The Philadelphia Geriatric Center Morale Scale (PGCMS)

1. Abstract

The Philadelphia Geriatric Center Morale Scale (PGCMS) is one of the most historically significant, extensively validated, and widely implemented psychometric instruments designed specifically to assess multidimensional subjective well-being and morale in older adult populations. Originally developed by M. Powell Lawton in 1972 at the Philadelphia Geriatric Center and subsequently revised in 1975, the scale addresses the distinct psychological, affective, and existential realities of late-life aging. While early gerontological evaluations routinely conflated morale with clinical depression or general psychiatric symptomatology, the PGCMS operationalizes morale as a multidimensional construct encapsulating basic satisfaction with oneself, a sense of belonging and interpersonal connection, and philosophical acceptance of the inevitable physical, cognitive, and social transitions associated with senescence.

The revised, standard 17-item version of the instrument comprises three empirically stable, theoretically robust subscales: Agitation (evaluating dysphoric arousal, anxiety, chronic worry, and emotional reactivity), Attitude Toward Own Aging (measuring subjective perceptions of personal decline, perceived utility, and change across the life course), and Lonely Dissatisfaction (indexing social isolation, perceived inadequacy of social contacts, and relational alienation). Historically administered via both self-report and interviewer-administered formats to accommodate sensory, motor, or mild cognitive deficits in clinical and residential cohorts, the PGCMS utilizes a simplified, predominantly dichotomous response format (e.g., Yes/No, Better/Worse, Satisfied/Not Satisfied). Psychometric investigations across community-dwelling, assisted-living, and institutionalized geriatric cohorts demonstrate high reliability (internal consistency coefficients spanning 0.76 to 0.88 for the total score and test-retest reliabilities surpassing 0.80) and robust construct, convergent, and discriminant validity. Structural equation modeling and confirmatory factor analyses confirm its tripartite architecture while supporting its capacity to predict institutional adaptation, healthcare utilization, and subjective quality of life independent of objective functional disability.

2. Keywords

Philadelphia Geriatric Center Morale Scale, PGCMS, M. Powell Lawton, geriatric morale, subjective well-being, psychological aging, Agitation, Attitude Toward Own Aging, Lonely Dissatisfaction, late-life mental health, psychometrics, quality of life in aging.

3. Authors

The Philadelphia Geriatric Center Morale Scale was conceptualized, operationalized, and psychometrically standardized by M. Powell Lawton, Ph.D. (1923–2001). Dr. Lawton was an internationally renowned clinical psychologist and one of the founding fathers of modern environmental, behavioral, and architectural gerontology. During his prolific career spanning over four decades, he served as the Director of Research at the Philadelphia Geriatric Center (subsequently renamed the Polisher Research Institute at the Madlyn and Leonard Abramson Center for Jewish Life in North Wales, Pennsylvania) and held academic affiliations as an Adjunct Professor of Psychology at the Temple University and the University of Pennsylvania.

Dr. Lawton’s seminal theoretical contributions include the Ecological Model of Aging (Lawton & Nahemow, 1973), the conceptualization of Environmental Press, and the rigorous operationalization of functional assessment batteries for older adults, including the Instrumental Activities of Daily Living (IADL) Scale. His clinical and psychometric research addressed the complex interplay between physical environments, cognitive capacity, subjective well-being, and perceived autonomy among frail and non-frail older persons. Subsequent critical structural validations, second-order psychometric modeling, and longitudinal reinterpretations of the scale were spearheaded by prominent gerontological sociologists and methodologists, notably Jersey Liang, Ph.D. (School of Public Health and Institute of Gerontology, University of Michigan) and Kenneth A. Bollen, Ph.D. (Department of Sociology, University of North Carolina at Chapel Hill).

4. Purpose

The primary clinical and research purpose of the Philadelphia Geriatric Center Morale Scale is to provide a reliable, brief, and ecologically sensitive measure of psychological morale and subjective quality of life tailored explicitly to the developmental stage of late adulthood. Before the introduction of the PGCMS in the early 1970s, mental health assessment in geriatric populations suffered from severe methodological and conceptual limitations. Investigators and clinicians routinely relied on generic psychiatric rating inventories—such as the Minnesota Multiphasic Personality Inventory (MMPI) or general neurosis inventories—which disproportionately over-pathologized normative physiological consequences of biological aging (e.g., sleep disruption, fatigue, reduced physical stamina, sensory attenuation) as evidence of somatic hypochondriasis or clinical depressive neurosis.

Lawton recognized that older adults face unique developmental tasks, including biological decline, the loss of lifelong social networks, role transitions associated with retirement, and the anticipation of personal mortality. Consequently, an instrument was required that could distinguish between transient psychological distress, clinical psychopathology, and the broader, more enduring construct of personal morale. The PGCMS was engineered to capture how an older person evaluates their life satisfaction, adapts to biological senescence, and manages internal affective strain. Its diagnostic objective is not to diagnose specific Diagnostic and Statistical Manual of Mental Disorders (DSM) categories, but rather to evaluate the subjective internal state of the individual—serving as an index of resilience, coping effectiveness, and mental equilibrium within residential, acute care, long-term care, and community contexts.

In contemporary research and practice, the PGCMS serves multiple interrelated functions:

• Epidemiological and Gerontological Research: It functions as a standardized dependent variable in large-scale cohort studies evaluating the psychological outcomes of health interventions, pharmacotherapy, physical rehabilitation, and psychosocial programming.
• Long-Term Care and Nursing Home Assessment: The scale evaluates the psychosocial impact of institutionalization, relocation trauma, and changes in care environments, enabling care providers to detect subtle declines in psychological well-being before overt behavioral or depressive symptoms emerge.
• Program Evaluation: Social service agencies, adult day centers, and senior community programs utilize the instrument to assess the efficacy of therapeutic recreational interventions, cognitive stimulation therapy, and peer socialization initiatives.
• Comprehensive Geriatric Assessment (CGA): Interdisciplinary clinical teams incorporate the PGCMS alongside physical, cognitive, and functional assessments to obtain a holistic appraisal of the patient’s lived experience, personal outlook, and subjective coping capacity.

5. Psychological Construct

The psychological construct assessed by the PGCMS is morale, defined within gerontological theory as a general feeling of well-being, a sense of personal adequacy, satisfaction with life, and an acceptance of what cannot be changed. Lawton (1972, 1975) conceptualized morale as an internal, multidimensional affective state reflecting a person’s cognitive and emotional adaptation to the realities of aging. Rather than representing a static personality trait, morale operates as a dynamic, transactional balance between environmental demands, personal competence, and internal psychological defense mechanisms. The PGCMS decomposes this overarching construct into three empirically established structural dimensions:

Agitation

The Agitation dimension reflects an individual’s level of emotional tension, subjective dysphoric arousal, chronic worry, and psychophysiological restlessness. Unlike generalized trait anxiety, agitation in the geriatric context manifests as hyperreactivity to daily stressors, subjective sleep disturbances driven by cognitive rumination, irritability, and an elevated vulnerability to acute worry. Older adults scoring high on this dimension express a pervasive sense that “little things bother me more,” that they worry to the point of insomnia, experience heightened fearfulness, and lose temper or emotional composure more readily than in their earlier adult years. This dimension captures the acute internal distress that destabilizes psychological equilibrium, functioning as a sensitive barometer of unmanaged emotional strain.

Attitude Toward Own Aging

The Attitude Toward Own Aging dimension gauges an individual’s subjective perception and evaluation of their personal aging process, biological changes, and perceived social utility. It taps directly into the internalized self-concept of the older adult as they navigate functional transitions and societal ageism. Items indexing this subscale evaluate whether the individual feels that “things keep getting worse as I get older,” whether they perceive themselves as possessing less energy or “pep” relative to the preceding year, whether they experience a diminished sense of social usefulness, and whether the subjective experience of aging matches or falls short of prior expectations. A favorable attitude reflects psychological resilience, successful assimilation or accommodation of physical alterations, and the preservation of personal dignity and purpose in the face of inevitable bodily changes.

Lonely Dissatisfaction

The Lonely Dissatisfaction dimension assesses subjective social isolation, perceived deficiency in interpersonal relationships, and an affective sense of emptiness or existential despair. Crucially, this dimension distinguishes between objective social network size and perceived relational adequacy. An older person may dwell in a populated congregate care facility yet experience profound loneliness; conversely, an individual living independently with modest social contacts may feel deeply satisfied. Items mapping to this construct measure perceived deficits in contact with friends and family, subjective experiences of pervasive loneliness (“How much do you feel lonely?”), general life dissatisfaction, and existential resignation (“Do you sometimes feel that life isn’t worth living?”). High scores indicate profound relational alienation, grief, and an overwhelming perception that life has lost its intrinsic reward structure.

6. Theoretical Framework

The Philadelphia Geriatric Center Morale Scale is anchored in the convergence of several major theoretical paradigms in psychology and social gerontology: Lawton and Nahemow’s Ecological Model of Aging, Neugarten’s paradigm of Subjective Well-Being and Life Satisfaction, and the historical debate between Disengagement Theory and Activity Theory.

Lawton’s Ecological Model of Aging and Environmental Press

The paramount theoretical underpinning of the PGCMS is Dr. Lawton’s own Ecological Model of Aging (Lawton & Nahemow, 1973). This model posits that human behavior and affect are direct functions of the dynamic transaction between personal competence (an individual’s biological health, sensory-motor functioning, cognitive capacity, and ego strength) and environmental press (the physical, interpersonal, and social demands exerted by the environment). According to Lawton’s theoretical formulations, as personal competence undergoes age-related decrements, an older individual becomes increasingly vulnerable to environmental press. When press exceeds or severely undercuts the individual’s competence, maladaptive behavior and negative affect—manifested specifically as lowered morale, agitation, and alienation—inevitably ensue. Conversely, an optimal balance between competence and press produces the “adaptation level” characterized by emotional comfort, high morale, and effective behavioral functioning. The PGCMS was explicitly designed as the subjective outcome indicator within this ecological equation, quantifying whether an individual’s cognitive and emotional coping systems have achieved equilibrium with their ambient social and physical environment.

Neugarten’s Paradigm of Life Satisfaction and Continuity

The developmental conceptualization of the PGCMS also draws heavily upon the work of Bernice Neugarten and colleagues (Neugarten, Havighurst, & Tobin, 1961), who pioneered the investigation of life satisfaction in older adulthood. Neugarten argued that successful aging could not be judged purely through external, normative markers of productivity or civic engagement; rather, it had to be understood from the internal frame of reference of the aging subject. Neugarten’s framework identified core attributes of late-life morale: zest versus apathy, resolution and fortitude, congruence between desired and achieved goals, positive self-concept, and mood tone. Lawton integrated these domains into the PGCMS, refining them to ensure that questions minimized cognitive abstraction and directly addressed the pragmatic, lived realities of elderly individuals across diverse socioeconomic and functional strata.

Integration with Activity and Disengagement Theories

During the developmental phase of the scale, social gerontology was fundamentally divided between Cumming and Henry’s (1961) Disengagement Theory—which conceptualized aging as an inevitable, mutual withdrawal between the aging individual and society—and Havighurst’s (1961) Activity Theory, which posited that sustained social interaction and role replacement were vital for psychological equilibrium. Lawton rejected an absolute, dogmatic alignment with either model. Instead, he designed the PGCMS to capture an individual’s subjective appraisal of their social world (reflected in the Lonely Dissatisfaction subscale) rather than tallying objective participation metrics. The scale embodies the theoretical premise that high morale can be preserved either through continuous active involvement or through tranquil, accepted disengagement, provided the older adult experiences their social context as congruent with their internal psychological needs.

7. Validity

The PGCMS has undergone exhaustive psychometric evaluation over five decades, accumulating robust empirical evidence supporting its construct, convergent, discriminant, and predictive validity across diverse populations and cultural settings.

Construct Validity

Initial construct validation conducted by Lawton (1972) involved administering the original 22-item scale to distinct cohorts of older adults categorized a priori by their functional status, living environments, and clinical classifications (e.g., community-dwelling independent seniors, residents of congregate housing, and institutionalized geriatric patients). Construct validity was demonstrated by the instrument’s capacity to systematically differentiate between these groups in accordance with theoretical expectations: community-dwelling seniors exhibited the highest aggregate morale, followed by congregate housing residents, with institutionalized nursing home patients demonstrating markedly lower scores. Subsequent confirmatory factor analytic studies, such as the seminal structural reinterpretation by Liang and Bollen (1983), confirmed that the multidimensional construct of morale is comprised of the three distinct but inter-correlated first-order factors, demonstrating strong construct coherence and factorial stability.

Convergent Validity

The convergent validity of the PGCMS has been corroborated through substantial correlations with parallel psychometric instruments assessing depressive symptoms, life satisfaction, and affective state. Studies evaluating concurrent validity have consistently demonstrated strong negative correlations between the PGCMS total score and validated depression measures, including the Geriatric Depression Scale (GDS; correlations typically ranging from r = -0.65 to -0.78) and the Center for Epidemiologic Studies Depression Scale (CES-D; r = -0.60 to -0.72). Furthermore, strong positive correlations have been repeatedly documented with the Life Satisfaction Index-A (LSI-A; r = 0.68 to 0.81) and Cantril’s Self-Anchoring Ladder of Life Satisfaction. Subscale-level convergence is equally pronounced: the Agitation subscale correlates heavily with standardized anxiety measures such as the State-Trait Anxiety Inventory (STAI-State; r = 0.58 to 0.70), while Lonely Dissatisfaction correlates robustly with the UCLA Loneliness Scale (r = 0.62 to 0.75).

Discriminant Validity

Discriminant validity is supported by the scale’s capacity to measure psychological morale as a distinct construct separable from objective physical health status and cognitive functioning. While physical illness and functional disability (measured via Basic and Instrumental Activities of Daily Living, ADLs/IADLs) correlate moderately with morale (typically r = 0.25 to 0.38), multivariate regression analyses routinely demonstrate that the PGCMS captures substantial unique variance in subjective well-being after controlling for functional impairment, physical comorbidity, age, and socioeconomic status. Moreover, in populations without moderate-to-severe dementia, PGCMS scores exhibit negligible correlations with Mini-Mental State Examination (MMSE) scores (r = 0.05 to 0.12), confirming that the instrument does not inadvertently measure cognitive performance.

Predictive and Ecological Validity

Longitudinal studies demonstrate that the PGCMS possesses strong predictive validity for diverse objective gerontological outcomes. Baseline morale scores significantly predict successful rehabilitation outcomes, functional recovery following orthopedic or cerebrovascular events, adherence to medical regimens, and subjective adaptation to residential care facilities. Furthermore, prospective epidemiological investigations have identified low baseline morale on the PGCMS as an independent predictor of premature mortality, cognitive decline, and acute hospitalization, even after adjusting for baseline somatic diseases, smoking status, and biological markers of frailty.

8. Reliability

The reliability of the Philadelphia Geriatric Center Morale Scale has been rigorously documented across numerous empirical investigations, establishing high internal consistency, strong test-retest stability, and robust inter-rater congruence.

Internal Consistency

In Lawton’s (1975) revised 17-item scale, internal consistency was evaluated utilizing Kuder-Richardson Formula 20 (KR-20) and Cronbach’s alpha (α), reflecting the predominantly dichotomous scoring of the instrument:

• Total PGCMS Scale: Cronbach’s alpha typically ranges from α = 0.76 to 0.88 across both community and institutional samples, indicating high overall measurement precision without excessive item redundancy.
• Agitation Subscale (6 items): Cronbach’s alpha ranges from α = 0.70 to 0.82, demonstrating reliable capture of the autonomic and subjective tension dimension.
• Attitude Toward Own Aging Subscale (5 items): Cronbach’s alpha ranges from α = 0.65 to 0.78. Although slightly lower due to fewer items, it maintains acceptable internal consistency for short subscales in clinical gerontology.
• Lonely Dissatisfaction Subscale (6 items): Cronbach’s alpha consistently demonstrates strong reliability, ranging from α = 0.72 to 0.85 across studies.

Subsequent psychometric examinations across diverse cohorts (including Morris, Wolf, & Klerman, 1975; Liang & Bollen, 1983) have consistently replicated these internal consistency metrics across varying socioeconomic, racial, and functional strata.

Test-Retest Stability

Temporal stability assessments reveal that the PGCMS measures an enduring, trait-like psychological state rather than fluctuating situational emotions. In Lawton’s (1972) original evaluations, test-retest reliability across a two-week interval yielded a correlation coefficient of r = 0.80. Morris et al. (1975) observed a three-month test-retest reliability coefficient of r = 0.75 among stable community residents. Across extended observational windows (six months to one year), test-retest coefficients remain stable in the range of r = 0.62 to 0.71, with fluctuations corresponding systematically to major intervening negative life events such as bereavement, new physical disability, or involuntary residential relocation.

Inter-Rater and Administration Reliability

Because the PGCMS is frequently administered through face-to-face structured interviews with older adults possessing visual impairments, motor tremors, or limited literacy, inter-rater reliability is critical. In structured interviewer-comparison trials, inter-rater agreement for both total scale scores and subscale ratings has consistently yielded intraclass correlation coefficients (ICCs) exceeding 0.90. Furthermore, comparative analyses evaluating self-administered paper questionnaires versus orally administered clinical interviews demonstrate high cross-modal congruence (r = 0.88 to 0.94), verifying that the instrument maintains structural fidelity regardless of administration format.

9. Factor Analysis

The factorial architecture of the PGCMS represents one of the most thoroughly analyzed factor structures in the history of geriatric assessment, evolving through exploratory factor analyses (EFA), confirmatory factor analyses (CFA), and advanced structural equation modeling (SEM).

The Original 22-Item Model (Lawton, 1972)

In his initial 1972 investigation, Lawton administered a pool of 28 candidate items to 824 older adults drawn from diverse residential and institutional environments. Principal Component Analysis with orthogonal (varimax) rotation identified six distinct factors accounting for the majority of shared variance: Agitation, Attitude Toward Own Aging, Lonely Dissatisfaction, Surgency, Physical/Health Satisfaction, and Acceptance of Status Quo. Lawton retained 22 items that exhibited robust factor loadings (> 0.40) while demonstrating face validity for late-life morale. However, several minor factors contained only two items or exhibited unstable loadings across replication subgroups.

The 1975 Revision (Lawton, 1975)

Recognizing the psychometric limitations of the smaller factors, Lawton (1975) re-evaluated the scale using an expanded sample of 1,027 respondents across varied community and residential environments. Factor analysis yielded three robust, replicable, and theoretically coherent factors containing 17 items total, eliminating items with low primary loadings or high cross-loadings (e.g., items 18, 19, 20, 21, and 22). This 17-item tripartite solution became the internationally accepted gold standard for the PGCMS:

• Agitation: Consisting of items 4, 7, 12, 13, 16, and 17, with standardized loadings ranging from 0.48 to 0.74.
• Attitude Toward Own Aging: Consisting of items 1, 2, 6, 8, and 10, with standardized factor loadings spanning 0.44 to 0.71.
• Lonely Dissatisfaction: Consisting of items 3, 5, 9, 11, 14, and 15, with primary factor loadings between 0.46 and 0.69.

Morris, Wolf, and Klerman’s Structural Validation (1975)

Concurrently, Morris, Wolf, and Klerman (1975) conducted an independent factor analysis on an extensive sample of over 3,000 elderly subjects. Their findings replicated Lawton’s three-factor solution with remarkable congruence, demonstrating factor congruence coefficients exceeding 0.90 across all three primary dimensions. They confirmed that the three-factor structure retained invariant structural integrity across differing living arrangements, functional levels, and geographical settings.

Liang and Bollen’s Structural Equation Modeling Reinterpretation (1983)

The definitive structural verification of the PGCMS was published by Liang and Bollen (1983) in the Journal of Gerontology. Utilizing maximum likelihood confirmatory factor analysis (CFA) within a LISREL framework, Liang and Bollen formally tested Lawton’s tripartite model against alternative unidimensional and multidimensional specifications. While their analysis supported the three latent constructs (Agitation, Attitude Toward Own Aging, and Lonely Dissatisfaction), they identified that a second-order factor model—in which a single overarching latent construct of “Morale” explains the covariation among the three first-order dimensions—provided an exemplary fit to empirical data.

Their structural model achieved robust goodness-of-fit indices (Goodness of Fit Index [GFI] > 0.94; Root Mean Square Residual [RMR] < 0.05). Furthermore, their parameter estimates demonstrated that correlated measurement errors existed between specific items sharing linguistic structures or negative polarity, confirming that accounting for method artifacts further enhances the construct fidelity of Lawton’s original three-factor framework. Subsequent modern multigroup invariance studies (e.g., across sex, age brackets 65–74 vs. 75–84 vs. 85+, and ethnoracial backgrounds) have verified metric and scalar invariance, supporting the cross-group comparability of PGCMS latent factor means.

10. Instrument / Measurement Tool

The Philadelphia Geriatric Center Morale Scale is structured as an objective, brief, multi-dimensional assessment tool. Below are the structural, operational, and scoring specifications of the instrument:

• Instrument Type: Standardized multidimensional psychological rating scale / self-report questionnaire or structured clinical interview.
• Target Population: Older adults (typically aged 60 and older) residing in community, independent living, assisted living, or long-term nursing facilities.
• Administration Format: Individual self-report (pencil-and-paper) or oral interview administration conducted by a trained clinician, nurse, psychologist, or social worker for respondents with sensory, motor, or cognitive limitations.
• Administration Time: Approximately 5 to 10 minutes.
• Total Number of Items: 17 items in the standard revised edition (Lawton, 1975); 22 items in the comprehensive historical research version (Lawton, 1972).
• Response Options: Primarily dichotomous forced-choice format (“Yes” vs. “No”), with specific categorical items offering designated comparative choices:
  • Item 3: “Not much” vs. “A lot”
  • Item 8: “Better” vs. “Worse” (or “Same” in three-choice variants)
  • Item 15: “Satisfied” vs. “Not Satisfied”
  • Item 21 (22-item version): “Good” vs. “Not so good”
• Subscale Allocation (Standard 17-Item Version):
  • Agitation (6 items): Items 4, 7, 12, 13, 16, and 17.
  • Attitude Toward Own Aging (5 items): Items 1, 2, 6, 8, and 10.
  • Lonely Dissatisfaction (6 items): Items 3, 5, 9, 11, 14, and 15.
• Scoring Protocol and Directionality:
  • Each item is scored dichotomously as 1 (High Morale / Positive response) or 0 (Low Morale / Negative response).
  • High Morale Responses (Scored 1 point):
    • Item 1: No
    • Item 2: Yes
    • Item 3: Not much
    • Item 4: No
    • Item 5: Yes
    • Item 6: No
    • Item 7: No
    • Item 8: Better (or Same)
    • Item 9: No
    • Item 10: Yes
    • Item 11: No
    • Item 12: No
    • Item 13: No
    • Item 14: No
    • Item 15: Satisfied
    • Item 16: No
    • Item 17: No
  • Low Morale Responses (Scored 0 points): Any response indicating dysphoria, loneliness, agitation, or adverse self-appraisal of aging.
• Interpretation of Total Scores (17-Item Version):
  • 13 to 17 points: High morale; indicates robust psychological adaptation, positive self-esteem, minimal agitation, and high subjective life satisfaction.
  • 10 to 12 points: Moderate / Mid-range morale; indicates acceptable psychological coping with identifiable, localized distress or transitional difficulties.
  • 0 to 9 points: Low morale; indicates substantial psychological distress, elevated agitation, feelings of social isolation, or marked existential despair. Warrants comprehensive psychological or psychiatric diagnostic evaluation.

11. Permissions & Fee and Test Year

The original Philadelphia Geriatric Center Morale Scale was published in 1972 by M. Powell Lawton in the Journal of Gerontology, with the definitive 17-item revised version published in 1975. Dr. Lawton and the Philadelphia Geriatric Center established an open-access philosophy regarding the instrument to stimulate rigorous empirical research, program evaluation, and clinical enhancement in geriatric care.

As an instrument developed through non-profit research published in peer-reviewed scientific literature, the PGCMS is situated in the public domain. It may be utilized, reproduced, and translated by clinical practitioners, academic researchers, and non-profit healthcare institutions free of charge, with no licensing fees or prior formal permissions required, provided that appropriate scholarly attribution and standard academic citations are accorded to M. Powell Lawton and the original source publications. The copyright of the original journal articles is maintained by the Gerontological Society of America (GSA). For commercial electronic health record (EHR) integrations or commercial proprietary distribution, contacting the institutional successor—the Madlyn and Leonard Abramson Center for Jewish Life (Polisher Research Institute) or Oxford University Press (publisher of the Journals of Gerontology)—is standard practice.

12. References

• Cumming, E., & Henry, W. E. (1961). Growing old: The process of disengagement. Basic Books.
• Havighurst, R. J. (1961). Successful aging. The Gerontologist, 1(1), 8–13. https://doi.org/10.1093/geront/1.1.8
• Lawton, M. P. (1972). The dimensions of morale. In D. P. Kent, R. Kastenbaum, & S. Sherwood (Eds.), Research planning and action for the elderly: The power and potential of social science (pp. 144–165). Behavioral Publications.
• Lawton, M. P. (1975). The Philadelphia Geriatric Center Morale Scale: A revision. Journal of Gerontology, 30(1), 85–89. https://doi.org/10.1093/geronj/30.1.85
• Lawton, M. P., & Nahemow, L. (1973). Ecology and the aging process. In C. Eisdorfer & M. P. Lawton (Eds.), The psychology of adult development and aging (pp. 619–674). American Psychological Association. https://doi.org/10.1037/10044-020
• Liang, J., & Bollen, K. A. (1983). The structure of the Philadelphia Geriatric Center Morale Scale: A reinterpretation. Journal of Gerontology, 38(2), 181–189. https://doi.org/10.1093/geronj/38.2.181
• Morris, J. N., Wolf, R. S., & Klerman, L. V. (1975). Common themes among morale: A factor analysis of the Philadelphia Geriatric Center Morale Scale. Journal of Gerontology, 30(2), 209–215. https://doi.org/10.1093/geronj/30.2.209
• Neugarten, B. L., Havighurst, R. J., & Tobin, S. S. (1961). The measurement of life satisfaction. Journal of Gerontology, 16(2), 134–143. https://doi.org/10.1093/geronj/16.2.134
• Van Lent, D. (1988). The relationship of spirituality, self-transcendence, and social support to morale in chronically ill elderly (Master of Science thesis, University of Arizona). University of Arizona Open Repository. http://arizona.openrepository.com/arizona/bitstream/10150/276820/1/azu_td_1335067_sip1_m.pdf

13. Items of the Scale