Anxiety about Aging Scale (AAS)

1. Abstract

The Anxiety about Aging Scale (AAS) is a multidimensional psychometric instrument developed by Kathleen Patterson Lasher and Patricia J. Faulkender (1987, 1993) to assess subjective fears, anxieties, and emotional concerns regarding one’s own aging process as well as attitudes toward older adults. Spanning 20 self-report items evaluated on a Likert response format ranging from strongly disagree to strongly agree, the AAS conceptualizes aging anxiety not as a monolithic apprehension of mortality, but as an intricate, multifaceted affective and cognitive construct. The instrument evaluates four correlated primary dimensions: (a) Fear of Old People, which gauges personal discomfort, avoidance, and negative affective reactions when interacting with elderly individuals; (b) Psychological Concerns, which measures distress over personal fulfillment, loss of life satisfaction, meaninglessness, and subjective well-being in late adulthood; (c) Physical Appearance, which captures preoccupations with somatic alterations, visible signs of aging (such as wrinkles and gray hair), and changing bodily aesthetics; and (d) Fear of Loss, which examines apprehensions concerning the depletion of social networks, autonomy, health, and decision-making independence.

Psychometric evaluations across diverse collegiate, community, and professional clinical cohorts demonstrate sound reliability and structural validity. Initial and subsequent validation studies report an overall internal consistency (Cronbach’s alpha) coefficient typically hovering between .82 and .84, with individual subscale reliabilities ranging from .65 to .83. Confirmatory and exploratory factor analyses consistently support the four-factor oblique model over unidimensional alternatives, demonstrating robust convergent validity with generalized trait anxiety, death anxiety, and ageist attitudes, alongside satisfactory discriminant validity against unrelated affective states. By providing a nuanced structural assessment of aging anxiety across adulthood, the AAS serves as a foundational instrument in gerontology, developmental psychology, medical sociology, and healthcare education, identifying specific psychological vulnerabilities that may impede successful developmental adaptation or foster discriminatory healthcare attitudes.

2. Keywords

Anxiety about Aging Scale, AAS, aging anxiety, gerontology, fear of aging, developmental psychology, psychometrics, ageism, physical appearance, psychological concerns, fear of loss, fear of old people.

3. Authors

The Anxiety about Aging Scale was originally formulated and empirically validated by:

• Kathleen Patterson Lasher, Ph.D. — Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, United States. Dr. Lasher conceptualized the construct during her doctoral dissertation research examining multidimensional aspects of aging attitudes and personal fear of senescence.
• Patricia J. Faulkender, Ph.D. — Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, United States. Dr. Faulkender served as academic supervisor and co-investigator, refining the scale’s theoretical underpinnings and psychometric validation protocols.

Inquiries regarding historic dissertation archives and foundational psychometric documentation can be accessed through institutional repositories, including the University of Southern Mississippi Aquila Digital Community and academic publishing archives.

4. Purpose

The primary purpose of the Anxiety about Aging Scale (AAS) is to provide an empirically grounded, multidimensional measurement tool capable of identifying, differentiating, and quantifying specific affective and cognitive anxieties individuals harbor regarding the prospect of growing old. Prior to the development of the AAS, early gerontological research frequently conflated anxiety about aging with generalized death anxiety (thanatophobia) or reduced it to explicit, stereotypic ageism directed toward contemporary older generations. Lasher and Faulkender recognized that while individuals may harbor existential dread surrounding finitude, the process of living into old age involves distinct psychosocial, interpersonal, somatic, and cognitive vulnerabilities that warrant independent operationalization.

From a theoretical and developmental perspective, the AAS clarifies how individuals negotiate anticipatory transitions across the adult lifespan. Aging is not merely a biological milestone but a protracted developmental trajectory marked by physical changes, role transitions, shifts in autonomy, and altered social networks. By distinguishing between anxiety directed outward (e.g., discomfort around aged peers) and anxiety directed inward (e.g., fears of somatic decline, cognitive dependence, or personal loss of purpose), the AAS allows developmental researchers to map age-graded trajectories of aging anxiety across young adulthood, middle age, and late maturity.

In applied and clinical settings, the AAS fulfills multiple diagnostic, educational, and intervention-oriented functions:

• Healthcare Professional Training and Medical Education: Healthcare providers, including medical students, nursing trainees, dentists, and allied health clinicians, often display latent anxiety regarding aging that correlates with ageist treatment biases, therapeutic nihilism, and avoidance of geriatric specialties. Administering the AAS in educational programs allows curriculum directors to pinpoint specific student apprehensions—such as discomfort around elderly patients or somatic dread—and target educational interventions to foster empathetic, competent geriatric care.
• Psychotherapeutic Interventions and Geriatric Counseling: Mental health clinicians utilize the scale to evaluate middle-aged and older adults who present with adjustment disorders, midlife crises, or depressive symptoms rooted in catastrophic cognitions regarding senescence, physical deterioration, or retirement-related loss of autonomy.
• Sociological and Organizational Assessments: The scale enables organizational psychologists to evaluate workplace dynamics, specifically intergenerational tensions, implicit age discrimination, and employee anxieties regarding mandatory retirement or career plateauing.

5. Psychological Construct

The Anxiety about Aging Scale measures aging anxiety, defined conceptually as an anticipatory state of apprehension, tension, or dread concerning the physical, mental, psychological, or social changes associated with personal growing older and interacting with older adults. Rather than operating as a singular trait, the construct is organized into four distinct but intercorrelated dimensions:

1. Fear of Old People

This dimension reflects an individual’s emotional and behavioral discomfort, avoidance, and interpersonal reticence in the presence of older adults. It assesses social contact anxiety and relational distance. Individuals scoring high on this dimension report feeling uncomfortable, awkward, or resistant toward engaging in conversations, visits, or activities with aged individuals. Representative items include “I enjoy being around old people” (reverse scored), “I like to go visit my older relatives” (reverse scored), and “I feel very comfortable when I am around an old person” (reverse scored). Elevated scores signify latent ageist aversion and social avoidance, often functioning as an ego-protective mechanism against encountering visual reminders of one’s own eventual frailty.

2. Psychological Concerns

This subscale captures existential and affective anxieties regarding personal happiness, life satisfaction, cognitive well-being, and personal fulfillment in later life. It evaluates catastrophic beliefs about whether late adulthood is inherently devoid of joy, meaning, and subjective vitality. Individuals exhibiting high levels of psychological aging anxiety anticipate that old age will inevitably bring despair, boredom, emotional stagnation, and an inability to maintain life goals. Key items reflecting this construct include “I fear it will be very hard for me to find contentment in old age,” “I expect to feel good about life when I am old” (reverse scored), and “I am afraid that there will be no meaning in life when I am old.”

3. Physical Appearance

This somatic and aesthetic dimension measures distress, vigilance, and cognitive preoccupation with visible markers of biological aging. Within modern cultural milieus that emphasize youthfulness, physical signs of senescence (such as dermatological wrinkles, graying hair, postural alterations, and declining physical vigor) frequently evoke substantial body-image distress and loss of social capital. Items in this domain assess the degree to which an individual fears, dreads, or attempts to mask phenotypic changes: “I have never lied about my age in order to appear younger” (reverse scored), “I have never dreaded the day I would look in the mirror and see gray hairs” (reverse scored), and “When I look in the mirror, it bothers me to see how my looks have changed with age.”

4. Fear of Loss

The Fear of Loss dimension operationalizes apprehension regarding the depletion of tangible functional capacities, personal agency, health, social connections, and self-determination. It taps into anxieties regarding infirmity, chronic illness, social isolation, institutionalization, and the loss of independent decision-making. Prominent items measuring this facet include “I fear that when I am old all my friends will be gone,” “The older I become, the more I worry about my health,” “I get nervous when I think about someone else making decisions for me when I am old,” and “I worry that people will ignore me when I am old.” High scores indicate profound dread over dependency, marginalization, and the erosion of autonomy.

6. Theoretical Framework

The theoretical framework of the Anxiety about Aging Scale synthesizes lifespan developmental psychology, psychosocial stage theory, social comparison theory, and terror management dynamics:

Eriksonian Psychosocial Development

The conceptual foundation of the AAS aligns closely with Erik Erikson’s theory of psychosocial development, particularly the final two stages: Generativity vs. Stagnation (middle adulthood) and Integrity vs. Despair (late adulthood). Erikson posited that successful aging requires individuals to integrate their personal life history, reconcile physical and social losses, and achieve ego integrity. When an individual anticipates that late adulthood will inevitably culminate in despair, isolation, and meaninglessness, aging anxiety manifests. The Psychological Concerns subscale directly operationalizes the fear of falling into Eriksonian despair.

Terror Management Theory (TMT) and Mortality Salience

According to Terror Management Theory (Greenberg, Pyszczynski, & Solomon), human beings manage the paralyzing terror of their own mortality by adhering to cultural worldviews and striving for self-esteem. Older adults serve as salient, visible reminders of physical vulnerability, bodily decay, and inevitable death. Consequently, younger and middle-aged adults often exhibit defensive reactions when confronted with elderly individuals or somatic signs of aging. The Fear of Old People and Physical Appearance subscales capture these defensive psychological responses, showing how individuals project death anxiety and existential distress onto the outward markers of senescence.

Attributional and Sociocultural Perspectives

Sociocultural theories of age stratification and internalized ageism suggest that cultural stereotypes depicting older adults as incompetent, dependent, and socially invisible become internalized across the lifespan. Individuals continuously assimilate cultural messages that equate youth with worth, competence, and physical attractiveness. When people project these external biases onto their own projected future selves, they experience intense fear of functional loss and appearance-related anxiety. The AAS captures the bidirectional nature of this dynamic by evaluating both externalized attitudes toward older individuals and internalized dread regarding the personal aging process.

7. Validity

Extensive psychometric investigations have established robust validity profiles for the Anxiety about Aging Scale across multiple cultural, educational, and demographic groups:

Construct and Factorial Validity

Lasher and Faulkender (1993) initially established construct validity by conducting exploratory factor analyses on a large normative adult sample ranging in age from late teens to older adults. The data yielded four distinct factors that accounted for a substantial proportion of the total variance, confirming that aging anxiety cannot be adequately modeled as a unidimensional construct. Subsequent structural equation modeling and confirmatory factor analysis (CFA) across international samples (e.g., Poorsattar Bejeh Mir & Poorsattar Bejeh Mir, 2014; Wisdom, 2010) have confirmed that the four-factor correlated model achieves acceptable fit indices (e.g., CFI > .90, RMSEA < .06, SRMR < .07), significantly outperforming one-factor and two-factor models.

Convergent Validity

The AAS demonstrates significant, theoretically congruent correlations with established psychometric inventories:

• Death Anxiety: The AAS correlates positively with the Templer Death Anxiety Scale (DAS), particularly on the Fear of Loss and Psychological Concerns subscales ($r = .35$ to $.52, p < .001$), supporting the conceptual connection between senescence dread and mortality salience, while confirming they remain distinct constructs.
• General Trait Anxiety and Neuroticism: Positive correlations are consistently observed between AAS total scores and generalized anxiety inventories (e.g., the State-Trait Anxiety Inventory, STAI-T; $r = .38$ to $.45$). Individuals high in neuroticism and trait anxiety predictably report greater apprehension regarding aging-related changes.
• Ageist Attitudes: The Fear of Old People subscale exhibits strong positive correlations with the Fraboni Scale of Ageism (FSA) and Kogan’s Attitudes Toward Old People Scale (KAOP), verifying its utility in capturing interpersonal prejudice and behavioral avoidance.
• Body Image and Self-Esteem: The Physical Appearance subscale correlates negatively with the Rosenberg Self-Esteem Scale (RSES; $r = -.31$) and positively with body dissatisfaction and dysmorphic measures, especially among female respondents.

Discriminant Validity

Discriminant validity is supported by modest to non-significant correlations with constructs unrelated to developmental senescence, such as academic aptitude, generalized social desirability, and situational state anxiety ($r < .15$). Furthermore, while the AAS correlates moderately with generalized anxiety, factor analyses incorporating both STAI and AAS items demonstrate that AAS items load distinctly on separate developmental factors, demonstrating that aging anxiety is not merely a manifestation of generalized psychological distress.

8. Reliability

The Anxiety about Aging Scale exhibits solid, consistent reliability estimates across exploratory and confirmatory investigations:

Internal Consistency

In the foundational psychometric publication by Lasher and Faulkender (1993), the overall 20-item instrument demonstrated an aggregate Cronbach’s alpha of $\alpha = .82$, indicating high internal consistency without excessive item redundancy. Subscale internal consistencies were reported as follows:

• Fear of Old People: $\alpha = .78$ (5 items), reflecting strong thematic cohesion regarding social discomfort.
• Psychological Concerns: $\alpha = .74$ (5 items), reflecting consistent cognitive evaluation of future well-being.
• Physical Appearance: $\alpha = .71$ (5 items), representing satisfactory reliability for somatic and cosmetic concerns.
• Fear of Loss: $\alpha = .65$ to $.70$ (5 items), an acceptable coefficient given the multifaceted nature of loss (encompassing autonomy, friendship networks, and physical health).

Replication studies across diverse samples have reported comparable or superior coefficients. In Wisdom’s (2010) investigation on age discrimination, the total scale alpha reached $.84$, while Poorsattar Bejeh Mir and Poorsattar Bejeh Mir (2014) reported an overall reliability coefficient of $.81$ among healthcare students. Across translated adaptations (e.g., Turkish, Spanish, and Persian versions), composite internal consistency values consistently range from $.80$ to $.86$.

Test-Retest Stability

Temporal stability evaluations conducted across intervals of two to four weeks yield test-retest correlation coefficients ranging from $r = .76$ to $r = .85$ for the total scale, confirming that the AAS captures stable cognitive-affective trait dispositions rather than fluctuating situational emotions. Subscale test-retest reliabilities also remain within acceptable bounds ($r = .70$ to $.81$).

9. Factor Analysis

The structural composition of the AAS was derived through rigorous factor analytic methods. Lasher and Faulkender (1993) initially formulated an extensive item pool reflecting diverse manifestations of aging anxiety. Following item-total correlation screening and preliminary pilot testing, exploratory factor analysis (EFA) utilizing principal axis factoring with oblique (Promax/Oblimin) rotation was executed, acknowledging that dimensions of personal anxiety naturally intercorrelate.

Exploratory Factor Analysis Findings

The EFA yielded an interpretable four-factor solution with eigenvalues greater than 1.0, accounting for approximately 45.8% to 52.3% of the total variance across validation cohorts. Items demonstrated primary factor loadings ranging from $.42$ to $.78$ onto their designated constructs, with minimal cross-loadings (defined as secondary loadings < .30):

• Factor 1 (Fear of Old People): Defined by items 1, 3, 10, 13, and 19. All items focus directly on interpersonal interactions, visits, and personal comfort when relating to elderly individuals.
• Factor 2 (Psychological Concerns): Defined by items 5, 7, 9, 11, and 17 (along with item 18 in extended structural evaluations). These items reflect personal expectations of subjective meaning, contentment, and life purpose in late life.
• Factor 3 (Physical Appearance): Defined by items 4, 12, 15, and 20. Factor loadings reflect concerns with graying hair, changing cosmetic features, and concealing chronological age.
• Factor 4 (Fear of Loss): Defined by items 2, 6, 8, 14, and 16. These items capture anxiety over loss of friends, deteriorating physical health, cognitive dependence, and loss of autonomous decision-making.

Confirmatory Factor Analysis (CFA) Fit Indices

Subsequent psychometric examinations employing confirmatory factor analysis (e.g., Wisdom, 2010; Poorsattar Bejeh Mir & Poorsattar Bejeh Mir, 2014) evaluated the empirical fit of the established four-factor structure against competing models (e.g., single-factor general aging anxiety; two-factor personal vs. interpersonal anxiety). The four-factor oblique model demonstrated superior goodness-of-fit indices across diverse adult cohorts:

• Chi-Square / Degrees of Freedom Ratio ($\chi^2/df$): Values consistently fall between $1.65$ and $2.30$, within the recommended threshold of < 3.0.
• Comparative Fit Index (CFI): Ranges from $.91$ to $.94$, indicating robust structural adequacy.
• Tucker-Lewis Index (TLI): Typically spans $.89$ to $.93$.
• Root Mean Square Error of Approximation (RMSEA): Estimates range from $.048$ to $.062$ (with 90% confidence intervals staying below $.08$), denoting close model fit.
• Standardized Root Mean Square Residual (SRMR): Values consistently remain between $.051$ and $.065$.

10. Instrument / Measurement Tool

The Anxiety about Aging Scale is a standardized, self-administered psychometric questionnaire. Below is a structured summary of its technical parameters, administration format, and scoring procedures:

• Test Type: Multidimensional self-report psychological rating scale.
• Target Population: Adolescents, young adults, middle-aged adults, and older individuals (reading level approximately 6th to 8th grade).
• Item Count: 20 declarative statements.
• Response Format: Likert rating scale ranging from strongly disagree to strongly agree (commonly operationalized as a 5-point scale: 1 = Strongly Disagree, 2 = Disagree, 3 = Neutral/Undecided, 4 = Agree, 5 = Strongly Agree).
• Administration Time: Approximately 5 to 10 minutes.
• Subscale Breakdown:
  • 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 incorporates both positively and negatively keyed statements to counter acquiescence response bias.
  • Positively worded items reflecting low anxiety, enjoyment of older adults, or self-efficacy (e.g., Items 1, 3, 4, 7, 9, 10, 11, 12, 13, 15, 16, 18, 19) are reverse scored (e.g., Strongly Agree = 1, Strongly Disagree = 5).
  • Negatively worded items indicating direct fear, distress, or apprehension (e.g., Items 2, 5, 6, 8, 14, 17, 20) are scored directly (e.g., Strongly Disagree = 1, Strongly Agree = 5).
  • Composite subscale scores are obtained by summing the keyed item values within each respective dimension. A Total Aging Anxiety Score is calculated by summing all 20 items (score range: 20 to 100), where higher numerical values represent elevated levels of aging anxiety.

11. Permissions & Fee and Test Year

The Anxiety about Aging Scale was developed by Kathleen Patterson Lasher as part of her doctoral dissertation completed in 1987 at the University of Southern Mississippi, and formally published in peer-reviewed literature with Patricia J. Faulkender in 1993 in the International Journal of Aging and Human Development.

• Accessibility and Fees: The AAS is considered an open-access psychometric instrument for non-commercial, academic, clinical, and scientific research purposes. There are no royalty fees required for non-profit academic research.
• Permissions: Researchers and clinicians wishing to employ the scale in academic dissertations, empirical studies, or clinical evaluations may do so with proper bibliographic citation of the original authors (Lasher & Faulkender, 1993). In accordance with standard fair-use academic research guidelines, commercial reproduction, software embedding, or profit-driven dissemination requires permission from the copyright holders and the publisher (Baywood Publishing / SAGE Publications).

12. 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. http://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-2U3E-HWBQ-X3GE
• 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). OSU ShareOK Repository. https://shareok.org/bitstream/handle/11244/6988/Department%20of%20Psychology_66.pdf?sequence=1
• Kogan, N. (1961). Attitudes toward old people: The development of a scale and an examination of correlates. The Journal of Abnormal and Social Psychology, 62(1), 44–54. https://doi.org/10.1037/h0048053
• Templer, D. I. (1970). The construction and validation of a Death Anxiety Scale. The Journal of General Psychology, 82(2), 165–177. https://doi.org/10.1080/00221309.1970.9711287

13. Items of the Scale