Sensory Drivers of Dental Phobia in the older adults: A Cross-age Study Based on an Integrated Kano-IPA Model

Background With the accelerating aging of society, oral health issues among the older adults are becoming increasingly prominent. Dental anxiety (DA) or dental phobia (DF) is significant psychological barriers that prevent patients from receiving necessary treatment. However, existing research mostly focuses on children and general adults, lacking in-depth exploration of the elder adults from a multi-sensory environmental perspective. Objective Guided 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 the anxiety of older adults patients, identify the priority order of phobia elements, and analyze differences among the older adults of different ages, so as to provide a basis for optimizing the diagnosis and treatment environment and formulating targeted intervention measures. Methodology: A cross-sectional survey design was adopted. From December 2024 to August 2025, a questionnaire survey was conducted among 968 older adults 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 inducing anxiety) and satisfaction (satisfaction with the current dental hospital) 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, thereby proposing an optimization design plan. Results This 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 inducing anxiety in older adults 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, anxiety levels of very older adults patients towards the core treatment stimuli significantly intensified, and they focused more on basic treatment needs, while their expectations for environmental comfort needs tended to be simplified. Conclusion In the dental diagnosis and treatment environment, direct sensory stimuli related to treatment are the main sources of anxiety for older adults patients, and the impact increases with age. Dental medical institutions should prioritize interventions for high-anxiety 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 anxiety and improve the patient experience and oral health levels.