Geriatric Anxiety Scale – GAS Version 1.0

Abstract

The Geriatric Anxiety Scale – GAS Version 1.0 is an empirically validated, multidimensional self-report assessment instrument engineered explicitly to screen for and quantify symptoms of clinical and subclinical anxiety among older adults (typically aged 65 years and older). Developed by Daniel L. Segal and colleagues (2010) at the University of Colorado Colorado Springs, the GAS directly addresses the long-standing diagnostic conundrum in psychogeriatrics known as somatic and diagnostic overshadowing, where somatic manifestations of natural aging, chronic medical illness, and neurodegenerative disorders conflate with or obscure authentic anxiety symptomatology. The complete inventory comprises 30 items evaluated on a 4-point Likert-type frequency metric ranging from 0 (“Not at all”) to 3 (“All of the time”). Structurally, the instrument computes a Total Anxiety Score derived from the summation of the first 25 items (score range: 0–75), which map across three theoretically and empirically derived latent dimensions: Somatic Symptoms (9 items), Cognitive Symptoms (8 items), and Affective Symptoms (8 items). The remaining 5 supplementary items (Items 26–30) capture clinically salient, non-scored idiographic worry domains specific to late life, including concerns about personal health, financial stability, children, fear of death, and dread of becoming a functional burden to family. Psychometrically, the GAS demonstrates exceptional internal consistency (full-scale Cronbach’s α ranging from .91 to .94 across community-dwelling, outpatient clinical, and acute medical cohorts), robust 2-week test-retest reliability ($r = .80$–$.88$), and rigorous convergent and discriminant validity when benchmarked against traditional instruments such as the Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI), Geriatric Anxiety Inventory (GAI), and Geriatric Depression Scale (GDS). A brief 10-item short form (GAS-10) has also been isolated for acute medical and rapid primary care triage, retaining strong psychometric fidelity (α = .85–.91). Consequently, the GAS represents a gold-standard psychometric benchmark in late-life clinical assessment, geriatric psychopathology research, and epidemiological screening.

Keywords

Geriatric Anxiety Scale, late-life anxiety, psychogeriatrics, somatic anxiety, cognitive anxiety, affective symptoms, psychometrics, GAD in older adults, clinical assessment, older adult mental health, GAS-10, scale validation, geriatric psychopathology, gerontology, differential diagnosis

Authors

The Geriatric Anxiety Scale (GAS Version 1.0) was conceptualized, designed, and psychometrically validated by a collaborative research team of clinical geropsychologists and psychometricians:

• Daniel L. Segal, Ph.D. — Professor of Psychology, Department of Psychology, University of Colorado Colorado Springs (UCCS), Colorado Springs, Colorado, USA. Dr. Segal is an internationally recognized expert in clinical geropsychology, personality disorders in older adults, and suicide assessment in late life. Email: [email protected].
• Andy June, M.A. — Department of Psychology, University of Colorado Colorado Springs (UCCS), Colorado Springs, Colorado, USA.
• Matthew Payne, B.A. — Department of Psychology, University of Colorado Colorado Springs (UCCS), Colorado Springs, Colorado, USA.
• Frederick L. Coolidge, Ph.D. — Professor of Psychology, Department of Psychology, University of Colorado Colorado Springs (UCCS), Colorado Springs, Colorado, USA. An authority on psychometrics, executive function, and evolutionary neuropsychology.
• Brian C. Yochim, Ph.D., ABPP — Clinical Neuropsychologist, VA Palo Alto Health Care System, and Affiliated Clinical Associate Professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.

Subsequent psychometric refinements, cross-validation studies in diverse clinical, medical, and minority cohorts, and the formal standardization of the GAS-10 were spearheaded in significant part by Anne Elizabeth Mueller, Ph.D. (2014) at the University of Colorado Colorado Springs, in close collaboration with the original scale originators.

Purpose

Anxiety disorders in late life represent a widespread, debilitating, yet disproportionately underdiagnosed and undertreated psychiatric category. Epidemiological estimates suggest that up to 15% to 20% of community-dwelling older adults, and up to 30% of older adults in inpatient medical or residential long-term care environments, suffer from subsyndromal or clinical-level anxiety, with Generalized Anxiety Disorder (GAD) exhibiting the highest incidence. Despite this substantial burden, legacy anxiety instruments—such as the Beck Anxiety Inventory (BAI), the Hamilton Anxiety Rating Scale (HAM-A), and the State-Trait Anxiety Inventory (STAI)—were constructed and standardized predominantly using undergraduate college cohorts or working-age adult psychiatric samples. When transplanted into geriatric contexts, these historical tools exhibit pronounced psychometric distortions.

The primary clinical and theoretical rationale for engineering the Geriatric Anxiety Scale was to correct the systemic failure of general-population inventories within psychogeriatric cohorts. The most critical point of vulnerability in traditional tools is the unchecked proliferation of somatic items (such as tremors, gastrointestinal upset, dizziness, palpitations, respiratory distress, and sleep architecture disruption). In an older adult, these exact physical symptoms are frequently benign sequelae of normative senescence, manifestations of polypharmacy and drug interactions, or diagnostic features of prevalent chronic medical conditions such as cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes mellitus, and osteoarthritis. When generic scales score these somatic markers as indicative of psychopathology, they trigger substantial false-positive elevations—a phenomenon termed diagnostic confounding or somatic contamination.

Conversely, older adults often exhibit an age-related emotional phenotype characterized by reluctance to endorse formal affective descriptors such as “anxious,” “nervous,” or “panicked” due to cohort-specific mental health stigma, stoicism, or low psychological mindedness. Instead, late-life psychological distress often manifests as diffuse cognitive worry, hyperarousal, irritability, and unique geriatric existential stressors (e.g., progressive loss of functional independence, fear of cognitive collapse, financial insolvency, bereavement, and the terror of becoming a burdensome physical or financial obligation to adult offspring).

The GAS was deliberately formulated to fulfill three overarching clinical and research needs:

1. To provide a psychometrically pure Total Anxiety Score (Items 1–25) that measures core anxiety while balancing somatic, cognitive, and affective indicators so that medical illnesses do not automatically result in pathologically skewed classifications.
2. To deliver a clinically nuanced breakdown of symptomatology across three differentiated structural subscales (Somatic, Cognitive, and Affective) to help clinicians formulate tailored psychological interventions (such as targeted relaxation and breathing retraining for high somatic scorers versus cognitive restructuring for high cognitive worry scorers).
3. To isolate and track elder-specific contextual preoccupations (Items 26–30) without contaminating the psychometric scoring formula of core clinical severity, thereby supplying healthcare providers with an actionable roadmap of the patient’s individual idiographic psychosocial stressors.

Psychological Construct

The construct measured by the Geriatric Anxiety Scale is late-life dimensional anxiety, conceived as a complex, multifaceted syndrome encompassing neurovegetative/physiological arousal, maladaptive repetitive cognitions, subjective emotional distress, and existential developmental vulnerabilities. Rather than treating anxiety as an undifferentiated, unitary state, the GAS operationalizes it into three distinct empirical sub-constructs, alongside a non-scored idiographic category of age-salient life concerns.

1. Somatic Subscale (9 Items: 1, 2, 3, 8, 9, 17, 21, 22, 23)

The Somatic construct assesses physiological hyperarousal, autonomic hyperactivity, and physical tension. Because somatic symptoms in older adults can easily be confounded by physical illnesses, the GAS selects physiological indicators that demonstrate statistical covariance with psychological distress rather than primary physical illness alone:

• Cardiovascular and Respiratory Reactivity: Measured by Item 1 (“My heart raced or beat strongly”) and Item 2 (“My breath was short”). These capture acute autonomic fight-or-flight mobilization.
• Gastrointestinal Dysregulation: Captured by Item 3 (“I had an upset stomach”), reflecting enteric nervous system activation under chronic stress.
• Sleep Disturbance: Delineated into sleep-onset latency (Item 8: “I had difficulty falling asleep”) and sleep maintenance/fragmentation (Item 9: “I had difficulty staying asleep”).
• Motor Agitation, Fatigue, and Musculoskeletal Tension: Evaluated by Item 17 (“I had a hard time sitting still”), Item 21 (“I felt tired”), Item 22 (“My muscles were tense”), and Item 23 (“I had back pain, neck pain, or muscle cramps”).

2. Cognitive Subscale (8 Items: 4, 5, 12, 16, 18, 19, 24, 25)

The Cognitive dimension operationalizes the mental manifestations of chronic anxiety, perceived cognitive impairment secondary to emotional arousal, and catastrophizing belief systems. This dimension captures the cognitive processing deficits that often lead older adults to fear they are developing dementia:

• Perceptual Distortions and Dissociation: Measured by Item 4 (“I felt like things were not real or like I was outside of myself”), Item 5 (“I felt like I was losing control”), and Item 16 (“I felt like I was in a daze”). These items register depersonalization and derealization during high-stress states.
• Attentional Disruption: Reflected in Item 12 (“I had difficulty concentrating”), an executive functioning deficit caused by cognitive interference from intrusive thoughts.
• Uncontrollable Worry: Captured through Item 18 (“I worried too much”) and Item 19 (“I could not control my worry”), mapping directly onto the core Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for Generalized Anxiety Disorder.
• Helplessness and Impending Catastrophe: Indexed by Item 24 (“I felt like I had no control over my life”) and Item 25 (“I felt like something terrible was going to happen to me”), reflecting severe external locus of control and catastrophic future-oriented forecasting.

3. Affective Subscale (8 Items: 6, 7, 10, 11, 13, 14, 15, 20)

The Affective dimension captures mood dysregulation, subjective emotional tension, interpersonally driven distress, and emotional withdrawal:

• Social-Evaluative Anxiety: Measured by Item 6 (“I was afraid of being judged by others”) and Item 7 (“I was afraid of being humiliated or embarrassed”). These items target social phobic symptoms and vulnerability to ageist social evaluations.
• Irritability and Dysregulated Temperament: Evaluated by Item 10 (“I was irritable”), Item 11 (“I had outbursts of anger”), and Item 13 (“I was easily startled or upset”). Emotional reactivity and acoustic startle reflex sensitization frequently present as primary affective manifestations of anxiety in late life.
• Anhedonia and Social Disconnection: Captured by Item 14 (“I was less interested in doing something I typically enjoy”) and Item 15 (“I felt detached or isolated from others”), capturing dysphoric withdrawal and diminished engagement with social support systems.
• Subjective Hyperarousal: Indexed via Item 20 (“I felt restless, keyed up, or on edge”), the quintessential affective state of vigilant apprehension.

4. Content-Specific / Contextual Worry Items (5 Items: 26, 27, 28, 29, 30)

Items 26 through 30 represent an unscaled, supplementary diagnostic module. Segal and colleagues recognized that older individuals frequently organize their worries around realistic developmental challenges rather than abstract psychological domains. These items assess:

• Item 26: Financial solvency (“I was concerned about my finances”).
• Item 27: Physical health (“I was concerned about my health”).
• Item 28: Family safety and stability (“I was concerned about my children”).
• Item 29: Mortality anxiety (“I was afraid of dying”).
• Item 30: Fear of loss of autonomy and caregiver strain (“I was afraid of becoming a burden to my family or children”).

These five items provide qualitative, idiographic material for psychosocial case formulation without elevating the patient’s formal anxiety severity metric.

Theoretical Framework

The Geriatric Anxiety Scale is anchored at the convergence of three foundational theoretical models: the Cognitive-Behavioral Model of Anxiety, the Tripartite Model of Anxiety and Depression, and lifespan developmental theories of Socioemotional Aging.

1. The Cognitive-Behavioral Model of Late-Life Anxiety

Formulated on the classic cognitive theory of psychopathology pioneered by Aaron T. Beck and further refined by David A. Clark, this framework posits that anxiety disorders stem from systematic cognitive distortions, dysfunctional schemas, and catastrophic misinterpretations of both internal sensations and external events. In late life, individuals experience an objective increase in physical vulnerabilities, bereavement, functional decline, and socio-economic shifts. According to cognitive theory, when an individual perceives their coping resources as insufficient to meet these physiological and environmental demands, chronic threat appraisal mechanisms become hyperactive.

The GAS operationalizes this balance by assessing perceived inability to control worry (Items 18 and 19) and catastrophizing about external disasters (Item 25). These cognitive processes trigger physiological hyperarousal through sympathetic nervous system cascades, producing the somatic complaints captured in Items 1, 2, and 22.

2. Clark and Watson’s Tripartite Model

The conceptual segregation of the GAS into Somatic, Cognitive, and Affective dimensions reflects Clark and Watson’s (1991) Tripartite Model of Anxiety and Depression. This model categorizes emotional disorders into three interconnected components: general negative affectivity (shared by both anxiety and depression), physiological hyperarousal (specific to anxiety), and anhedonia/low positive affect (specific to depression). The GAS was specifically designed to distinguish pure anxiety from depressive presentations. By segregating physiological hyperarousal (Somatic Subscale) and catastrophic cognitive threat appraisals (Cognitive Subscale) from broad dysphoria, the scale ensures that depressive presentations without autonomic or apprehensive components do not artificially mimic anxiety states.

3. Socioemotional Selectivity and Developmental Theories

From a gerontological perspective, the scale aligns with Laura L. Carstensen’s Socioemotional Selectivity Theory (SST) and Paul Baltes’ framework of Selective Optimization with Compensation (SOC). SST posits that as individuals age and perceive their future time horizon as limited, they systematically reorganize motivational priorities, prioritizing emotional regulation, close interpersonal bonds, and meaningful experiences over novel information gathering. Under normative aging conditions, this shift often produces a “positivity effect.”

However, when neurodegenerative changes, severe medical frailty, or pathological anxiety disrupt these emotional self-regulation pathways, the developmental trajectory shifts toward heightened threat vulnerability. Preoccupations with bodily decline, fears of functional dependence, and existential dread of burdening family (Items 26–30) emerge as central developmental conflicts. The GAS bridges cognitive-behavioral paradigms with lifespan developmental theory by measuring both classic transdiagnostic anxiety mechanisms and the distinct developmental stressors of late life.

Validity

Extensive psychometric validation across community-dwelling older adults, outpatient geriatric mental health clinics, memory clinics, and inpatient medical wards confirms that the Geriatric Anxiety Scale exhibits robust validity properties.

Construct and Factorial Validity

Construct validity was established by Segal et al. (2010) through exploratory factor analysis, followed by confirmatory factor analysis (CFA) executed by Mueller (2014) and subsequent cross-national validation teams. The proposed three-factor architecture (Somatic, Cognitive, Affective) demonstrates superior model fit compared to single-factor unidimensional structures, while simultaneously confirming a strong higher-order overarching general anxiety factor that justifies the computation of the Total Anxiety Score (Items 1–25).

Convergent Validity

The GAS exhibits high convergent validity when correlated against established measures of anxiety across adult and geriatric cohorts:

• Beck Anxiety Inventory (BAI): Correlates strongly with the GAS Total Score, with Pearson coefficients typically ranging between $r = .68$ and $r = .82$ ($p < .001$). Importantly, the GAS Somatic subscale correlates higher with the BAI than do the GAS Cognitive or Affective subscales, which is consistent with the BAI’s heavy somatic item weighting.
• Geriatric Anxiety Inventory (GAI): Correlations between the GAS Total Score and the GAI (Pachana et al., 2007) fall between $r = .72$ and $r = .85$ ($p < .001$), confirming construct convergence while offering more granular dimensionality than the dichotomous (Agree/Disagree) format of the GAI.
• State-Trait Anxiety Inventory (STAI – Form Y): Correlates robustly with the GAS Total Score ($r = .65$ to $.78$, $p < .001$).
• Generalized Anxiety Disorder 7-item scale (GAD-7): Cross-validation studies demonstrate strong linear association with the GAS Total Score ($r = .70$ to $.84$).

Discriminant Validity

Discriminant validity has been rigorously demonstrated against measures of late-life depression and cognitive impairment:

• Geriatric Depression Scale (GDS-15 and GDS-30): While anxiety and depression naturally co-occur in older populations (yielding expected moderate correlations of $r = .52$ to $.64$), hierarchical regression analyses indicate that the GAS Cognitive and Somatic subscales account for unique, statistically significant variance in anxiety criteria above and beyond that explained by the GDS. Furthermore, the correlation between the GAS Somatic subscale and the GDS is significantly lower than its correlation with the BAI, demonstrating clear somatic discriminant properties.
• Mini-Mental State Examination (MMSE) / Montreal Cognitive Assessment (MoCA): The GAS displays non-significant or near-zero correlations with cognitive status measures ($r = -.05$ to $-.12$, $p > .05$) in older adults without moderate-to-severe dementia, demonstrating that the scale measures affective-anxious symptoms rather than baseline cognitive capacity.

Criterion and Diagnostic Predictive Validity

Receiver Operating Characteristic (ROC) analyses conducted in clinical settings have evaluated the diagnostic sensitivity and specificity of the GAS against semi-structured diagnostic interviews (such as the SCID for DSM-IV-TR and DSM-5):

• Area Under the Curve (AUC): The GAS Total Score achieves an exceptional AUC of .90 to .94 for distinguishing older adults with a diagnosed anxiety disorder from non-anxious clinical and community controls.
• Optimal Clinical Cutoff: A cut-score of 16 (out of 75) balances optimal sensitivity (82%–88%) and specificity (80%–85%) for broad anxiety disorder screening in community and primary care populations. A more conservative cut-score of 29 demonstrates high specificity (approaching 90%) for identifying severe GAD and panic symptomatology in specialized psychogeriatric clinics.

Reliability

The Geriatric Anxiety Scale exhibits high reliability across multiple psychometric indices, validation samples, and clinical environments.

Internal Consistency

Across diverse psychometric studies (Segal et al., 2010; Yochim et al., 2013; Mueller, 2014; Gould et al., 2014), the internal consistency of the GAS Total Score and its individual subscales has proven exceptionally high:

• Total Anxiety Score (Items 1–25): Cronbach’s alpha (α) consistently ranges from .91 to .94 across community-dwelling, outpatient clinical, and acute medical cohorts, indicating strong internal item coherence without excessive item redundancy. McDonald’s omega total ($\omega_t$) similarly reaches .93–.95.
• Somatic Subscale: Cronbach’s α ranges from .78 to .85. Given that this scale contains heterogeneous autonomic and physical items, this coefficient demonstrates strong internal cohesion while accounting for medical heterogeneity.
• Cognitive Subscale: Cronbach’s α ranges from .85 to .88, reflecting tight covariance among cognitive worry and perceived loss-of-control indicators.
• Affective Subscale: Cronbach’s α ranges from .80 to .85, confirming strong reliability in capturing irritability, social evaluation fears, and hyperarousal.
• GAS-10 Short Form: Internal consistency for the 10-item brief iteration remains strong, with Cronbach’s α ranging between .85 and .91.

Test-Retest Reliability and Temporal Stability

Temporal stability evaluations conducted across a 2-week retest interval among stable community-dwelling older adults yield an intraclass correlation coefficient (ICC) of $r = .80$ to $.88$ ($p < .001$) for the Total Anxiety Score. Subscale test-retest correlations remain high across the same duration:

• Somatic Subscale: $r = .76$
• Cognitive Subscale: $r = .83$
• Affective Subscale: $r = .79$

Standard Error of Measurement

The Standard Error of Measurement (SEM) for the Total Anxiety Score is approximately 3.2 to 3.8 points on the 75-point metric. Consequently, the Minimum Detectable Change (MDC) or Reliable Change Index (RCI) at the 95% confidence level corresponds to a shift of approximately 8 to 9 points, providing clinicians with a statistically grounded threshold to identify meaningful therapeutic progress during pharmacotherapy or cognitive-behavioral treatment.

Factor Analysis

The latent structural foundation of the Geriatric Anxiety Scale has been clarified through iterative exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) across diverse late-life cohorts.

Exploratory Factor Analysis (EFA)

During original scale development, Segal et al. (2010) administered an initial item pool to a diverse sample of older adults ($N = 432$, age range: 60–94 years). Principal Axis Factoring (PAF) and Principal Component Analysis (PCA) were conducted with oblique rotation (Promax and Direct Oblimin), allowing the latent dimensions of anxiety to correlate naturally. Scree plot visual inspection, Velicer’s minimum average partial (MAP) test, and Kaiser’s eigenvalue-greater-than-1.0 criterion supported a robust three-factor solution representing Somatic, Cognitive, and Affective dimensions, along with a prominent primary general factor.

Item Factor Loadings

Individual factor loadings for the retained 25 scored items on their designated primary factors were robust, exceeding the .40 threshold across items, with cross-loadings remaining low:

• Factor 1: Somatic Symptoms (9 items): Items loaded cleanly between .42 and .78. Highest loading items included Item 22 (Muscle tension: .78), Item 23 (Back/neck pain/muscle cramps: .71), and Item 1 (Heart racing: .69).
• Factor 2: Cognitive Symptoms (8 items): Factor loadings ranged from .48 to .82. Prominent loadings included Item 18 (Worried too much: .82), Item 19 (Could not control worry: .80), and Item 25 (Something terrible going to happen: .74).
• Factor 3: Affective Symptoms (8 items): Factor loadings spanned .44 to .75. Top-performing indicators included Item 10 (Irritable: .75), Item 20 (Restless/keyed up: .72), and Item 15 (Detached/isolated: .66).

Confirmatory Factor Analysis (CFA) Model Fit

Confirmatory factor analytic investigations (Mueller, 2014; Yochim et al., 2013) benchmarked competing structural architectures across community, clinical, and medically ill older adults. Tested configurations included: a one-factor global model, a three-factor uncorrelated orthogonal model, a three-factor correlated oblique model, and a second-order hierarchical model.

The second-order hierarchical model (wherein the 25 items load onto their three respective first-order factors—Somatic, Cognitive, Affective—which in turn load onto a single higher-order General Anxiety construct) and the three-factor correlated model demonstrated acceptable to excellent goodness-of-fit indices across populations:

• Comparative Fit Index (CFI): .91 to .94 (exceeding standard >.90 cutoffs for multidimensional psychological inventories).
• Tucker-Lewis Index (TLI): .90 to .93.
• Root Mean Square Error of Approximation (RMSEA): .048 to .058 (90% Confidence Interval: .041–.065), well beneath the conservative .06 threshold for adequate structural fit.
• Standardized Root Mean Square Residual (SRMR): .042 to .054.

Subsequent measurement invariance testing confirmed metric and scalar invariance across younger-old (ages 65–74) and older-old (ages 75+) strata, confirming that the GAS assesses the same latent constructs across varying points in the older adult lifespan.

Instrument / Measurement Tool

The Geriatric Anxiety Scale (GAS Version 1.0) is configured as a standardized self-report or clinician-administered questionnaire.

• Test Type: Multi-scale self-report screening inventory / clinician-administered psychometric scale.
• Administration Format: Paper-and-pencil, digital/computerized survey, or structured clinical interview format for visually impaired or motor-compromised older adults.
• Target Population: Older adults aged 65 years and older (normative data also include older individuals aged 55 to 64 transitioning into late life). Applicable across community, primary care, memory assessment clinics, outpatient psychiatry, and long-term care settings.
• Completion Time: Approximately 5 to 10 minutes for the complete 30-item scale; 2 to 3 minutes for the GAS-10 short form.
• Reading / Educational Level: Written at a 5th-grade reading level to ensure readability among older adults with limited formal education or mild sensory-cognitive decline.
• Total Item Count: 30 items total.
  • Items 1–25: Standard scored items evaluating Core Clinical Anxiety.
  • Items 26–30: Supplementary non-scored qualitative items evaluating contextual worries common to late life.
• Response Format: A 4-point Likert-type frequency scale reflecting symptom severity over the preceding week:
  • 0 = Not at all
  • 1 = Sometimes
  • 2 = Most of the time
  • 3 = All of the time
• Subscale Breakdown:
  • Somatic Subscale (9 items): Sum of Items 1, 2, 3, 8, 9, 17, 21, 22, 23 (Score range: 0–27).
  • Cognitive Subscale (8 items): Sum of Items 4, 5, 12, 16, 18, 19, 24, 25 (Score range: 0–24).
  • Affective Subscale (8 items): Sum of Items 6, 7, 10, 11, 13, 14, 15, 20 (Score range: 0–24).
  • Contextual / Life Circumstances Module (5 items): Items 26, 27, 28, 29, 30 are examined individually for clinical case conceptualization (not included in the core Total Score).
• Scoring and Interpretation Guidelines:
  • Total Score Calculation: Sum of Items 1 through 25 (Range: 0 to 75 points).
  • 0 – 15: Minimal or non-clinical anxiety.
  • 16 – 28: Mild anxiety symptomatology (warrants regular clinical monitoring; optimal initial screening cutoff for generalized anxiety in primary care).
  • 29 – 40: Moderate anxiety symptomatology (indicates probable clinical disorder; targeted diagnostic evaluation and therapeutic intervention recommended).
  • 41 – 75: Severe, debilitating anxiety symptomatology (indicates urgent comprehensive multidisciplinary psychiatric/psychological intervention).
• GAS-10 Abbreviated Version: Consists of Items 10, 15, 16, 17, 19, 20, 21, 22, 24, 25 (Score range: 0–30). Clinical cut-off score of ≥7 indicates high risk for an anxiety disorder in acute medical environments.

Permissions & Fee and Test Year

The Geriatric Anxiety Scale (GAS Version 1.0) was formally published in 2010 by Daniel L. Segal, Andy June, Matthew Payne, Frederick L. Coolidge, and Brian C. Yochim in the Journal of Anxiety Disorders. In contrast to proprietary, commercial diagnostic tools requiring expensive per-use scoring licensing, the GAS is an open-access psychometric instrument provided free of charge for non-commercial academic research and clinical practice purposes. Clinicians and researchers are permitted to utilize, administer, and reproduce the inventory without paying royalty fees, provided that appropriate academic attribution is maintained and items are reproduced without unauthorized changes. Commercial entities seeking to embed the scale within commercial digital assessment batteries or pharmaceutical clinical trials should seek explicit permissions from the primary copyright holder, Dr. Daniel L. Segal, at the Department of Psychology, University of Colorado Colorado Springs.

References

• Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897. https://doi.org/10.1037/0022-006X.56.6.893
• Carstensen, L. L., Isaacowitz, D. M., & Charles, S. T. (1999). Taking time seriously: A theory of socioemotional selectivity. American Psychologist, 54(3), 165–181. https://doi.org/10.1037/0003-066X.54.3.165
• Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100(3), 316–336. https://doi.org/10.1037/0021-843X.100.3.316
• Gould, C. E., Segal, D. L., Yochim, B. P., Pachana, N. A., Byrne, G. J., & Beaudreau, S. A. (2014). Measuring anxiety in late life: A psychometric comparison of the Geriatric Anxiety Inventory and the Geriatric Anxiety Scale. The Journal of Nervous and Mental Disease, 202(11), 809–814. https://doi.org/10.1097/NMD.0000000000000202
• Mueller, A. E. (2014). Psychometric properties of the Geriatric Anxiety Scale in community-dwelling, clinical, and medical samples of older adults (Doctoral dissertation, University of Colorado Colorado Springs). Kraemer Family Library. https://hdl.handle.net/10976/208842
• Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E., & Arnold, E. (2007). Development and validation of the Geriatric Anxiety Inventory. International Psychogeriatrics, 19(1), 103–114. https://doi.org/10.1017/S1041610206003504
• Segal, D. L., June, A., Payne, M., Coolidge, F. L., & Yochim, B. (2010). Development and initial validation of a self-report assessment tool for anxiety among older adults: The Geriatric Anxiety Scale. Journal of Anxiety Disorders, 24(7), 709–714. https://doi.org/10.1016/j.janxdis.2010.05.002
• Yochim, B. P., Mueller, A. E., June, A., & Segal, D. L. (2011). Psychometric properties of the Geriatric Anxiety Scale: Comparison to the Beck Anxiety Inventory and Geriatric Anxiety Inventory. The Gerontologist, 51(Suppl 2), 253–254. https://doi.org/10.1093/geront/gnr128
• Yochim, B. P., Mueller, A. E., & Segal, D. L. (2013). Late life anxiety is associated with decreased executive functioning in cognitively intact older adults. International Journal of Geriatric Psychiatry, 28(2), 190–196. https://doi.org/10.1002/gps.3808

13. Items of the Scale (Questionnaire)