Aging Sexual Knowledge and Attitudes Scale

Abstract

The Aging Sexual Knowledge and Attitudes Scale (ASKAS) is a specialized psychometric instrument designed by Charles B. White to comprehensively measure two distinct realms of sexuality specific to the elderly population. These realms include 1) knowledge concerning age-related physiological and psychological changes (and non-changes) in sexual response in both males and females, and 2) general attitudes regarding sexual activity among the aged. Unlike general sexual scales, the ASKAS focuses specifically on the challenges and realities of older age (typically 65+).

The ASKAS is primarily intended for clinical and educational applications, such as assessing the effectiveness of group or individual interventions aimed at improving sexual functioning in the aged, often utilizing a pretest-posttest design. Furthermore, the measure serves as an effective foundation for facilitating discussion concerning sexual knowledge and identifying attitudinal barriers to sexual intimacy in later life.

Keywords

Aging, Gerontology, Sexual Knowledge, Sexual Attitudes, ASKAS, Elderly Sexuality, Intervention Assessment, Psychometric Scale

Authors

Charles B. White, Trinity University

Purpose

The primary purpose of the ASKAS is twofold: to provide a standardized, psychometrically sound measure of specific knowledge and attitudes regarding sexuality in older adults, and to assess the impact of educational or therapeutic interventions. The scale is particularly valuable for measuring pre- and post-intervention changes in knowledge acquisition and shifts toward more permissive attitudes among various groups, including older adults themselves, their family members, and professional staff who work with the aged.

The scale’s scores can be used for rigorous research studies, but the individual items also serve a practical clinical function by allowing practitioners to gauge an individual’s specific knowledge gaps and identify attitudinal obstacles that may impede healthy sexual activity or intimacy in old age.

Construct

The ASKAS measures the construct of sexual orientation specific to the geriatric population, which is conceptualized as comprising two distinct factors: Knowledge and Attitude.

• Knowledge: This factor assesses factual understanding of physiological and psychological changes related to advanced age (65+) in sexual response for both men and women. This includes understanding the slowing of response time, changes in erectile function, vaginal lubrication, and common myths (e.g., risk of heart attack, inability to perform).
• Attitude: This factor measures general disposition, acceptance, or resistance toward sexual behavior and expression among the elderly, particularly within institutional settings like nursing homes. A low attitude score indicates a more permissive and accepting stance toward sexuality in the aged.

Validity

The validity of the ASKAS has been demonstrated primarily through its responsiveness to educational interventions. Studies have consistently shown that experimental groups receiving psychological-educational interventions (e.g., sexual education programs) exhibited significant post-test increases in knowledge and significant shifts toward more permissive attitudes, relative to both their own pre-test scores and non-intervention control groups (White & Catania, 1981; Hammond, 1979).

Furthermore, research involving nursing home residents established criterion validity by demonstrating that both attitude and knowledge scores were associated with actual sexual activity: greater sexual activity was linked to higher knowledge (lower score) and more permissive attitudes (lower score) (White, 1982a). Illustrative means and standard deviations from various studies are presented below, though they are not intended as normative data but rather as indicators of group variation in ASKAS performance.

Table 2: Aging Sexual Knowledge and Attitudes Scale (ASKAS) Score Means and Standard Deviations Score by Group (Pretest Scores)

The possible range of ASKAS scores are: Knowledge = 35–105; Attitudes = 26–182. Lower scores indicate higher knowledge and more permissive attitudes.

Reliability

Multiple studies have assessed the reliability of the ASKAS across diverse samples, yielding consistently positive and acceptable coefficients. Both internal consistency and temporal stability have been established for both the Knowledge and Attitude subscales.

Internal consistency, measured by Cronbach’s Alpha and Split-Half correlations (corrected for test length), ranged from 0.76 to 0.93 across samples including nursing home staff, residents, community older adults, and families of older adults. Test-retest reliability was also strong, with coefficients ranging from 0.72 to 0.97 over a 4–6 week period.

Table 1: Aging Sexual Knowledge and Attitudes Scale (ASKAS) Reliabilities

*These correlations have been corrected for test length.

Factor Analysis

A factor analysis of the ASKAS results, derived from the various samples presented in Table 2, confirmed the hypothesized structure of the scale (White, 1982b). The analysis resulted in a clear two-factor solution.

Crucially, each individual item loaded most heavily on its intended factor, confirming its hypothesized membership in either the Attitude section or the Knowledge section of the measure. This empirical evidence supports the conceptual division of the ASKAS into two primary, distinct components.

Instrument

Test Type: Psychological Scale; Self-Report/Interview Assessment

Format: The instrument consists of 61 items divided into two distinct sections:

• 35 items assessing Knowledge using a True/False/Don’t Know format.
• 26 items assessing Attitudes using a 7-point Likert-type scale (ranging from disagreement to agreement).

The items are counterbalanced, and the administration takes approximately 20–40 minutes to complete. It can be administered individually or in a group setting, via paper-and-pencil or interview format.

Language Available: English (Original)

Population Group: Older adults (aged 65+), nursing home staff, families of older adults, and professionals working in gerontology/elder care.

Age Group: 65+ (Target population and related professional groups)

Population Details: The scale has been validated across diverse older adult groups, including institutionalized nursing home residents and community-dwelling older adults, as well as staff and family members involved in their care.

Test Methodology: The scoring system is tailored such that lower scores indicate desirable outcomes (high knowledge or permissive attitudes). For the Knowledge section (Q1–35), scoring is True=1, False=2, Don’t Know=3, with specific items (1, 10, 14, 17, 20, 30, 31) reverse scored. For the Attitude section (Q36–61), a 7-point Likert scale is used, with specific items (44, 47, 48, 50–56, 59) reverse scored to ensure a low score reflects a permissive attitude.

Keywords

Geriatrics, Sexual Health, Attitude Measurement, Knowledge Assessment, Psychometrics, Nursing Home Care, Charles B. White

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: [email protected]

Correspondence Address: Charles B. White, Trinity University, 1 Stadium Drive, San Antonio, TX 78212

Permissions & Fee and Test Year

The ASKAS may be utilized by researchers and practitioners without requiring formal permission from the author. However, users are requested to share all findings derived from the scale with the test author.

The scale was developed and validated in studies published in the early 1980s (e.g., White & Catania, 1981; White, 1982a, 1982b).

Reference’s

• Hammond, D. (1979). An exploratory study of a workshop on sex and aging. Unpublished doctoral dissertation, University of Georgia, Athens, GA.
• White, C. B. (1982a). Interest, attitudes, knowledge, and sexual history in relation to sexual behavior in the institutionalized aged. Archives of Sexual Behavior, 11, 11–21.
• White, C. B. (1982b). A scale for the assessment of attitudes and knowledge regarding sexuality in the aged. Archives of Sexual Behavior, 11, 491–502.
• White, C. B., & Catania, J. (1981). Sexual education for aged people, people who work with the aged, and families of aged people. International Journal of Aging and Human Development, 15, 121–138.

Items of the Aging Sexual Knowledge and Attitudes Scale

Knowledge Questions (Correct answer shown in parentheses. True False Don’t know options repeated for Items 2–35. *Indicates that the scoring should be reversed such that 2 = 1, and 1 = 2 (i.e., a low score indicates high knowledge).)

1. *Sexual activity in aged persons is often dangerous to their health. (F)
2. Males over the age of 65 typically take longer to attain an erection of their penis than do younger males. (T)
3. Males over the age of 65 usually experience a reduction in intensity of orgasm relative to younger males. (T)
4. The firmness of erection in aged males is often less than that of younger persons. (T)
5. The older female (65+ years of age) has reduced vaginal lubrication secretion relative to younger females. (T)
6. The aged female takes longer to achieve adequate vaginal lubrication relative to younger females. (T)
7. The older female may experience painful intercourse due to reduced elasticity of the vagina and reduced vaginal lubrication. (T)
8. Sexuality is typically a life-long need. (T)
9. Sexual behavior in older people (65+) increases the risk of heart attack. (F)
10. *Most males over the age of 65 are unable to engage in sexual intercourse. (F)
11. The relatively most sexually active younger people tend to become the relatively most sexually active older people. (T)
12. There is evidence that sexual activity in older persons has beneficial physical effects on the participants. (T)
13. Sexual activity may be psychologically beneficial to older person participants. (T)
14. *Most older females are sexually unresponsive. (F)
15. The sex urge typically increases with age in males over 65. (F)
16. Prescription drugs may alter a person’s sex drive. (T)
17. *Females, after menopause, have a physiologically induced need for sexual activity. (F)
18. Basically, changes with advanced age (65+) in sexuality involve a slowing of response time rather than a reduction of interest in sex. (T)
19. Older males typically experience a reduced need to ejaculate and hence may maintain an erection of the penis for a longer time than younger males. (T)
20. *Older males and females cannot act as sex partners as both need younger partners for stimulation. (F)
21. The most common determinant of the frequency of sexual activity in older couples is the interest or lack of interest of the husband in a sexual relationship with his wife. (T)
22. Barbiturates, tranquilizers, and alcohol may lower the sexual arousal levels of aged persons and interfere with sexual responsiveness. (T)
23. Sexual disinterest in aged persons may be a reflection of a psychological state of depression. (T)
24. There is a decrease in frequency of sexual activity with older age in males. (T)
25. There is a greater decrease in male sexuality with age than there is in female sexuality. (T)
26. Heavy consumption of cigarettes may diminish sexual desire. (T)
27. An important factor in the maintenance of sexual responsiveness in the aging male is the consistency of sexual activity throughout his life. (T)
28. Fear of the inability to perform sexually may bring about an inability to perform sexually in older males. (T)
29. The ending of sexual activity in old age is most likely and primarily due to social and psychological causes rather than biological and physical causes. (T)
30. *Excessive masturbation may bring about an early onset of mental confusion and dementia in the aged. (F)
31. *There is an inevitable loss of sexual satisfaction in post-menopausal women. (F)
32. Secondary impotence (or non-physiologically caused) increases in males over the age of 60 relative to young males. (T)
33. Impotence in aged males may literally be effectively treated and cured in many instances. (T)
34. In the absence of severe physical disability, males and females may maintain sexual interest and activity well into their 80s and 90s. (T)
35. Masturbation in older males and females has beneficial effects on the maintenance of sexual responsiveness. (T)

Attitude Questions (7-point Likert-type scale, where disagree = 1, agree = 7. +Reverse scoring on these items. A low score indicates a permissive attitude.)

36. Aged people have little interest in sexuality. (Aged = 65+ years of age.)
37. An aged person who shows sexual interest brings disgrace to himself/herself.
38. Institutions, such as nursing homes, ought not to encourage or support sexual activity of any sort in its residents.
39. Male and female residents of nursing homes ought to live on separate floors or separate wings of the nursing home.
40. Nursing homes have no obligation to provide adequate privacy for residents who desire to be alone, either by themselves or as a couple.
41. As one becomes older (say past 65) interest in sexuality inevitably disappears.
42. If a relative of mine, living in a nursing home, was to have a sexual relationship with another resident I would: Complain to the management.
43. If a relative of mine, living in a nursing home, was to have a sexual relationship with another resident I would: Move my relative from this institution.
44. +If a relative of mine, living in a nursing home, was to have a sexual relationship with another resident I would: Stay out of it as it is not my concern.
45. If I knew that a particular nursing home permitted and supported sexual activity in residents who desired such, I would not place a relative in that nursing home.
46. It is immoral for older persons to engage in recreational sex.
47. +I would like to know more about the changes in sexual functioning in older years.
48. +I feel I know all I need to know about sexuality in the aged.
49. I would complain to the management if I knew of sexual activity between any residents of a nursing home.
50. +I would support sex education courses for aged residents of nursing homes.
51. +I would support sex education courses for the staff of nursing homes.
52. +Masturbation is an acceptable sexual activity for older males.
53. +Masturbation is an acceptable sexual activity for older females.
54. +Institutions, such as the nursing home, ought to provide large enough beds for couples who desire such to sleep together.
55. +Staff of nursing homes ought to be trained or educated with regard to sexuality in the aged and/or disabled.
56. Residents of nursing homes ought not to engage in sexual activity of any sort.
57. Institutions, such as nursing homes, should provide opportunities for the social interaction of men and women.
58. Masturbation is harmful and ought to be avoided.‌
59. +Institutions, such as nursing homes, should provide privacy such as to allow residents to engage in sexual behavior without fear of intrusion of observation.‌
60. If family members object to a widowed relative engaging in sexual relations with another resident of a nursing home, it is the obligation of the management and staff to make certain that such sexual activity is prevented.
61. Sexual relations outside the context of marriage are always wrong.