Sensory drivers of dental fear in the older adults: a cross-age study based on an integrated Kano-IPA model.

backgroundWith the accelerating aging of society, oral health issues among older adults are becoming increasingly prominent. Dental fear (DF) is a significant psychological barrier that prevent patients from receiving necessary treatment. However, existing research mostly focuses on children and general adults, lacking in-depth exploration of older adults from a multi-sensory environmental perspective.

objectiveGuided by the Five Senses Theory, this study aims to systematically investigate the impact of different sensory stimuli in the dental diagnosis and treatment environment on fear among older adult patients, identify the priority order of fear-inducing elements, and analyze differences among the older adults of different ages, in order to inform the optimization of clinical environments and the formulation of targeted interventions. METHODOLOGY: A cross-sectional survey design was adopted. From December 2024 to August 2025, a questionnaire survey was conducted among 968 older adult patients aged 60 and above at the Hospital of Stomatology Xi’an Jiaotong University and Affiliated Stomatological Hospital of Xuzhou Medical University. Based on literature review, patient and expert interviews, an evaluation system containing 20 indicators across 5 dimensions (vision, hearing, olfaction, gustation, touch) was constructed. Using the Kano-IPA model, the importance (severity of fear induction) and satisfaction (current state in the dental setting) of each sensory stimulus factor were analyzed. A stratified comparison was conducted across three age groups: 60–69, 70–79, and 80 and above, to quantitatively analyze indicators and determine the priority of design indicators for patients of different ages.

resultsThis study found that sensory experiences directly related to treatment, such as tactile pain from anesthesia injections, visual impressions of medical devices, and auditory noise from equipment, were core factors fear-inducing in older adult patients, with the importance scores being the highest (all > 4.2) and the satisfaction scores being the lowest (all < 2.8). The Kano-IPA model further identified seven indicators that were consistently categorized as must-be elements across three age groups, i.e., high importance-low satisfaction, representing common core demands that cause anxiety and require the highest priority for improvement. As age increases, fear towards core treatment stimuli significantly intensified, and patients’ expectations shifted toward basic treatment needs, with reduced emphasis on environmental comforts.

conclusionIn the dental diagnosis and treatment environment, direct sensory stimuli related to treatment are the main sources of anxiety for older adult patients, and the impact increases with age. Dental medical institutions should prioritize interventions for high-fear core aspects, such as promoting painless treatment, optimizing device design, and reducing equipment noise. Simultaneously, differentiated and precise environmental optimization and service improvement strategies should be formulated according to the needs of the older adults of different age groups to effectively alleviate their dental fear and improve the patient experience and oral health levels.