How to Score a Geriatric Anxiety Scale: Understanding the Geriatric Anxiety Inventory (GAI) and Geriatric Anxiety Scale (GAS)

According to the Anxiety & Depression Association of America, anxiety disorders affect as many as 10–20% of older adults, yet they are often under-diagnosed. A critical step in addressing this issue is understanding how to score a geriatric anxiety scale accurately, which can help professionals and caregivers properly assess and monitor anxiety symptoms in this population.

Quick Summary

This guide provides comprehensive instructions on scoring the most widely used geriatric anxiety scales, the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS). It details the scoring methodology, cutoff points for severity levels, and clinical considerations for interpreting results.

Key Points

• Differentiate between GAI and GAS: The Geriatric Anxiety Inventory (GAI) is a 20-item scale with a simple yes/no response, while the Geriatric Anxiety Scale (GAS) is a 30-item scale using a 4-point frequency scale for 25 scorable items.

• Score the GAI by summation: For the GAI, sum all 'yes' or 'agree' responses. The total score ranges from 0–20, with higher scores indicating more severe anxiety.

• Interpret GAI with cutoffs: A GAI score of 9 or higher often suggests a possible anxiety disorder, with a score of 11 or higher potentially indicating Generalized Anxiety Disorder (GAD).

• Score the GAS with a Likert scale: For the GAS, sum the ratings (0-3) for the first 25 items. The total score ranges from 0–75 and is divided into severity categories.

• Use GAS score ranges for severity: A GAS score of 0–25 suggests minimal anxiety, 26–50 indicates moderate anxiety, and 51–75 points to high or severe anxiety.

• Integrate unscored GAS items: The final five items on the GAS are not part of the total score but provide crucial clinical context on age-specific worries like finances and health.

• Combine scores with clinical judgment: Standardized scores should always be interpreted in the context of a patient’s overall medical and psychological history, as some medical conditions can mimic anxiety.

Accurately scoring a geriatric anxiety scale requires careful attention to the specific version of the tool being used, as there are distinct differences between the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS). Both are valuable tools for measuring anxiety in older adults, but their scoring procedures and interpretation differ. A solid understanding of these methods ensures a reliable assessment for identifying, monitoring, and managing anxiety in the elderly.

Scoring the Geriatric Anxiety Inventory (GAI)

The Geriatric Anxiety Inventory (GAI) is a 20-item self-report scale designed for older adults, including those with mild cognitive impairment. It is characterized by its simple dichotomous (agree/disagree) response format.

Scoring methodology

To score the GAI, simply sum the responses where the individual's answer indicates an anxiety symptom. The scoring process is as follows:

1. Response format: Each of the 20 items is answered with a "True" or "False" (or "Agree" / "Disagree") response.
2. Assigning points: For each item, assign one point (1) for an answer that aligns with an anxiety symptom and zero points (0) for an answer that does not.
3. Calculate the total score: Sum all the points to get a final score. The total score will range from 0 to 20, with higher scores reflecting greater anxiety symptoms.

Interpreting GAI scores

Clinicians use specific cutoff points to interpret the severity of anxiety, although these can vary slightly across studies.

• Score of 8 or 9 and above: This is often used as a cut-point for identifying any anxiety disorder.
• Score of 10 or 11 and above: Some studies use this as a cutoff for identifying probable cases of generalized anxiety disorder (GAD).
• Clinical context: Interpretation should always incorporate clinical judgment, as cutoffs are merely a guide.

Scoring the Geriatric Anxiety Scale (GAS)

The Geriatric Anxiety Scale (GAS) is a 30-item questionnaire that is also widely used, with 25 items contributing to the total score. Unlike the GAI's binary format, the GAS uses a Likert scale, allowing for a more nuanced measure of symptom frequency.

Scoring methodology

Scoring the GAS involves calculating a total score from the first 25 items only.

1. Response format: Each item is rated on a four-point Likert scale, indicating how often the symptom was experienced in the past week:
   • 0 = Not at all
   • 1 = Several days
   • 2 = More than half the days
   • 3 = All of the time
2. Calculate the total score: Add the scores for the first 25 items to calculate the total score. The total score will range from 0 to 75.
3. Clinical consideration for extra items: Items 26–30 are not included in the total score but provide valuable clinical insights into specific areas of worry common in older adults, such as health and finances.

Interpreting GAS scores

The total score for the GAS is used to classify the severity of anxiety:

• Low or minimal anxiety: A total score between 0 and 25.
• Moderate anxiety: A total score between 26 and 50.
• High or severe anxiety: A total score between 51 and 75.

Comparison of the GAI and GAS scoring methods

Feature	Geriatric Anxiety Inventory (GAI)	Geriatric Anxiety Scale (GAS)
Number of items scored	20 items	25 items (from a 30-item scale)
Response format	Dichotomous (Agree/Disagree or True/False)	4-point Likert scale (0-3 for frequency)
Total score range	0 to 20	0 to 75
Scoring process	Sum of all "True" or "Agree" responses.	Sum of Likert scale ratings for the first 25 items.
Interpretation of scores	Uses specific cutoffs for potential anxiety disorders, such as a score of 9+ for any anxiety disorder.	Uses score ranges to classify severity: minimal (0-25), moderate (26-50), and severe (51-75).
Target population	Designed for older adults, including those with mild cognitive impairment due to simple response format.	Widely validated across community, psychiatric, and medical older adult samples.

Clinical considerations for interpreting scores

While scoring a geriatric anxiety scale provides a quantitative measure, interpreting the result requires clinical context. Healthcare professionals must consider several factors alongside the score:

• Presence of medical conditions: Many physical illnesses common in older adults can mimic anxiety symptoms, making careful diagnosis essential.
• Overlap with depression: Both the GAI and GAS show some overlap with depression measures, highlighting the need to assess for both conditions.
• Cognitive impairment: The GAI is particularly well-suited for individuals with mild cognitive impairment due to its simple format.
• Qualitative information: The five unscored items on the GAS can offer additional insight into specific patient worries, such as financial or health concerns.
• Serial administration: Monitoring scores over time can help track a patient's response to treatment and adjust care plans.

Conclusion

To score a geriatric anxiety scale, it is essential to first identify the correct tool, whether it's the GAI or the GAS. For the GAI, one must sum the 20 dichotomous items for a total score up to 20, using cutoffs for clinical significance. For the GAS, the total score from 25 of its 30 items is summed to a total of 75, which is then mapped to minimal, moderate, or severe anxiety categories. Regardless of the scale, combining the numerical score with professional clinical judgment provides the most complete and effective assessment for managing anxiety in older adults.

Frequently Asked Questions

What is the difference between the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS)?

The main difference lies in their format and scoring. The GAI is a 20-item tool using a simple dichotomous (yes/no) response, with a maximum score of 20. The GAS is a 30-item tool that uses a more detailed 4-point Likert scale for its 25 scorable items, resulting in a maximum total score of 75.

How do you score the 20-item Geriatric Anxiety Inventory (GAI)?

To score the GAI, you simply add up the total number of "True" or "Agree" responses. Each response indicative of anxiety counts as one point, and the total score can range from 0 to 20.

What is the interpretation of the different score ranges for the Geriatric Anxiety Scale (GAS)?

For the GAS, a total score from 0–25 suggests low or minimal anxiety. A score from 26–50 indicates moderate anxiety, while a score of 51–75 suggests high or severe anxiety.

What is a clinically significant score on the GAI?

While cutoffs may vary, a GAI score of 9 or higher is often considered clinically significant for detecting any anxiety disorder. A score of 10 or 11 and above may suggest a diagnosis of Generalized Anxiety Disorder (GAD).

What are the five extra items on the Geriatric Anxiety Scale (GAS) for?

The final five items on the 30-item GAS are not used to calculate the total score. Instead, they provide extra clinical insight into common anxieties among older adults, such as worries about finances, health, or becoming a burden to family.

Can the Geriatric Anxiety Scale be used for all older adults, including those with cognitive impairment?

The GAI, with its simple yes/no response format, is often more suitable for older adults with mild cognitive impairment because it reduces the cognitive load required to answer. The GAS, with its 4-point scale, may be more challenging for some cognitively impaired individuals.

What should a clinician do after scoring a geriatric anxiety scale?

The score should be used as a guide and interpreted alongside a comprehensive clinical evaluation. The clinician should consider the patient's full medical history and current life circumstances, as well as administer other relevant mental health screeners, to confirm a diagnosis and develop a personalized treatment plan.