Abstract
Introduction
The objective of this study was to clarify the frequency of fear of dementia and the factors associated with it.
Methods
Data were taken from a nationally representative sample (n = 4,000; average age was 54.9 years, SD: 8.5 years, age ranges from 40 to 70 years, 49.6% of the respondents were women). Similar to prior research, fear of dementia was quantified using a tool ranging from 1 (no fear of dementia) to 4 (severe fear of dementia).
Results
In sum, 19.0% reported no fear of dementia, 34.6% reported a little fear of dementia, 33.8% reported some fear of dementia, and 12.7% reported severe fear of dementia. Regressions showed that greater fear of dementia was significantly associated with being female, being younger, poorer self-rated health, the presence of at least one chronic disease, not living in the same household with a partner or not being in a relationship at all, having depressive symptoms and anxiety symptoms.
Conclusion
Study findings showed that fear of dementia is particularly associated with health-related factors, age and gender. Lifestyle factors and other socioeconomic factors were only occasionally significant. Future research should explore the reasons for such a higher frequency of people’s fear of dementia. It would also be interesting to find out new factors associated with the fear of dementia. Furthermore, further research could focus on cross-country comparisons and could stratify the results by important groups, e.g., by sex or education, but also cultural and ethnic aspects.
Keywords: Dementia, Dementia worry, Fear of dementia, Cognitive impairment, Cognitive decline
Introduction
Dementia is a severe disease with prevalence of 6.97% (697/10,000) in the age group 50 years and over [1]. The prevalence markedly increases with age (e.g., 27/10,000 among individuals aged 50–59 years up to 6,592/10,000 among individuals aged 100 years and over) [1]. Fear of dementia can be seen as an emotional reaction to the perceived risk of developing dementia, that can occur regardless of a person’s age or cognitive abilities [2]. It involves both affective components, such as fear, and cognitive components, such as thoughts and associations related to the perceived threat of developing dementia [2]. This fear can range in intensity from mild concerns or worries to severe preoccupation or phobia. Negative consequences can be seen on societal and individual levels, even where the degree of fear is mild [2, 3]. It is conceivable that people who are continuously preoccupied with their anxiety will be influenced by it and will then be exposed to constant stress, which in turn has a negative impact on health outcomes, i.e., via the development of cardiovascular diseases or sleep disorders [4, 5]. On an interpersonal level, it could also lead to forgetfulness in everyday life being over-interpreted and too quickly being associated with a serious illness [6].
Factors that can be associated with fear of dementia have been identified in some previous studies. In the current body of research [7–9], the factors most commonly examined are age, sex, education, income, perceived risk, and having individuals with dementia in one’s social circle. Most studies have found that individuals with a greater level of fear of dementia are female [9, 10] and had individuals with dementia in their social environment [11, 12]. Furthermore, it was found that people who rate their own risk of developing dementia higher also tend to have a greater fear of dementia [9, 11]. Regarding age, it was found that people of older age also fear dementia more [13, 14]. Furthermore, an association was found between higher socioeconomic status (higher education and higher income) and fear of dementia [12, 14–16]. This is worth noting because such factors are protective against several adverse health outcomes [17, 18].
However, these associations were examined in studies with small sample sizes and were partly based on convenience samples. Therefore, our aim was to investigate the prevalence and determinants of fear of dementia based on data from the general adult population aged 40 years and over. More precisely, the aims of this paper are twofold: (1) to display the level of fear of dementia (also for corresponding subgroups, e.g., by gender and age group) and (2) to examine the determinants of the fear of dementia. This study specifically focuses on three key groups of determinants: socioeconomic factors, lifestyle-related factors, and health-related factors. Socioeconomic factors include education and income for example. Lifestyle-related factors such as physical activity are also considered. Lastly, health-related factors including depressive symptoms are taken into account. Such factors have been included in view of the limited knowledge regarding these factors and the fear of dementia.
This topic is of particular relevance as a high level of fear of dementia may ultimately contribute to chronic mental health conditions [19]. For example, the fear may spread to other areas of life or even lead to depression and suicidal ideation [20]. Individuals may become trapped in a “vicious cycle of stress” [21]. Stress itself is one of the risk factors for depression, Alzheimer’s disease and Cushing’s disease [22]. Furthermore, stress is also associated with cardiac infarctions and arrhythmias, as well as sleep disorders [4, 5].
This paper aimed to examine theories such as the “subjective distance to death” theory [23]. The question arises whether individuals in old age, i.e., with a higher risk of dementia in the following decades, report a greater level of fear of dementia compared to middle-aged individuals, or whether individuals may fear dementia less because of their limited life left (i.e., the subjective experience of approaching the end of life may play a role in the fear of dementia).
Methods
Sample
The data were collected by the certified market research institute Bilendi and Respondi (ISO 26362 certified online sample provider) in autumn 2021. The Bilendi Group was founded in the late 1990s and has since developed into one of the largest online market research institutes in Europe. It now employs more than 400 people in 13 countries, including Germany, France, Spain, and the UK. The data were collected as a quota sample and corresponded to a total number of participants of n = 4,000 individuals aged 40–70 years. The survey is representative of the general population in terms of the federal state, age, and sex. Due to some missing values in fear of dementia (where individuals did not respond to the question described in section 3.2), n = 3,890 individuals are included in the analytical sample.
Dependent Variables
Analogous to a previous study by Hajek and König (2020) [9], the outcome in this study was divided into “no fear,” “a little fear,” “some fear” and “severe fear.” Compared to the conventional Likert scale, this has the advantage that the choices are described in the same way, and thus, there is good comparability.
Independent Variables
Socioeconomic factors included age (in years), sex (women; men), family status (single; widowed; divorced; partnership, separate household; registered civil partnership/married, same household), highest educational attainment (no vocational qualification; vocational school; college; university; other), net household income per month in EUR (less than 500; 500 to lower than 750; 750 to lower than 1,000; 1,000 to lower than 1,500; 1,500 to lower than 2,000; 2,000 to lower than 3,000; 3,000 to lower than 5,000; more than 5,000), and health insurance (private or statutory). Furthermore, the lifestyle factors of frequency of sports activities per week (no sport; less than 1 h; 1–2 h; 2–4 h; and >4 h), smoking (daily; occasionally; no more and never), and alcohol consumption (daily; several times a week; once a week; 1 to 3 times a month; less often or never) were examined. Lastly, the participants were also asked about their current health. Specifically, the factors of chronic diseases (yes or no or unknown), anxiety symptoms (using the GAD-2 [24]), and depressive symptoms (using the PHQ-2 [24]) were included. It may be worth noting that anxiety symptoms and depressive symptoms were surveyed separately. The question regarding chronic conditions (no = absence of chronic conditions; yes = at least one chronic condition) is based on the question used in the German Health Interview and Examination Survey for Adults.
Statistical Analysis
First, the sample characteristics of the analytical sample (also stratified by fear of dementia) were defined. Next, an analysis to identify the factors which are linked to the fear of dementia through multiple linear regression (with listwise deletion to deal with missing data) was conducted. A standardized normal probability plot was used to investigate the normality of the residuals. From this, we can infer that the residuals are approximately normally distributed. To ensure the robustness of our findings, ordered probit regressions were employed in a sensitivity analysis. Moreover, a full-information maximum likelihood was employed to deal with missing data in a further sensitivity analysis. The significance level was established at α = 0.05. All statistical analyses were carried out using Stata 17.0 software (Stata Corp., College Station, TX, USA).
Results
Sample Characteristics and Bivariate Analysis
The average age of the sample was 54.9 years (SD: 8.5 years; ranging from 40 to 70 years). In total, 49.6% of the respondents were women. In sum, 18.9% of the individuals reported “not at all” referring to the fear of dementia. Furthermore, 34.6% of the respondents declared “a little” and 33.8% of the individuals “some” fear of dementia. Moreover, 12.7% of the individuals had “severe” fear of dementia. Further details are provided in Table 1.
Table 1.
Sample characteristics for the total sample (total and stratified by fear of dementia)
| Fear of dementia | Not at all | A little | Some | Severe | Total | p value |
|---|---|---|---|---|---|---|
| n (%) | 737 (18.9) | 1,345 (34.6) | 1,313 (33.8) | 495 (12.7) | 3,890 (100.0) | |
| Age group | 1.0 e−3 | |||||
| 40–44 | 89 (12.1) | 220 (16.4) | 192 (14.6) | 78 (15.8) | 579 (14.9) | |
| 45–49 | 96 (13.0) | 192 (14.3) | 190 (14.5) | 76 (15.4) | 554 (14.2) | |
| 50–54 | 111 (15.1) | 232 (17.2) | 223 (17.0) | 103 (20.8) | 669 (17.2) | |
| 55–59 | 161 (21.8) | 260 (19.3) | 272 (20.7) | 117 (23.6) | 810 (20.8) | |
| 60–64 | 131 (17.8) | 227 (16.9) | 218 (16.6) | 69 (13.9) | 645 (16.6) | |
| 65–70 | 149 (20.2) | 214 (15.9) | 218 (16.6) | 52 (10.5) | 633 (16.3) | |
| Sex | 0.000 | |||||
| Female | 346 (47.1) | 625 (46.5) | 663 (50.5) | 295 (59.7) | 1,929 (49.6) | |
| Male | 389 (52.9) | 719 (53.5) | 650 (49.5) | 199 (40.3) | 1,957 (50.4) | |
| Highest education | 2.96 e−1 | |||||
| Without vocational qualification | 31 (4.2) | 45 (3.3) | 48 (3.7) | 20 (4.0) | 144 (3.7) | |
| Vocational school | 369 (50.1) | 738 (54.9) | 743 (56.6) | 272 (54.9) | 2,122 (54.6) | |
| College | 134 (18.2) | 222 (16.5) | 210 (16.0) | 75 (15.2) | 641 (16.5) | |
| University | 189 (25.6) | 311 (23.1) | 297 (22.6) | 116 (23.4) | 913 (23.5) | |
| Other | 14 (1.9) | 29 (2.2) | 15 (1.1) | 12 (2.4) | 70 (1.8) | |
| Family status | 0.000 | |||||
| Registered civil partnership/married, same household | 382 (51.8) | 572 (42.5) | 602 (45.8) | 213 (43.0) | 1,769 (45.5) | |
| Single/widowed/divorced/partnerships, separate household | 355 (48.2) | 773 (57.5) | 711 (54.2) | 282 (57.0) | 2,121 (54.5) | |
| Insurance | 9.96 e−1 | |||||
| Statutory health insurance | 659 (89.4) | 1,198 (89.1) | 1,171 (89.2) | 442 (89.3) | 3,470 (89.2) | |
| Private health insurance | 78 (10.6) | 147 (10.9) | 142 (10.8) | 53 (10.7) | 420 (10.8) | |
| Income | 9.0 e−3 | |||||
| <3,000 EUR/month | 435 (65.6) | 720 (58.1) | 757 (62.7) | 276 (60.9) | 2,188 (61.4) | |
| >/ = 3,000 EUR/month | 228 (34.4) | 519 (41.9) | 450 (37.3) | 177 (39.1) | 1,374 (38.6) | |
| Sporta | 5.9 e−2 | |||||
| Irregularly | 358 (48.6) | 686 (51.0) | 670 (51.0) | 279 (56.4) | 1,993 (51.2) | |
| Regularly a little | 276 (37.4) | 504 (37.5) | 501 (38.2) | 172 (34.7) | 1,453 (37.4) | |
| Regularly a lot | 103 (14.0) | 155 (11.5) | 142 (10.8) | 44 (8.9) | 444 (11.4) | |
| Smokingb | 2.47 e−1 | |||||
| Active smoker | 271 (36.8) | 459 (34.1) | 473 (36.0) | 158 (31.9) | 1,361 (35.0) | |
| Not active smoker | 466 (63.2) | 886 (65.9) | 840 (64.0) | 337 (68.1) | 2,529 (65.0) | |
| Alcohol consumptionc | 8.8 e−2 | |||||
| Regularly a lot | 190 (25.8) | 370 (27.5) | 334 (25.4) | 140 (28.3) | 1,034 (26.6) | |
| Regularly a little | 201 (27.3) | 433 (32.2) | 411 (31.3) | 146 (29.5) | 1,191 (30.6) | |
| Sometimes/not at all | 346 (46.9) | 542 (40.3) | 568 (43.3) | 209 (42.2) | 1,665 (42.8) | |
| Self-rated health | 0.000 | |||||
| Very good | 149 (20.2) | 107 (8.0) | 68 (5.2) | 29 (5.9) | 353 (9.1) | |
| Good | 318 (43.1) | 606 (45.2) | 517 (39.4) | 154 (31.2) | 1,595 (41.1) | |
| Medium | 178 (24.2) | 439 (32.7) | 477 (36.4) | 188 (38.1) | 1,282 (33.0) | |
| Bad | 71 (9.6) | 164 (12.2) | 199 (15.2) | 93 (18.8) | 527 (13.6) | |
| Very bad | 21 (2.8) | 25 (1.9) | 51 (3.9) | 30 (6.1) | 127 (3.3) | |
| Chronic diseases | 0.000 | |||||
| At least one | 256 (35.3) | 514 (39.4) | 587 (46.5) | 264 (55.5) | 1,621 (43.0) | |
| None | 469 (64.7) | 792 (60.6) | 675 (53.5) | 212 (44.5) | 2148 (57.0) | |
| Depressive symptoms (PHQ-2) | 0.8 (1.4) | 1.1 (1.4) | 1.4 (1.5) | 2.0 (1.8) | 1.3 (1.5) | 0.000 |
| Anxiety symptoms (GAD-2) | 0.6 (1.2) | 1.0 (1.4) | 1.3 (1.5) | 1.9 (1.8) | 1.1 (1.5) | 0.000 |
aIrregularly = no physical activity or less than 1 h sport per week; regularly a little = 1−2 or 2−4 h sport per week; regularly a lot = more than 4 h sport per week.
bActive smoker = daily and occasionally smoking; not active smoker = not smoking anymore or never been.
cRegularly a lot = drinking daily or multiple times per week; regularly a little = drinking 1 time per week or 1 to 3 times per month; not at all/sometimes = drinking less than 1 to 3 times per month or not at all.
Regression Analysis
Multiple linear regressions are shown in Table 2. Greater fear of dementia was significantly associated with being female (β = −0.14, p < 1.0 e−3), being younger (e.g., age group “65–70 years old” compared to “40–44 years old,” β = −0.19, p < 1.0 e−3), poorer self-rated health (e.g., “very bad” compared to “very good,” β = 0.47, p < 1.0 e−3), the presence of at least one chronic disease (β = −0.11, p < 1.0 e−3), not living in the same household with a partner or not being in a relationship at all (compared to registered civil partnership/married, same household, β = 0.12, p < 1.0 e−2), and having more depressive symptoms (β = 0.11, p < 1.0 e−3). In contrast, a greater fear of dementia was neither significantly associated with all lifestyle factors such as alcohol consumption, smoking, or sports nor, with socioeconomic factors like education, income, or health insurance. When anxiety symptoms were used (rather than depressive symptoms), there was an association between having more anxiety symptoms and a greater fear of dementia (β = 0.11, p < 1.0 e−3).
Table 2.
Determinants of fear of dementia
| Independent variables | Fear of dementia |
|---|---|
| Age group: −45–49 years (reference category: 40–44 years) | −0.03 |
| (0.06) | |
| −0.57 | |
| −50–54 years | −0.03 |
| (0.05) | |
| −0.57 | |
| −55–59 years | −0.08 |
| (0.05) | |
| −1.47 | |
| −60–64 years | −0.15** |
| (0.06) | |
| −2.64 | |
| −65–70 years | −0.19*** |
| (0.06) | |
| −3.39 | |
| Sex: female (reference category: male) | −0.14*** |
| (0.03) | |
| −4.31 | |
| Education: −vocational school (reference category: no vocational qualification) | 0.07 |
| (0.08) | |
| 0.82 | |
| −College | 0.02 |
| (0.09) | |
| 0.24 | |
| −University | 0.09 |
| (0.09) | |
| 1.02 | |
| −Other | 0.08 |
| (0.15) | |
| 0.54 | |
| Family status: single/widowed/divorced or partnership, separate household (reference category: registered civil partnership/married, same household) | 0.12*** |
| (0.03) | |
| 3.39 | |
| Insurance: private health insurance (reference category: statutory health insurance) | 0.04 |
| (0.05) | |
| 0.86 | |
| Income: more than 3,000 EUR/month (reference category: less than 3,000 EUR/month) | 0.06+ |
| (0.04) | |
| 1.71 | |
| Sport: −regularly a little (reference category: doing sport irregularly) | 0.01 |
| (0.03) | |
| 0.23 | |
| −regularly a lot | −0.00 |
| (0.05) | |
| −0.02 | |
| Smoking: not active smoker (reference category: active smoker) | 0.03 |
| (0.03) | |
| 1.03 | |
| Alcohol: −regularly a little (reference category: drinking alcohol regularly a lot) | 0.02 |
| (0.04) | |
| 0.56 | |
| −sometimes/not at all | −0.06 |
| (0.04) | |
| −1.57 | |
| Self-rated health: −good (reference category: very good) | 0.34*** |
| (0.06) | |
| 5.65 | |
| −medium | 0.48*** |
| (0.07) | |
| 7.39 | |
| −bad | 0.47*** |
| (0.08) | |
| 6.05 | |
| −very bad | 0.47*** |
| (0.12) | |
| 4.05 | |
| Chronic disease: no chronic disease (reference category: having at least one chronic disease) | −0.11** |
| (0.04) | |
| −2.95 | |
| Depressive symptoms (PHQ-2) | 0.11*** |
| (0.01) | |
| 8.82 | |
| Constant | 1.94*** |
| (0.12) | |
| 16.84 | |
| Observations | 3,448 |
| R 2 | 0.09 |
| F(24, 3,423) | 13.79 (p< 1.0 e−3) |
Results of multiple linear regressions.
Unstandardized beta-coefficients; robust standard errors in parentheses; thereafter, t-values are shown.
***p < 1.0 e−3, **p < 1.0 e−2, *p < 5.0 e−2, +p < 1.0 e−1.
In a first robustness check, multiple linear regressions were replaced by ordered probit regressions (where fear of dementia was treated as an ordinal outcome). However, in terms of significance, results remained almost the same. In a second robustness check, multiple linear regressions with listwise deletion were replaced by multiple linear regressions with FIML to address missing data. However, in terms of effect size and significance, results remained virtually the same (results of the sensitivity analyses are not shown but available upon request).
Discussion
Main Findings
Based on a large representative sample, the aim of the study was to clarify the frequency of fear of dementia and the factors associated with this fear among middle-aged and older individuals. In sum, nearly 1 out of 5 reported no fear of dementia, about 1 out of 3 reported little fear of dementia, 1 out of 3 some fear of dementia, and approximately 1 out of 8 reported severe fear of dementia. Regressions showed that a greater fear of dementia was significantly associated with being female, being younger, having poorer self-rated health, the presence of at least one chronic disease, being unmarried or not being in a relationship at all, and having more depressive symptoms and anxiety symptoms.
Relation to Previous Research
In our study, 81.1% of the participants stated they were at least a bit afraid of dementia and 12.7% of the participants indicated severe fear. Similar results were found in previous studies. In Hajek and König [9], 71.2% of the participants stated that they were at least a little afraid of dementia (using data from the general German adult population in the year 2012). In a study conducted by Norman et al. [25], this proportion was 85.9%. The latter study of Norman et al. included 202 healthy older adults aged 65–93 years (mainly recruited from senior centers in Illinois and Wisconsin Dells, WI, USA). Differences could arise here due to the number of participants, time and type of data collection, and particularly due to the selection of participants (e.g., different age or sex). It is worth noting that these differences may cover cultural and societal perspectives of dementia such as different chronic disease self-management and health literacy in different ethnic groups [26]. Furthermore, the varying prevalence of chronic illness, as well as the different stigmas associated with, and/or media presentation of, chronic illnesses in different cultures, could also play a role in the fear of dementia [27]. More generally, the use of different measurement methods and scales, e.g., a 4-point Likert scale in Léon et al. [14] or a 5-point Likert scale in Zeng et al. [28], of fear of dementia makes the comparability of the stated prevalences difficult.
In our study, greater fear of dementia was significantly associated with poorer self-rated health. Previous studies also demonstrated such an association [10, 12, 29]. Poor self-rated health can lead to higher mortality [30]. Thus, it sounds plausible that people with lower self-rated health are more likely to fear life-shortening diseases like dementia [31]. Moreover, the association between chronic disease and fear of dementia – which was identified in our study – could be explained similarly. It could be that people see themselves as more vulnerable to further illness if they already have a chronic disease. In addition, among people with chronic disease, the prevalence of fear in general is higher [32]. This may explain a greater fear of dementia.
Chronically ill people have experienced themselves that illnesses usually mean a loss of quality of life [33]. The fear of dementia and the subsequent significant decline in quality of life among this particular group may be attributed to their own experiences.
In addition, as in other studies [10, 15], an association between being female and a greater fear of dementia has been demonstrated in our study. It is possible that the association between fear of dementia with the female sex can be explained by the knowledge of the higher life expectancy among women. This could be because of the fact that dementia is a disease of predominantly older people. Therefore, the risk of developing dementia is higher for a female than a male. However, the association between being female and a greater fear of dementia could also be explained by the greater burden of informal care being undertaken by women [34]. That is, women may be more aware of the implications of a chronic illness with high care needs, and what the change in quality of life a chronic illness, such as dementia, may precipitate. In addition, there is the fact that more women than men are affected by dementia [35]. Thus, the association with the female gender can also be explained by the knowledge of this fact [36] and a greater negative feeling toward dementia [37] in individuals aged 40–70 years in Western industrialized nations like Germany. Women are also generally more inclined to be worried than men, which could also serve as an explanation. It is quite conceivable that one fears dementia more if one has a generally rather anxious nature [9].
Consistent with previous studies, an association between age and fear of dementia could be found. In previous research, the results in this regard were quite mixed. Some studies have recognized positive associations with age [12, 16, 29], while others have identified a negative association [7, 38, 39]. In this study, we showed an association between higher age and lower fear of dementia. This is surprising because one might expect the increasing awareness of age-related diseases with age, and the fact that with increasing age there may also be more people with a dementia disease in the environment. Both these factors can lead to a greater fear of dementia [11, 40]. Furthermore, the probability of developing dementia increases significantly with age, which could explain a greater fear with increasing age. However, in this study, the opposite was found. One possible explanation for this could be the increasing life expectancy in today’s society [31]. Thus, the current young generation has a higher life expectancy than the current older generation. Since dementia is usually a disease of old age and people are getting older on average and are therefore more affected [31], it makes sense to fear such a disease more. Thus, the “subjective distance to death” theory [23], which says that people experience more psychological stress and therefore possibly also fear toward the end of their lives, does not apply to this study. Sun et al. [41] also demonstrated an association between suffering less from fear of dementia with increasing age. They assumed that younger people in particular may be more afraid of developing dementia themselves due to their possible experiences of caring for relatives and the possibility of inheriting diseases such as dementia.
In our study, we found that more depressive as well as more anxiety symptoms are associated with greater fear of dementia. This result is consistent with previous studies that have found similar associations [41, 42]. Possible explanations include the idea that depressive symptoms may lead to a lower level of resilience [43]. Accordingly, a person is more vulnerable to diseases or could have trouble managing a disease [43]. This could be part of the explanation as to why people with more depressive symptoms fear dementia more. In addition, loneliness could also play a role. It is well known that loneliness is a risk factor in the incidence of dementia [44–46]. Consequently, the fear of a lack of care from the environment in the case of dementia appears to be plausible. Furthermore, the loss of quality of life that people with depressive symptoms may experience [47] is associated with subjective cognitive impairment [48]. This could also help explain the association between depressive symptoms and fear of dementia.
In our study, we found that being single, widowed, divorced or partnership in a separate household is associated with a greater fear of dementia. Even though this factor is not often examined, Cantegreil-Kallen and Pin were also able to establish an association between living alone and a greater fear of dementia [12]. One possible explanation for this association may be that people living alone often feel less joy in life than people in a partnership [49, 50]. A lack of joy in life and happiness results in an increased risk of disease and mortality [51]. In this negative view of the future, a dementia disease that one has to cope with without a partner is also more likely. Since those with dementia are relatively dependent on help from one’s environment and single people may have poorer access to potential informal care due to the lack of a partner [52], the fear of the disease could then also be greater if one knows that one will be in this situation without help. For a contrary result, Cutler and Hodgson suggested that married people may be afraid of caring for a partner with dementia [53].
Strengths and Limitations
A main strength of this study was the large sample size (4,000 participants). Moreover, the study was based on a quota sample of the general adult population aged 40–70 years, which was representative in terms of age group, state and sex. This study includes individuals from different age groups which can provide valuable insights into the differences in the levels of fear of dementia among different age groups. Furthermore, the use of an online survey for data collection allows for easy and convenient access to participants, which can increase the response rate and reduce the potential for bias introduced by the presence of an interviewer. More precisely, participants in an online survey may feel more comfortable answering sensitive questions about their anxiety around dementia since they can do so anonymously, which can lead to a more honest response [54].
The use of an online survey may introduce self-selection bias since only individuals who are comfortable with and have access to the Internet can participate. This means our sample may not be fully representative of the entire population (e.g., in terms of education or age group) i.e., one cannot dismiss the possibility that well-educated individuals are somewhat overrepresented. However, it is noted that the impact of potential bias is not perceived to be significant, in view of the ubiquity of Internet use, including among older generations. In this study, fear of dementia was measured using the same tool as in Hajek and König [9]. There is the possibility of using different questionnaires. For example, there is the “Dementia Worry Scale” [10], the “Fear of Alzheimer’s Disease Scale” [15, 16] or the modified “Cancer Worry Scale” [8]. Here, the questions are also asked with the help of Likert scales.
Conclusion
Study findings showed that fear of dementia is related to health-related factors, age, and gender. Lifestyle factors and other socioeconomic factors were only occasionally significant. This knowledge can assist in characterizing individuals with a greater fear of dementia and offers a starting point for programs to reduce people’s fear.
Statement of Ethics
The Local Psychological Ethics Committee of the University Medical Center Hamburg-Eppendorf approved the project (LPEK-0385). Written informed consent was provided by all individuals prior to participation.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
This study was not supported by any sponsor or funder.
Author Contributions
J.L.M.: conceptualization, data curation, formal analysis, investigation, methodology, software, writing – original draft, and visualization. E.B.S.: writing – review and editing, conceptualization, and data curation. H.H.K.: writing – review and editing. A.H.: conceptualization, data curation, writing – review and editing, and supervision. All authors have read and agreed to the published version of the manuscript.
Funding Statement
This study was not supported by any sponsor or funder.
Data Availability Statement
Data are not publicly available due to ethical restrictions but interested parties may contact the authors for more information. Further inquiries can be directed to the corresponding author (jan-luca.meyer@outlook.de).
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data are not publicly available due to ethical restrictions but interested parties may contact the authors for more information. Further inquiries can be directed to the corresponding author (jan-luca.meyer@outlook.de).