Aging Sexual Knowledge and Attitudes Scale

Aging Sexual Knowledge and Attitudes Scale‌

CHARLES B. WHITE,1 Trinity University

The Aging Sexual Knowledge and Attitudes Scale (ASKAS) is designed to measure two realms of sexuality:

knowledge about changes (and nonchanges) in sexual response to advanced age in males and females and (b) general attitudes about sexual activity in the aged. The items are largely specific to the elderly rather than a general sexual knowledge-attitudes scale. The ASKAS was developed for use in assessing the impact of group or individual interventions on behalf of sexual functioning in the aged utilizing, for example, a pretest-posttest procedure. Further, the measure may form the basis for group and individual discussion about sexual attitudes and/or sexual knowledge. The scale is also appropriate for use in educational programs for those working with the aged.

The actual numerical scores may be conveniently used for research purposes, but the individual items are also useful to assess the extent of an individual’s knowledge upon which to base clinical interventions, as well as identifying attitudinal obstacles to sexual intimacy in old age.

Description, Response Mode, and Timing

The ASKAS consists of 61 items, 35 true/false/don’t know in format and 26 items responded to on a 7-point Likert-type scale as to degree of agreement or disagreement with the particular item. The 35 true/false questions assess knowledge about sexual changes and nonchanges which are or are not age related. The 26 agree/disagree items assess attitudes toward sexual behavior in the aged. The items are counterbalanced. The instrument takes 20–40 minutes to complete.

Scoring

The ASKAS may be given in an interview of paper-and- pencil format and may be group administered or individu- ally administered. The nature of the scoring and items are readily adaptable to computer scoring systems.

Scoring is such that a low knowledge score indicates high knowledge and a low attitude score indicates a more per- missive attitude. The rationale for the low knowledge score reflecting high knowledge is that don’t know was given a value of 3, indicating low knowledge. In the Knowledge section, Questions 1 through 35, the following scoring applies: true = 1, false = 2, and don’t know = 3. Items 1, 10,

14, 17, 20, 30, and 31 are reversed scored. In the Exhibit, the correct answers are in parentheses for Items 1 through

35. The attitude questions, 36 through 61, are each scored according to the value selected by the respondent with the

exception of Items 44, 47, 48, 50–56, and 59 in which the scoring is reversed.

Reliability

The reliability of the ASKAS has been examined in several different studies, and in varying ways, summarized in Table 1. As can be seen, reliabilities are very positive and at acceptable levels.

Validity

Presented in Table 2 are the means and standard deviations of ASKAS scores from several studies. These means are not meant to be viewed as normative, but rather illustrative of group variation in ASKAS performance.

The validity of the ASKAS has been examined in a sexual education program for older persons, by individuals working with older persons, and by adult family members of aged persons in which each group received the psychological-educational intervention separately (White & Catania, 1981). Each experimental group had a comparable

TABLE 1

Aging Sexual Knowledge and Attitudes Scale (ASKAS) Reliabilities

Type of reliability

Reliability coefficient

Sample size

Type of sample

Knowledge

Split-halfa

.91

163

Nursing home staff

Split-halfa

.90

279

Nursing home residents

Alpha

.93

163

Nursing home staff

Alpha

.91

279

Nursing home residents

Alpha

.92

30

Community older adults

Alpha

.90

30

Nursing home staff

Alpha

.90

30

Families of older adults

Test-retest

.97

15

Community older adults

Test-retest

.90

30

Staff of nursing home and

families of the older

adults

Attitudes

Split-halfa

.86

163

Nursing home staff

Split-halfa

.83

279

Nursing home residents

Alpha

.85

163

Nursing home staff

Alpha

.76

279

Nursing home residents

Alpha

.87

30

Community older adults

Alpha

.87

30

Nursing home staff

Alpha

.86

30

Families of older adults

Test-retest

.96

15

Community older adults

Test-retest

.72

30

Staff of nursing home and

families of the aged

a These correlations have been corrected for test length.

1Address correspondence to Charles B. White, Trinity University, 1 Stadium Drive, San Antonio, TX 78212; e-mail: [email protected]

TABLE 2‌

Aging Sexual Knowledge and Attitudes Scale (ASKAS) Score Means and Standard Deviations Score by Group

Group

n

Mean

SD

Nursing home residentsa

273

Attitudes

84.56

23.32

Knowledge

65.62

15.09

Community older adults b

30

Attitudes

86.40

17.28

Knowledge

73.73

12.52

Families of older adults b

30

Attitudes

75.00

22.66

Knowledge

78.00

13.61

Persons who work with older adults b

30

Attitudes

76.00

17.60

Knowledge

62.46

12.50

Nursing home staff b

163

Attitudes

61.08

25.79

Knowledge

64.19

17.25

Note. The possible range of ASKAS scores are as follows: Knowledge = 35–105; Attitudes = 26–182. All scores reported here are the pretest scores in cases where both pretests and posttests were administered.

aWhite, 1981.

bWhite and Catania, 1981.

nonintervention control group. In all cases, the educational intervention resulted in significant increases in knowledge and significant changes in the direction of a more permis- sive attitude, both relative to their own pretest scores and relative to the appropriate control group, whereas the con- trol group posttest scores were not significantly changed relative to their pretest scores. There was a 4–6 week period between pre- and posttests.

Hammond (1979) utilized the ASKAS in a sexual educa- tion program for professionals working with the aged. She reported significant changes from pre- to posttest toward

Exhibit

increased knowledge and more permissive attitudes in the interception group, as in the White and Catania (1981) research, whereas the control group scores were unchanged from pre- to posttest.

White (1982a), in a study of nursing home residents in 15 nursing homes, reported that both ASKAS attitude and knowledge scores were associated with whether an indi- vidual was sexually active or not such that more activity was associated with greater knowledge and with more per- missive attitudes.

A factor analysis of the ASKAS results (White, 1982b) from the studies in Table 2 resulted in a two-factor solution, with each item loading most heavily on its hypothesized membership in either the attitude or knowledge section of the measure.

Other Information

The ASKAS may be utilized without permission. It is only requested that all findings be shared with the test author.

 

Aging Sexual Knowledge and Attitudes Scale

Knowledge Questions (Correct answer shown in parentheses.)

*1. Sexual activity in aged persons is often dangerous to their health. (F)

True False Don’t knowa

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)

1 1 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)

13Sexual 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 hus- band 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 responsive- ness. (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)

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.

For Items 42, 43, and 44:

If a relative of mine, living in a nursing home, was to have a sexual relationship with another resident I would:

42 Complain to the management.

43 Move my relative from this institution.

+44. 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.

57Institutions, 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.


a These options are 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).

+Reverse scoring on these items. A low score indicates a permissive attitude.


References

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 knowl- edge regarding sexuality in the aged. Archives of Sexual Behavior, 11, 491–502.

White, C. B., & Catania, J. (1981). Sexual education for aged people, peo- ple who work with the aged, and families of aged people. International Journal of Aging and Human Development, 15, 121–138.