From the Guidelines
The Geriatric Anxiety Inventory (GAI) and the Penn State Worry Questionnaire-Abbreviated (PSWQ-A) are recommended scoring systems for assessing anxiety in geriatric patients, as they are specifically designed for older adults and account for the unique presentation of anxiety in this population. The GAI features a simple yes/no format with 20 items that minimizes cognitive burden, making it an effective tool for assessing anxiety symptoms in older adults 1. The PSWQ-A is a widely used abbreviated version of the 16-item PSWQ that was developed as a screening tool to assess worry symptoms and anxiety in older adults, with a cut-off of 17 suggested for detection of significant anxiety in individuals with mild/moderate dementia 1. Other scoring systems, such as the Hospital Anxiety and Depression Scale (HADS) and the Generalized Anxiety Disorder-7 (GAD-7), may also be useful in assessing anxiety in geriatric patients, but the GAI and PSWQ-A are particularly well-suited for this population due to their simplicity and focus on worry symptoms. When implementing these tools, clinicians should consider the patient's cognitive status, literacy level, and cultural background, and regular reassessment using the same tool can help track treatment effectiveness 1. It is also important to note that the GAI and PSWQ-A are preferred over general anxiety measures because they account for the unique presentation of anxiety in older adults, including somatic complaints, worry about health or family, and the overlap between anxiety symptoms and physical health conditions. In contrast to other studies, such as those published in 2014 and 2015, which discuss various scoring systems for anxiety and depression, the most recent study from 2025 provides the most up-to-date and relevant information for assessing anxiety in geriatric patients 1.
From the Research
Scoring Systems for Anxiety in Geriatric Patients
The following scoring systems are recommended for assessing anxiety in geriatric patients:
- Geriatric Anxiety Inventory (GAI) 2: a 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people, with a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD)
- Geriatric Anxiety Inventory - Short Form (GAI-SF) 3: a 5-item version of the GAI, with a score of three or greater being optimal for the detection of DSM-IV GAD
- Geriatric Anxiety Scale (GAS) 4: a self-report measure of anxiety that was designed to address unique issues associated with anxiety assessment in older adults, with a ten-item short form (GAS-10) available
- Hamilton Rating Scale for Anxiety (HAM-A) 5: a scale used to assess anxiety symptoms, with a score of 18 or greater indicating significant anxiety
- Hospital Anxiety and Depression Scale (HADS) anxiety subscale 6: a scale used to assess anxiety symptoms, with a score of 8 or greater indicating significant anxiety
Characteristics of Scoring Systems
The characteristics of these scoring systems include:
- Internal consistency: the GAI 2 and GAI-SF 3 have high internal consistency, with Cronbach's alpha values of 0.91 and 0.81, respectively
- Convergent and divergent validity: the GAI 6 has good convergent and divergent validity, with correlations between the GAI and other anxiety scales
- Sensitivity to treatment: the GAI 6 has been shown to be sensitive to treatment, with significant changes in scores after treatment with duloxetine
- Cut-off scores: the GAI 2 has a cut-point of 10/11 for the detection of DSM-IV GAD, while the GAI-SF 3 has a score of three or greater being optimal for the detection of DSM-IV GAD