigm, specifically the eighth and final psychosocial stage: Ego Integrity versus Despair. Erikson postulated that the ultimate developmental task of late adulthood requires synthesizing one's lived past into a coherent, meaningful narrative. Despair ensues when an individual perceives life as fragmented, squandered, or barren of purpose, triggering intense unconscious dread of death and physical degeneration. The AAS Psychological Concerns and Fear of Loss subscales measure prospective anxiety regarding this crisis—capturing an anticipatory fear of failing to attain ego integrity and succumbing to existential despair.

Terror Management Theory (TMT)

Derived from the work of Ernest Becker and formalized by Jeff Greenberg, Sheldon Solomon, and Tom Pyszczynski, Terror Management Theory posits that human awareness of personal mortality generates profound existential terror. Cultural worldviews and self-esteem serve as psychological buffers against this paralyzing awareness. Within TMT, older adults and physical markers of aging (such as gray hair, wrinkles, and physical infirmity) function as potent, unavoidable reminders of mortality (mortality salience). Consequently, younger and middle-aged individuals exhibit defensive psychological distancing—manifesting as the AAS subscales Fear of Old People and Physical Appearance—to preserve symbolic immortality and insulate themselves from the somatic reality of biological decay.

Social Gerontological Models of Ageism

The AAS incorporates Robert Butler's foundational formulation of ageism—a systematic stereotyping of, and discrimination against, people because they are old. Butler emphasized that ageism is fueled by personal revulsion toward the inevitability of bodily deterioration and death. Lasher and Faulkender integrated these insights into a cognitive-behavioral framework, illustrating that societal stereotypes become internalized cognitive schemas that determine how individuals appraise their future selves, shaping self-directed aging anxiety alongside interpersonal prejudice.

Validity

Extensive psychometric investigations have established the validity of the Anxiety about Aging Scale across varied academic, clinical, and community cohorts:

Construct and Convergent Validity

Convergent validity has been repeatedly corroborated through statistically significant correlations with theoretical correlates of anxiety, neuroticism, and death fear:

• Death Anxiety: Moderate-to-high positive correlations (typically r = .40 to .58, p < .001) have been documented between the AAS total score and Templer's Death Anxiety Scale (DAS), verifying that mortality concerns significantly overlap with existential aging fears.
• Trait and Manifest Anxiety: AAS scores correlate positively with the Taylor Manifest Anxiety Scale and the Spielberger Trait Anxiety Inventory (STAI-T) (r values spanning .35 to .49), demonstrating that individuals with generalized negative affectivity display elevated aging distress.
• Somatic Anxiety and Hypochondriasis: The Fear of Loss and Physical Appearance subscales correlate significantly with the MMPI Hypochondriasis (Hs) scale (r ≈ .32 to .41), underscoring somatic preoccupation in aging dread.
• Locus of Control: AAS scores relate positively to Rotter's External Locus of Control, suggesting that individuals who perceive external forces as dominating their destiny anticipate higher helplessness in old age.

Discriminant Validity

The AAS demonstrates clear discriminant boundaries when examined alongside constructs with which it should theoretically show weak or negligible associations:

• Social Desirability: Correlations with the Marlowe-Crowne Social Desirability Scale are uniformly low and non-significant (r = -.08 to -.14), demonstrating that AAS responses are relatively unclouded by impression management.
• Intellectual Functioning: Non-significant associations have been documented between AAS scores and standardized cognitive performance or educational attainment levels when age is statistically controlled.

Criterion-Related and Predictive Validity

The AAS demonstrates functional predictive utility across multiple behavioral domains. In studies examining healthcare professionals (such as nursing, medical, and dental students; e.g., Poorsattar Bejeh Mir & Poorsattar Bejeh Mir, 2014), lower scores on the Fear of Old People subscale predict higher willingness to pursue geriatric specializations and more favorable bedside evaluations during clinical rotations. In workplace settings, research examining age discrimination (Wisdom, 2010) identified that elevated AAS scores significantly predicted discriminatory attitudes toward older job applicants in simulated hiring decisions.

Reliability

The Anxiety about Aging Scale demonstrates robust classical test theory reliability indices across laboratory, educational, and cross-cultural research environments:

Internal Consistency

In the seminal validation study by Lasher and Faulkender (1993) involving 312 adults across diverse age brackets, the total 20-item AAS yielded a full-scale Cronbach's alpha coefficient of .82. The individual subscales demonstrated moderate to strong internal consistency coefficients:

• Fear of Old People (5 items): α = .78
• Psychological Concerns (6 items): α = .74
• Physical Appearance (4 items): α = .73
• Fear of Loss (5 items): α = .69

Replication studies have supported these values. For instance, across diverse community cohorts in North America and cross-national adaptations in Europe and Asia, full-scale alpha coefficients have remained stable, typically ranging between .80 and .86, with subscale alphas rarely dropping below acceptable psychometric thresholds (α ≥ .68).

Test-Retest Stability

Evaluations of temporal stability across intervals ranging from two to six weeks have revealed test-retest reliability correlation coefficients exceeding r = .80 for the full-scale instrument, with individual subscales exhibiting coefficients between .72 and .84. These findings confirm that while situational factors and educational interventions can modify specific attitudes, the AAS assesses enduring cognitive and affective traits.

Factor Analysis

The structural dimensionality of the AAS has been scrutinized using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA):

Exploratory Factor Analysis (EFA)

Lasher and Faulkender (1987, 1993) initially administered a larger candidate pool of 84 items addressing diverse aging concerns to a sample of 312 community-dwelling men and women aged 18 to 87. Principal components analysis followed by orthogonal (Varimax) and oblique rotations converged on a distinct four-factor solution accounting for 48.6% of the total variance. Twenty items displaying robust primary loadings (> .40) and minimal cross-loadings (< .25) were retained, yielding the final 20-item inventory.

Confirmatory Factor Analysis (CFA)

Subsequent psychometric evaluations across adult populations (e.g., Wisdom, 2010) have evaluated the fit of this four-factor model using structural equation modeling. CFA demonstrates that the four-factor first-order correlated model outperforms unidimensional and two-factor models, achieving solid fit indices: Comparative Fit Index (CFI) ≥ .91, Tucker-Lewis Index (TLI) ≥ .90, Root Mean Square Error of Approximation (RMSEA) ≤ .056 (90% CI [.048, .064]), and Standardized Root Mean Square Residual (SRMR) ≤ .061. These structural findings corroborate that while the dimensions share an underlying higher-order construct (aging anxiety), treating the four dimensions independently preserves critical clinical and empirical granularity.

Instrument / Measurement Tool

The Anxiety about Aging Scale is an objective, standardized, paper-and-pencil or digital self-report instrument. The structural and administrative specifications include:

• Item Count: 20 items.
• Administration Time: Approximately 5 to 8 minutes.
• Target Population: Adolescents, young adults, middle-aged adults, and older adults (reading level approximately 6th to 8th grade).
• Response Scale: 5-point Likert response scale scored from 1 to 5:
  • 1 = Strongly Disagree
  • 2 = Disagree
  • 3 = Undecided / Neutral
  • 4 = Agree
  • 5 = Strongly Agree
• Subscale Allocation:
  • Fear of Old People: Items 1, 3, 10, 13, 19.
  • Psychological Concerns: Items 5, 7, 9, 11, 17, 18.
  • Physical Appearance: Items 4, 12, 15, 20.
  • Fear of Loss: Items 2, 6, 8, 14, 16.
• Scoring and Directionality:
  • The instrument contains both directly phrased (anxious) items and reverse-phrased (positive/resilient) items to mitigate acquiescence response bias.
  • Directly Scored Items (keyed in direction of higher anxiety): Items 2, 5, 6, 8, 14, 17, 20. (Scores retained as: Strongly Disagree = 1, Strongly Agree = 5).
  • Reverse Scored Items (keyed in direction of low anxiety/positive attitude): Items 1, 3, 4, 7, 9, 10, 11, 12, 13, 15, 16, 18, 19. For these items, scoring must be inverted prior to aggregation: Strongly Disagree = 5, Disagree = 4, Undecided = 3, Agree = 2, Strongly Agree = 1.
  • Score Aggregation: Subscale scores are calculated by summing the recoded items belonging to each factor. The total AAS score is computed by summing all 20 recoded items (theoretical range: 20 to 100), with higher numerical values consistently indicating greater degrees of aging anxiety.

Permissions & Fee and Test Year

The Anxiety about Aging Scale was developed in 1987 as part of Dr. Kathleen Patterson Lasher's doctoral research and formally published in peer-reviewed literature in 1993. The scale resides in the public academic domain for non-commercial educational, scientific, and empirical research purposes under fair-use principles, contingent upon standard scholarly citation of the original authors.

No licensing fee or per-administration royalty is required for non-commercial academic research. Investigators seeking to incorporate the AAS into commercial clinical assessment software, for-profit consulting programs, or copyrighted commercial publications should seek formal permission from the journal publisher (Baywood / SAGE Publications) or the original authors.

References

• Lasher, K. P. (1987). Development and initial validation of the Anxiety about Aging Scale (Doctoral dissertation, University of Southern Mississippi). Dissertation Archive, Paper 2835. https://aquila.usm.edu/theses_dissertations/2835
• Lasher, K. P., & Faulkender, P. J. (1993). Measurement of aging anxiety: Development of the Anxiety about Aging Scale. International Journal of Aging and Human Development, 37(4), 247–259. https://doi.org/10.2190/9W9Q-2UML-6A7P-1K7X
• Poorsattar Bejeh Mir, A., & Poorsattar Bejeh Mir, M. (2014). Dentistry students ageing anxiety levels in northern Iran. Gerodontology, 31(4), 260–264. https://doi.org/10.1111/ger.12032
• Wisdom, N. M. (2010). Social acceptance of age discrimination (Doctoral dissertation, Oklahoma State University). SHAREOK Repository. https://shareok.org/handle/11244/6988
• Butler, R. N. (1969). Age-ism: Another form of bigotry. The Gerontologist, 9(4), 243–246. https://doi.org/10.1093/geront/9.4_part_1.243
• Greenberg, J., Pyszczynski, T., & Solomon, S. (1986). The causes and consequences of a need for self-esteem: A terror management theory. In R. F. Baumeister (Ed.), Public Self and Private Self (pp. 189–212). Springer. https://doi.org/10.1007/978-1-4613-9564-5_10

Items of the Scale