Quality of Life Research

, Volume 24, Issue 11, pp 2795–2805 | Cite as

Psychometric properties and feasibility of the Swedish version of the Philadelphia Geriatric Center Morale Scale

  • Johan Niklasson
  • Mia Conradsson
  • Carl Hörnsten
  • Fredrica Nyqvist
  • Mojgan Padyab
  • Björn Nygren
  • Birgitta Olofsson
  • Hugo Lövheim
  • Yngve Gustafson



Morale is related to psychological well-being and quality of life in older people. The Philadelphia Geriatric Center Morale Scale (PGCMS) is widely used to assess morale. The purpose of this study was to evaluate the psychometric properties and feasibility of the Swedish version of the 17-item PGCMS among very old people.


The Umeå 85+/GERDA study included Swedish-speaking people aged 85, 90 and 95 years and older, from Sweden and Finland. Participants were interviewed in their own homes using a predefined set of questions. In the main sample, 493 individuals answered all 17 PGCMS items (aged 89.0 ± 4.3 years). Another 105 answered between 1 and 16 questions (aged 89.6 ± 4.4 years). A convenience sample was also collected, and 54 individuals answered all 17 PGCMS items twice (aged 84.7 ± 6.7 years). The same assessor restated the questions within 1 week.


Cronbach’s alpha was 0.74 among those who answered all 17 questions in the main sample. Confirmatory factor analysis was used to test the construct validity of the most widely used version of the PGCMS, with 17 items and three factors, and showed a generally good fit. Among those answering between 1 and 17 PGCMS questions, 92.6 % (554/598) answered 16 or 17. The convenience sample was used for intra-rater test–retesting, and the intraclass correlation coefficient (ICC) was 0.89. The least significant change between two assessments, with 95 % confidence interval, was 3.53 PGCMS points.


The Swedish version of the PGCMS seems to have satisfactory psychometric properties and feasibility among very old people.


Psychometrics Morale Quality of life Feasibility studies Aged, 80 and over Psychological well-being 



This work was supported by funds from the Interreg IIIA Kvarken-MittSkandia Program (2005–2007) and the Bothnia-Atlantica Program, both funded by the European Union and the European Regional Development Fund. This work was also supported by the Umeå University Foundation for Medical Research, King Gustav V’s and Queen Viktoria’s Foundation of Freemasons, Västerbotten County Council, the Strategic Research Program in Care Sciences, Norrbotten County Council, Sweden, Joint Committee of County Councils in Northern Sweden “Visare Norr,” the Swedish Research Council for Health, Working Life and Welfare (Grant Number 2013–1512) and the Swedish Research Council (Grant Number K2014-99X-22610-01-6). Special thanks to Professor Stig Karlsson for assessing some of the participants in the convenience sample. Also thanks to all participants and medical staff who took an active part in this study.

Conflict of interest

There are no conflicts of interest.


  1. 1.
    Mannell, R. C., & Dupuis, S. (1996). Life satisfaction. In J. E. Birren (Ed.), Encyclopedia of Gerontology. Age, aging and the aged (Vol. 2). San Diego: Academic Press, Inc.Google Scholar
  2. 2.
    McDowell, I. (2006). Measuring health—a guide to rating scales and questionnaires. New York: Oxford University Press, Inc.CrossRefGoogle Scholar
  3. 3.
    Royal College of Physicians of London, B. G. S. (1992). Standardized assessment scales for elderly people. A report of joint workshops in the Research Unit of the Royal College of Physicians of London and the British Geriatrics Society. London: The Royal College of Physicians of London and the British Geriatrics Society.Google Scholar
  4. 4.
    Lawton, M. (1972). The dimensions of morale. In D. Kent, R. Kastenbaum & S. Sherwood (Eds.), Research planning and action for the elderly: The power and potential of social science. New York: Behavioral Publications.Google Scholar
  5. 5.
    Stock, W. A., Okun, M. A., & Gomez Benito, J. (1994). Subjective well-being measures: reliability and validity among Spanish elders. International Journal of Aging and Human Development, 38(3), 221–235.CrossRefPubMedGoogle Scholar
  6. 6.
    Wong, E., Woo, J., Hui, E., & Ho, S. C. (2004). Examination of the Philadelphia Geriatric Morale Scale as a subjective quality-of-life measure in elderly Hong Kong Chinese. Gerontologist, 44(3), 408–417.CrossRefPubMedGoogle Scholar
  7. 7.
    Pinar, R., & Oz, H. (2011). Validity and reliability of the Philadelphia Geriatric Center Morale Scale among Turkish elderly people. Quality of Life Research, 20(1), 9–18. doi: 10.1007/s11136-010-9723-4.CrossRefPubMedGoogle Scholar
  8. 8.
    Lawton, M. P. (1975). The Philadelphia Geriatric Center Morale Scale: A revision. Journal of Gerontology, 30(1), 85–89.CrossRefPubMedGoogle Scholar
  9. 9.
    Morris, J. N., & Sherwood, S. (1975). A retesting and modification of the Philadelphia Geriatric Center Morale Scale. Journal of Gerontology, 30(1), 77–84.CrossRefPubMedGoogle Scholar
  10. 10.
    Liang, J., & Bollen, K. A. (1983). The structure of the Philadelphia Geriatric Center Morale scale: A reinterpretation. Journal of Gerontology, 38(2), 181–189.CrossRefPubMedGoogle Scholar
  11. 11.
    Liang, J., & Bollen, K. A. (1985). Sex differences in the structure of the Philadelphia Geriatric Center Morale Scale. Journal of Gerontology, 40(4), 468–477.CrossRefPubMedGoogle Scholar
  12. 12.
    Liang, J., Lawrence, R. H., & Bollen, K. A. (1986). Age differences in the structure of the Philadelphia Geriatric Center Morale Scale. Psychology and Aging, 1(1), 27–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Ma, L., Green, K. E., & Cox, E. O. (2010). Stability of the Philadelphia Geriatric Center Morale Scale: A multidimensional item response Model and Rasch analysis. Journal of Applied Gerontology, 29(4), 475–493. doi: 10.1177/0733464809339623.CrossRefGoogle Scholar
  14. 14.
    Kozma, A., & Stones, M. J. (1987). Social desirability in measures of subjective well-being: A systematic evaluation. Journal of Gerontology, 42(1), 56–59.CrossRefPubMedGoogle Scholar
  15. 15.
    Conradsson, M., Rosendahl, E., Littbrand, H., Gustafson, Y., Olofsson, B., & Lövheim, H. (2013). Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging Ment Health, 17(5), 638–645. doi: 10.1080/13607863.2012.758231.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Ryden, M. B., & Knopman, D. (1989). Assess not assume—measuring the morale of cognitively impaired elderly. J Gerontol Nurs, 15(11), 27–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Conradsson, M., Littbrand, H., Boström, G., Lindelöf, N., Gustafson, Y., & Rosendahl, E. (2013). Is a change in functional capacity or dependency in activities of daily living associated with a change in mental health among older people living in residential care facilities? Clinical Interventions in Aging, 8, 1561–1568. doi: 10.2147/CIA.S53270.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Conradsson, M., Littbrand, H., Lindelöf, N., Gustafson, Y., & Rosendahl, E. (2010). Effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people living in residential care facilities: A cluster-randomized controlled trial. Aging Ment Health, 14(5), 565–576. doi: 10.1080/13607860903483078.CrossRefPubMedGoogle Scholar
  19. 19.
    Lawton, M. P. (2003). Lawton’s PGC Morale Scale. Accessed 1 Feb 2015.
  20. 20.
    Sheikh, J., & Yesavage, J. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clin Gerontol, 5, 165–172.CrossRefGoogle Scholar
  21. 21.
    D’Ath, P., Katona, P., Mullan, E., Evans, S., & Katona, C. (1994). Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Family Practice, 11(3), 260–266.CrossRefPubMedGoogle Scholar
  22. 22.
    de Craen, A. J., Heeren, T. J., & Gussekloo, J. (2003). Accuracy of the 15-item geriatric depression scale (GDS-15) in a community sample of the oldest old. International Journal of Geriatric Psychiatry, 18(1), 63–66. doi: 10.1002/gps.773.CrossRefPubMedGoogle Scholar
  23. 23.
    Pomeroy, I. M., Clark, C. R., & Philp, I. (2001). The effectiveness of very short scales for depression screening in elderly medical patients. International Journal of Geriatric Psychiatry, 16(3), 321–326.CrossRefPubMedGoogle Scholar
  24. 24.
    Goring, H., Baldwin, R., Marriott, A., Pratt, H., & Roberts, C. (2004). Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients. International Journal of Geriatric Psychiatry, 19(5), 465–471. doi: 10.1002/gps.1115.CrossRefPubMedGoogle Scholar
  25. 25.
    Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198.CrossRefPubMedGoogle Scholar
  26. 26.
    Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40(9), 922–935.CrossRefPubMedGoogle Scholar
  27. 27.
    Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65.PubMedGoogle Scholar
  28. 28.
    Challis, D., & Knapp, M. (1980). An examination for the PGC Morale Scale in an English context. University of Kent: PSSRU.Google Scholar
  29. 29.
    Löfgren, B., Gustafson, Y., & Nyberg, L. (1999). Psychological well-being 3 years after severe stroke. Stroke, 30(3), 567–572.CrossRefPubMedGoogle Scholar
  30. 30.
    Guillemin, F., Bombardier, C., & Beaton, D. (1993). Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. Journal of Clinical Epidemiology, 46(12), 1417–1432.CrossRefPubMedGoogle Scholar
  31. 31.
    Bland, J. M., & Altman, D. G. (1997). Statistics notes: Cronbach’s alpha. BMJ, 314(7080), 572.PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Streiner, D. L., & Norman, G. R. (2008). Helath measurement scales: A practical guide to their development and use. Oxford: Oxford University Press.CrossRefGoogle Scholar
  33. 33.
    Bland, M. (2000). An introduction to medical statistics (3rd ed.). Oxford: Oxford University Press.Google Scholar
  34. 34.
    Bland, J. M., & Altman, D. G. (1996). Measurement error. BMJ, 313(7059), 744.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174.CrossRefPubMedGoogle Scholar
  36. 36.
    Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8(2), 23–74.Google Scholar
  37. 37.
    Schweizer, K. (2010). Some guidelines concerning the modeling of traits and abilities in test construction. [editorial]. European Journal of Psychological Assessment, 26(1), 1–2. doi: 10.1027/1015-5759/a00001.CrossRefGoogle Scholar
  38. 38.
    Byrne, B. M. (2009). Structural equation modeling with AMOS: Basic concepts, applications, and programming (2nd ed.). Ottawa, Ontario: Taylor and Francis.Google Scholar
  39. 39.
    Blunch, N. J. (2013). Introduction to structural equation modelling using SPSS and AMOS (2nd ed.). Cornwall: Sage.Google Scholar
  40. 40.
    Raykov, T. (2000). On the large-sample bias, variance, and mean squared error of the conventional noncentrality parameter estimator of covariance structure models. Structural Equation Modeling: A Multidisciplinary Journal, 7(3), 431–441. doi: 10.1207/S15328007SEM0703_4.CrossRefGoogle Scholar
  41. 41.
    Raykov, T. (2005). A first course in structural equation modeling (2nd ed.). New Jersey: Lawrence Erlbaum Associates Inc.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Johan Niklasson
    • 1
  • Mia Conradsson
    • 1
  • Carl Hörnsten
    • 1
  • Fredrica Nyqvist
    • 2
  • Mojgan Padyab
    • 3
    • 4
  • Björn Nygren
    • 5
  • Birgitta Olofsson
    • 5
  • Hugo Lövheim
    • 1
  • Yngve Gustafson
    • 1
  1. 1.Department of Community Medicine and Rehabilitation, Geriatric MedicineUmeå UniversityUmeåSweden
  2. 2.Faculty of Education and Welfare Studies, Study Programme of Social SciencesÅbo Akademi UniversityVaasaFinland
  3. 3.Center for Population Studies, Aging and Living Conditions ProgrammeUmeå UniversityUmeåSweden
  4. 4.Department of Social WorkUmeå UniversityUmeåSweden
  5. 5.Department of NursingUmeå UniversityUmeåSweden

Personalised recommendations