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

Sensory Drivers of Dental Phobia in the older adults: A Cross-age Study Based on an Integrated Kano-IPA Model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sensory Drivers of Dental Phobia in the older adults: A Cross-age Study Based on an Integrated Kano-IPA Model Mengting Li, Kexin Wei, Meng Zhou, Yameng Si, Zhenzhen Wang, Jiabin Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7695253/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Feb, 2026 Read the published version in BMC Geriatrics → Version 1 posted 16 You are reading this latest preprint version Abstract 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. Kano-IPA model the older adults dental hospital dental anxiety Figures Figure 1 Figure 2 Figure 3 Figure 4 1 Introduction In recent decades, the number of the older adults in China has increased significantly, reaching 260 million people aged 60 and above (accounting for 22% of the total population) [ ] . This has influenced the expansion of research targeting this age group, particularly the research concerning maintaining the health and quality of life of the older adults. The maintenance of quality of life in the older adults is inseparable from their own health status [ ] . The connection between oral health and overall health is particularly evident in the older adults [ ] . Poor oral health can exacerbate general health risks and directly lead to impaired chewing in the older adults, thereby reducing nutritional intake [ ] . Similarly, the high prevalence of polypharmacy in this group may further complicate the impact on oral health [ ][ ] . Embarrassment about tooth shape or missing teen, discolored, or damaged teeth can negatively affect the social interactions and mental health of the older adults [ ][ ] . Taking China as an example, according to the results of the 4th National Oral Health Survey, adults aged 65 and above account for 50% to 60% of patients visiting dental hospitals or dental departments. The average number of missing teeth per person among adults aged 65 to 74 is 7.5, and the proportion of total anodontia is 4.5%. Approximately 63.2% of agomphious older adults wear dentures [ ] . Their periodontal health rate is only 9.3%, while the caries prevalence is as high as 98% [ ] . This survey indicates that the aging of China's population is closely related to oral health demands. Therefore, addressing the oral healthcare of the older adults is a key public health issue that the field of oral healthcare must consider. Regular dental check-ups are very important for maintaining oral health. However, anxiety about dental services and treatment is a significant obstacle to maintaining good oral health [ ] . In the context of dental visits, dental anxiety (DA) or dental phobia (DF) is a prevalent psychological disorder [ ] , characterized by persistent, excessive nervousness, phobia, or avoidance of dental treatment and related environment [ ] . Studies have shown that high levels of dental anxiety not only lead patients to delay or cancel treatment, worsening oral diseases [ ][ ] , and forming a vicious cycle of "phobia-worsening condition-more phobia", but also cause significant negative impacts on their overall health and quality of life [ ] . This is a global public health problem and widely affects people of all ages and regions [ ][ ] . Previous research on dental anxiety has mostly focused on children or general adult populations. Existing research indicates that the occurrence of dental anxiety is related to multiple factors, including psychological traits, past experiences, and environmental stimuli [ ][ ][ ][ ][ ] . Current research findings on dental anxiety in the older adults mainly focus on socioeconomic status, gender, and satisfaction with dental care services [ ][ ][ ] . Pain from treatment and self-perceived oral health status are considered main factors leading to dental anxiety in the older adults [ ][ ] . However, although the aforementioned research reveals the importance of demographic characteristics and psychological factors, a key dimension remains under-explored: the stimulating impact of the dental diagnosis and treatment environment on older adults patients. The dental visit is an intense multi-sensory process [ ] , involving the visual environment of the clinic, auditory stimuli during treatment, the vulnerable posture sitting in the dental chair, and even unpleasant odors and the smell of blood from treatment are examples of environmental factors influencing dental anxiety [ ][ ][ ] . Sensory functions of older adults adults, such as vision and hearing generally degenerate [ ][ ] . This may alter their perception and processing of stimuli in the dental diagnosis and treatment environment, thereby exacerbating discomfort and phobia triggered by certain specific sensory inputs, and may differ significantly from young people. Therefore, there is an urgent need for a more integrated theoretical perspective to deeply analyze the multi-sensory factors of dental anxiety in the older adults within the dental diagnosis and treatment environment and their priorities. This study intends to introduce the Five Senses Theory to construct specific and measurable sensory dimension questions, thereby enabling more precise identification of root causes of problems. This theory originates from fields such as environmental psychology, customer praxiology, and neurosciences [ ] . Its core argument is that cognitive, emotional, and behavioral responses of humans to the environment are not determined by a single sense but are co-shaped by information received through the five sensory channels: vision, hearing, touch, smell, and taste [ ][ ] . The Five Senses Theory emphasizes that multi-sensory experience is the foundation for constructing overall perception and emotional valence (positive or negative) [ ] . Especially among the older adults, who are more sensitive to the environment, the connection between sensory experience and emotional response is more significant. In the context of dental visits, older adults people often have their dental anxiety induced or exacerbated by multiple sensory stimuli. This anxiety not only affects their visit experience but may also lead to avoidance behavior, thereby affecting oral health status. Therefore, analyzing the impact mechanism of various environmental sensory factors on the emotions of older adults patients has important practical significance. This study introduces and modifies the Kano-IPA model, and employs a questionnaire survey approach based on the Five Senses Theory framework, to systematically investigate the phobia factors and the severity caused by the environment across sensory dimensions for older adults patients of different ages during dental visits. This study systematically explores the following core questions: (1) Identify the key multi-sensory stimulus sources that trigger dental anxiety in the older adults and their severity during dental visits; (2) Explore whether there are significant differences in the sensory drivers of phobia among the older adults of different ages; (3) Determine the priority for environmental and service interventions targeting dental anxiety in the older adults. The expected outcomes of this study will help deepen the understanding of the multi-dimensional causes, differences, and priorities for intervention of dental anxiety in the older adults within the dental visit environment from a multi-sensory environmental perspective. It will provide an efficient and reliable method for investigating phobia factors suitable for the older adults, and offer empirical evidence for dental medical institutions to optimize the diagnosis and treatment environment, improve service processes, and develop personalized phobia alleviation interventions, ultimately enhancing the patient experience and oral health levels of older adults patients. 2 Methodology 2.1 Study samples A cross-sectional survey design was adopted in this study. Data will be collected at the Hospital of Stomatology Xi’an Jiaotong University and Department of Geriatrics, Affiliated Stomatological Hospital of Xuzhou Medical University from January 2025 to August 2025. The study subjects were older adults people aged 60 and above requiring dental treatment. A total of 1,000 questionnaires were distributed, and 968 valid questionnaires were collected. Inclusion criteria for study objects: 1) Age ≥ 60 years; 2) Clear consciousness and ability to complete questionnaires; 3) No severe cognitive impairment; 4) History of dental visits. Exclusion criteria: 1) History of severe mental illness; 2) Neurodegenerative diseases (e.g., Alzheimer's disease); 3) Inability to communicate effectively. This study was approved by the Xuzhou Stomatological Hospital Ethics Committee (No. 2024-KY-001-01), and all subjects signed informed consent forms. 2.2 Methodology and process 2.2.1 Indicator system Indicators for this study were selected from 3 sources. (1) Existing research literature and design cases [ ][ ][ ][ ][ ] . (2) Interviews related to the sampled older adults population. A total of 30 older adults patients visiting the Hospital of Stomatology Xi’an Jiaotong University and Department of Geriatrics, Affiliated Stomatological Hospital of Xuzhou Medical University were selected for interviews, in which they were guided to describe the anxiety factors in the dental hospital environment. (3) Expert interviews. A total of 25 medical staff from the Hospital of Stomatology Xi’an Jiaotong University, Affiliated Stomatological Hospital of Xuzhou Medical University and experts and scholars in the field of environmental design from universities were invited for interviews, in which they described factors causing anxiety in the older adults in the hospital environment across different sensory levels and the descriptions were recorded. After data screening and categorization, 20 indicators across 5 dimensions were extracted to construct the indicator system (Table 1 ). Table 1 Questionnaire Evaluation Indicators Five senses indicators Description VP (visual perception) VP1 color Visual perception of cool colors such as white, gray, blue in the hospital VP2 lighting Visual perception of LED cool lighting and bright light environments, etc., in the hospital VP3 medical devices Visual perception of devices such as needles, dental drills, forceps VP4 facilities Visual perception of facilities such as metal chairs, plastic facilities, electronic guides, glass partitions VP5 medical staff image Visual perception of medical staff's white coats, masks, etc. VP6 human behavior Visual perception of other patients receiving treatment, other patients waiting for treatment, medical staff activities AP (auditory perception) AP1 tool noise Sounds produced by drills or other treatment devices AP2 human noise Sounds generated by conversations of other patients, etc. AP3 background sound Environmental sounds such as calling numbers, music in the hospital, broadcasts AP4 medical staff voice Medical staff's service attitude, tone, speech rate, etc. OP (olfactory perception) OP1 medicinal odor Odors from disinfectant, treatment medicines OP2 air circulation Odors in environment, lack of air purification OP3 treatment activities Odors caused by treatment behaviors like tooth grinding GP (gustatory perception) GP1 chemicals Gustatory sensations from agents such as anesthesia, mouthwash GP2 devices Odors from cotton balls, gauze, medical gloves GP3 treatment behavior Gustatory sensations such as blood taste, burning sensation during treatment TP (tactile perception) TP1 devices Foreign body sensation from medical devices such as mouth mirrors, probes, saliva ejectors TP2 treatment sensation Tactile discomfort such as pain from anesthesia injections, soreness from dental drills TP3 facility sensation Discomfort from facilities such as dental chairs, seats TP4 proprioceptive sensation Discomfort such as muscle soreness from prolonged mouth opening during treatment, and muscle tension from nervousness 2.2.2 Questionnaires Quantitative analysis based on questionnaire survey was adopted in this study, during which respondents were required to indicate their perceptions of the listed items. The questionnaire consisted of three parts: The first part was the demographic details of the respondents, such as age, gender, dental treatment experience, etc. The second part was the evaluation questionnaire on the importance of five-senses stimuli regarding the 20 indicators across 5 dimensions. The third part was the evaluation questionnaire on the satisfaction regarding five-senses stimuli. Regarding the 20 indicators. Each indicator was scored using a Likert 5-point scale. A score of 1 indicated very minimal influence or very dissatisfaction with the current state of the indicator, A score of 5 indicated very important influence or very satisfied with the current state of the indicator. The questionnaire was filled out one-on-one. For patients with reading difficulties, the investigators filled it out on their behalf according to their wishes to ensure their true intentions were accurately recorded. Finally, the data were statistically analyzed with SPSS 26.0. 2.2.3 Kano-IPA Model The Kano model is a methodology for systematically understanding user needs and expectations (Xie Z et al. 2024) [ ] . This model categorizes user needs into five typical types: Must-be Quality (M), One-dimensional Quality (O), Attractive Quality (A), Indifferent Quality (I), and Reverse Quality (R). This model can classify need types, thus allowing for a reasonable classification of needs in design. The IPA model is a comprehensive analysis method consisting of two dimensions: importance and performance. The IPA is divided into four quadrants, typically measured on the horizontal axis by the level of user-perceived importance and on the vertical axis by the level of user-perceived satisfaction [ ] . Kurt Matzler et al. proposed the Kano-IPA model [ ] . The Kano-IPA model combines the Kano model's consideration of implicit importance and the IPA model's non-linear and asymmetric relationship between element performance and overall satisfaction [ ] . It is particularly suitable for analyzing multi-dimensional and non-linear environmental elements. Data collection is concise and easy to understand, and the analysis framework is clear and explicit, which enables decision-makers to clarify the priority of element improvement, thereby allocating resources more effectively [ ][ ] . The results of the five-senses stimulus importance evaluation questionnaire were used as the horizontal (X) axis, and the results of the five-sense stimulus satisfaction evaluation questionnaire were used as the vertical (Y) axis (Fig. 1 ). The average value of these two dimensions was used as the coordinate origin [ ] . Factors located in the first quadrant are one-dimensional elements (O), with high satisfaction and importance. They are the factors older adults patients fear most, but that are currently well addressed. Factors in the second quadrant are attractive elements (A), with high satisfaction. However, their importance is not high enough to indicate that such needs are over-concerned. This indicates that current older adults patients are not deeply fearful of these indicators and that the current situation is well handled. Indicators in the third quadrant are indifferent elements (I), with low satisfaction and importance. They are factors older adults patients find less anxiety-inducing and have not yet been properly addressed or intervened. Indicators in the fourth quadrant are must-be elements (M), with low satisfaction but high importance. It indicates that such indicators are more anxiety-inducing for older adults patients and currently cause dissatisfaction. Based on the Kano-IPA model, the relative priority of environmental elements is sorted from high to low as follows: must-be elements, one-dimensional elements, attractive elements, and indifferent elements. 3 Results 3.1 Socio-demographic characteristics A total of 968 respondents participated in this study (Table 2 ). Among them, 388 were aged 60–69, 347 was aged 70–79, and 233 aged 80 and above. The average age of the respondents was 70.97 years old. 467 respondents were male, and 501 were female. 679 respondents were agomphious, accounting for over 70%. 906 respondents had varying degrees of dental diseases such as periodontal disease and caries. Only 39 older adults people rated their oral condition as "basically normal", accounting for only 4.03%. 639 respondents, i.e., over 66%, had visited the hospital more than 10 times. 329 respondents had visited the hospital between 1–10 times. In previous visit experiences, over 72% of respondents, 697 older adults people, believed that the dental visit experience was dominated by negative emotions such as phobia, fright, and anxiety. Overall, the surveyed older adults were mainly from the younger older adults population, with a balanced gender distribution. This population commonly experienced dental diseases and agomphosis, had frequent visit experiences, and the vast majority held negative emotions towards previous dental visit experiences. Table 2 Socio-demographic Characteristics Questionnaire Results Indicator Number of people Percentage Gender Male 467 48.24% Female 501 51.76% Age 60–69 388 40.08% 70–79 347 35.85% 80 and above 233 24.07% Oral condition (Multiple choice) Basically normal 39 4.03% Agomphiasis 679 70.14% Presence of dental diseases such as periodontal disease and caries 906 93.60% Number of visits 1–5 visits 103 10.64% 6–10 visits 226 23.35% More than 10 visits 639 66.01% Previous visit experience Mainly negative emotions such as phobia, fright and anxiety 697 72.00% Mainly positive emotions such as reassurance, relaxation, comfort 57 5.89% General or no feeling 214 22.11% 3.2 Evaluation results of five-senses stimulus importance and satisfaction This study conducted a comprehensive evaluation of the importance and satisfaction of five-sense stimuli in the dental hospital environment for 968 older adults people. Overall (Table 3 ), the sensory stimulus factors considered most likely to cause anxiety and most important by the older adults group were all highly related to direct treatment experience. Among all 20 indicators, TP2 in tactile perception, such as pain from anesthesia injections and soreness from dental drills, and VP3 in visual perception, such as the visual impression of needles and dental drills, tied for the most important sources of anxiety (both 4.39). Followed closely were AP1 in auditory perception, such as sounds produced by drills or other treatment devices (4.29), VP6 in visual perception, such as scenes of other patients receiving treatment, other patients waiting for treatment, and medical staff activities (4.24), and TP4 in tactile perception, such as discomfort such as muscle soreness from prolonged mouth opening during treatment, and muscle tension from nervousness (4.21). The last three indicators in terms of importance were VP4 in visual perception, such as metal chairs, plastic facilities, electronic guides, glass partitions (2.63), AP3 in auditory perception, such as calling numbers, music in the hospital, broadcasts (2.86), and TP1 in tactile perception, such as foreign body sensation from medical devices including mouth mirrors, probes and saliva ejectors (2.95) In contrast, older adults people's satisfaction with the current environment of the Hospital of Stomatology Xi’an Jiaotong University and Department of Geriatrics, Affiliated Stomatological Hospital of Xuzhou Medical University was generally lower than the importance, indicating a significant experience gap. The indicators with the lowest satisfaction were also concentrated on the core treatment experience, with TP2 satisfaction (2.19) being the lowest among all indicators. The satisfaction of AP1 (2.59) and VP3 (2.59) were also extremely low. Conversely, the satisfaction with VP5, such as medical staff's clothing, masks and other image elements (3.82), OP2, such as air purification effectiveness (3.55), and AP4, such as medical staff's service attitude, tone, speech rate, etc. (3.52) was relatively high. Table 3 Evaluation Results of Five-senses Stimulus Importance and Satisfaction for the Older adults of Different Age Groups Five senses indicators Overall importance Overall satisfaction Low age group (60–69 years) Mid age group (70–79 years) High age group (80 years and above) Importance Satisfaction Importance Satisfaction Importance Satisfaction Visual perception VP1 3.64 3.06 3.37 3.04 3.77 3.09 3.89 3.05 VP2 4.12 3.14 4.01 3.13 4.10 3.16 4.33 3.12 VP3 4.39 2.59 4.23 2.61 4.49 2.57 4.51 2.58 VP4 2.63 2.92 2.47 2.89 2.68 3.02 2.82 2.84 VP5 3.29 3.82 3.22 3.91 3.36 3.72 3.32 3.81 VP6 4.24 2.78 4.14 2.82 4.25 2.77 4.39 2.71 Auditory perception AP1 4.29 2.59 4.26 2.65 4.30 2.58 4.31 2.50 AP2 3.23 3.07 3.15 3.03 3.23 3.13 3.37 3.03 AP3 2.86 3.06 2.86 3.12 2.84 3.06 2.90 2.97 AP4 3.95 3.52 3.92 3.54 3.97 3.51 3.95 3.52 Olfactory perception OP1 3.87 3.24 3.88 3.27 3.88 3.23 3.81 3.21 OP2 3.70 3.55 3.67 3.58 3.72 3.54 3.73 3.53 OP3 3.48 2.89 3.21 2.97 3.66 2.88 3.68 2.79 Gustatory perception GP1 3.32 3.02 3.09 3.10 3.45 2.99 3.53 2.93 GP2 2.95 3.25 2.74 3.36 3.07 3.24 3.12 3.08 GP3 3.89 2.71 3.81 2.74 3.94 2.72 3.96 2.66 Tactile perception TP1 4.06 2.78 3.99 2.89 4.06 2.81 4.17 2.56 TP2 4.39 2.19 4.34 2.31 4.41 2.06 4.45 2.17 TP3 3.91 3.09 3.92 3.09 3.89 3.11 3.92 3.08 TP4 4.21 2.80 4.13 2.87 4.25 2.75 4.30 2.76 3.3 Kano-IPA model analysis results for the older adults of different ages Based on the Kano-IPA model analysis method, a four-quadrant coordinate system was established in this study, with the average values of importance and satisfaction of the three age groups as the coordinate origin. This system was used for detailed classification evaluation of the 20 five-sense stimuli indicators, and to deeply analyze the need differences and priorities of each age group. Low age group (60–69 years)(Fig. 2 ): With the average value of importance (3.67) and the average value of satisfaction (3.05) as the origin of the coordinate system, the results showed: One-dimensional elements (O) involved only 5 indicators, including OP2, AP4, OP1, VP2, and TP3. Their high satisfaction indicates that the current performance of the hospital in these aspects meets the expectations of this age group. Attractive elements (A) involved 4 indicators, including GP1, AP3, GP2, VP5. These are not core concerns for this group, but the current situation is satisfactory. Indifferent elements (I) involved 4 indicators, including VP1, VP4, AP2, OP3. These elements do not attract significant attention or dissatisfaction from this group. Must-be elements (M) involved 7 indicators, including TP1, TP4, VP6, GP3, VP3, AP1, and TP2. These elements are the core sources of anxiety for younger older adults patients, but their satisfaction levels were all below the average of this group, especially TP2 having the lowest satisfaction. Middle age group (70–79 years)(Fig. 3 ): With the average value of importance (3.77) and the average value of satisfaction (3.00) as the origin of the coordinate system, the results showed: One-dimensional elements (O) involved 5 indicators, including VP1, OP1, TP3, VP2, and AP4. Attractive elements (A) involved 6 indicators, including OP2, VP5, AP2, GP2, AP3, and VP4. Indifferent elements (I) involved only 2 indicators, including GP1, OP3. Must-be elements (M) involved 7 indicators, including GP3, TP1, VP6, TP4, AP1, TP2, and VP3. Notably, the satisfaction with treatment sensation (TP2) plummeted to the lowest of all indicators in this age group (2.06), indicating that pain management is the worst experienced aspect for 70-79-year-olds. High age group (80 years and above) (Fig. 4 ): With the average value of importance (3.82) and the average value of satisfaction (2.94) as the origin of the coordinate system, the results showed: One-dimensional elements (O) involved 4 indicators, including VP1, TP3, AP4, and VP2. Their satisfaction slightly rebounded, indicating that a professional image is crucial for stabilizing the emotions of the very older adults. Attractive elements (A) involved 6 indicators, including OP1, OP2, AP2, GP2, AP3, and VP5. Indifferent elements (I) involved only 3 indicators, including VP4, GP1, and OP3. Must-be elements (M) still involved 7 indicators, including GP3, TP1, TP4, VP6, VP3, AP1, and TP2. The comparison indicated that as age increases, the number of must-be elements hardly differs, but the quantitative values change. TP2, VP3, AP1, VP6, GP3, TP4, and TP1, these seven elements with high importance and low satisfaction, were categorized as must-be elements in all age groups, indicating that they are the core sources causing dental visit anxiety in older adults patients and should be prioritized for improvement. The number of one-dimensional elements decreased. The importance scores of these 7 indicators mostly increase with age, such as VP3, which increases from 4.23 in the low age group to 4.51 in the high age group, indicating that the older the age, the higher the sensitivity and anxiety towards these factors. From the low age group to the high age group, the number of one-dimensional elements decreased, and their composition changed. In the low age group, VP2, OP1, AP4, OP2, TP3 were one-dimensional elements. However, in the middle age group, OP2 was not an one-dimensional element, and VP1 became a one-dimensional element. In the high age group, OP1 was not the one-dimensional elements, leaving only four one-dimensional elements. This change indicates that as age increases, older adults patients' expectations for environmental comfort become more focused on basic visual clarity, communication quality, and facility comfort, while their expectations for air environment and medicinal odors relatively decrease. The number of attractive elements gradually increases from 4 items in the low age group to 6 items in the middle and high age groups. This trend shows that as age increases, more environmental factors are seen as good added value rather than core needs. Notably, VP5 always remains in the category of attractive elements, and its satisfaction score was relatively high, indicating that a professional medical staff image is a bonus point for enhancing the visit experience at any age. Indifferent elements decreased from 4 items in the low age group to 2 items in the middle age group, and then to 3 items in the high age group, showing slight changes. GP1 and OP3 always belong to indifferent elements, indicating that older adults patients of different ages have relatively low attention and requirements for these factors. The gap between the satisfaction levels of other added indicators VP4 and VP1 and the average satisfaction of their group was not large, showing dynamic changes between indifferent elements (I) and one-dimensional elements (O). This indicates that these two indicators are neither pain points nor highlights. Overall, the older the age, the more sensitive and critical older adults patients become towards the dental environment. More types of sensory stimuli can trigger their anxiety, and dissatisfaction with the current situation is more common. 4 Discussion 4.1 Influencing factors of Kano-IPA model analysis results for the older adults of different ages In dental medical institutions, creating a calm and comfortable environment for the older adults and reducing their anxiety from different sensory levels to pursue better diagnosis and treatment outcomes remains a severe challenge. This study systematically analyzed the impact of different sensory stimuli in the dental visit environment on the anxiety of older adults patients based on the Five Senses Theory framework. The results of this study show that direct sensory experiences related to treatment, such as tactile injection pain, device operation soreness, visual impressions of medical devices, auditory device noise, and olfactory odors brought by treatment, are the most core factors inducing anxiety in older adults patients. This finding is highly consistent with previous research emphasizing that direct sensory discomfort is the result of causing dental anxiety [ ] . Existing research has confirmed that fear of bleeding, treatment pain, and self-perceived oral health status [ ] are the main factors of dental anxiety in the older adults. Factors such as odor [ ] , device noise [ ] , and the visual image of medical devices [ ] have also been confirmed to significantly impact dental anxiety. This study further clarifies specific sensory channels and their severity from a multi-sensory integration perspective. VP3 is the most important factor among all elements (severity of inducing anxiety), indicating that the visual image of medical devices causes relatively severe anxiety in older adults patients. The other indicators TP2, AP1, VP6, GP3, TP4, and TP1 caused varying degrees of anxiety in older adults patients and were factors they were particularly dissatisfied with. These factors were categorized as "must-be elements" (M) in all age groups, i.e., high importance-low satisfaction elements. This indicates that they are common root causes of anxiety. High levels of dental anxiety can lead patients to delay or cancel treatment [ ] , and they are also the aspects that should be prioritized for environmental and service improvement. As age increases, older adults patients' sensitivity and anxiety towards such direct and threatening stimuli significantly rise. For example, the importance score of the visual perception "medical devices" (VP3) in the 80 years and above group was as high as 4.51, significantly higher than that in the low age group. This may be related to the widespread sensory function degeneration [ ] , decline in cognitive flexibility [ ] , and enhanced perception of their own health vulnerability [ ] in the very older adults population. They focus more on the basic functional and safety needs during the treatment process, while their expectations for "comfort" or "value-added" elements in the environment, such as background music and space decoration, tend to be simplified. This finding resonates with previous research on the oral health-related quality of life of the older adults, namely that the older adults population pays more attention to functionality [ ][ ] . This study confirms the dynamic change pattern of this trend through age grouping. This result provides key evidence for dental medical institutions to implement precise intervention strategies specific to different age groups. Furthermore, non-treatment-related space environment elements, such as medical staff image (VP5), medical staff voice (AP4), and air purification (OP2), were classified as "Attractive" or "One-dimensional" elements in most groups. Although these elements can enhance visit satisfaction and trust, they are not the main sources of dental visit anxiety for the older adults population. This differs from conclusions found for child groups, where environmental design such as colors and smells can effectively reduce anxiety in children [ ] . It illustrates the differences in anxiety drivers between the older adults and child groups, and emphasizes the necessity of research targeting specific populations. This may be related to the fact that phobia in the older adults is more based on experience, knowledge, and real risks [ ][ ] . Their needs are more focused on safe and efficient solutions to the illness and getting through the treatment process. In addition, sensory function degeneration also affects their perception of the impact of environmental factors such as colors and sounds [ ] , causing changes in how they interact with the environment. Improving the dental visit experience for the older adults requires multi-dimensional efforts. Although efforts to alleviate anxiety should prioritize focusing on core treatment, space environment elements also need attention from older adults patients. These elements can, to some extent, alleviate patients' anxiety and other negative emotions, such as appropriate fragrance [ ] , comfortable colors [ ] , a kind and neat medical staff image [ ] , slow and gentle verbal guidance [ ] , etc. It is worth noting that the specific evaluation scores of these elements may be highly related to the subjective definition differences among the older adults. Taking background sound (AP3) as an example, judging from the numerical values, the satisfaction value of this indicator in the evaluation results of the three age groups is close to the average score and did not cause significant visit anxiety in the older adults. This may be related to the subjective feelings of the older adults towards the background broadcasts and music. In the research by Potter et al. (2017), some older adults people found the sound of music disturbing, while others found it interesting [ ] . Considering that these elements are greatly influenced by subjective feelings, comprehensive improvement may still struggle to meet the emotional needs of all older adults people. Therefore, research on improving these elements needs to be further explored. 4.2 Practical design improvements based on research results Based on the research results, the following development suggestions are proposed for the Hospital of Stomatology Xi’an Jiaotong University and Affiliated Stomatological Hospital of Xuzhou Medical University. Interventions should prioritize targeting high-anxiety core aspects, such as encouraging the comprehensive implementation of "painless treatment" techniques, popularizing painless anesthesia techniques, and informing patients of possible sensations before the operation, giving patients psychological expectations and a sense of control. Optimize device design, consider using devices with softer colors and more rounded shapes to reduce the coldness and sharpness of traditional devices. Prioritize low-noise treatment devices, use sound-absorbing and sound-insulating materials in clinic decoration, and consider providing patients with active noise cancellation (ANC) headphones to play light music or white noise, thus effectively neutralizing device noise. Optimize space layout and process management, reduce crowding in waiting areas and patient waiting time, and provide drinking water, reading materials and soothing videos to distract patients. Standardize the use of powerful suction devices to ensure timely removal of saliva, blood, and debris, thereby minimizing the chance for patients to sense odors. During long operations, medical staff should actively inform patients that they can close their mouth to rest and arrange short rest intervals. Provide comfortable neck pillows, lumbar supports, optimize the ergonomic support of dental chairs, and reduce physical strain. Furthermore, from a long-term perspective, use colors friendly to the older adults, such as beige, gray, and wood tones, to create a harmonious visual environment. Use wooden, fabric, or leather facilities, coupled with an emphasis on cleanliness and full functionality, to help advance the development of age-friendly dental clinics. Simultaneously enhance ventilation, increase the use of air purifiers, select neutral fragrances to improve the olfactory environment, and eliminate odors generated from treatment. Under the premise of equivalent efficacy, prioritize the use of mouthwashes or medications with more palatable flavors such as fruit, instead of traditional options with strong chemical tastes, so as to improve tolerability and reduce sensory irritation. 4.3 Innovations Dental anxiety involves multiple complex factors, and the perspective of the older adults is often overlooked in current research. Existing research on dental anxiety mostly focuses on children and general adults, and seldom involves environment-related analysis. Due to the intensifying social aging, the oral health of the older adults demographic is receiving growing concern. From the perspective of environmental psychology, systematically identifying the multi-sensory causes of dental anxiety in the older adults and determining their order of priority is crucial for promoting the dental health of older patients. Compared with previous research, this study innovatively integrates the Five Senses Theory from environmental psychology with the Kano model and Importance-Performance Analysis (IPA) from management decision science, thus constructing an interdisciplinary and systematic analytical framework for multi-sensory anxiety in the older adults. Different from previous research that mainly relied on a single perspective of psychology or clinical medicine, this framework regards dental anxiety as a product of the synergistic effect of multiple sensory inputs such as visual perception, auditory perception, tactile perception, olfactory perception, and gustatory perception, thus achieving a paradigm shift from "single-dimensional causal analysis" to "exploration of multi-sensory interaction and integration mechanisms", therefore deepening the understanding of the formation mechanism of dental anxiety. Meanwhile, this study has made adaptive improvements to the classic Kano-IPA model. By defining the "importance" dimension as "the severity of sensory stimulus inducing anxiety" and the "satisfaction" dimension as "the satisfaction with the management of that sensory stimuli", this study enables the quantitative measurement and visual representation of patients' negative emotions and perceptual experiences. This method effectively categorizes various sensory demands into attribute types (e.g., must-be, one-dimensional, attractive, indifferent) and reveals their relationship with overall anxiety levels. It further identifies key design improvement points and establishes clear priorities, thereby providing objective, detailed decision-making support and practical guidance for environmental upgrades, service process optimization, and human-centered enhancements in dental healthcare institutions. Furthermore, this study breaks away from the traditional limitation of viewing the older adults as a homogeneous group by conducting a detailed stratified age-based comparison (60–69 years, 70–79 years, 80 years and above). This design reveals that the sensory drivers of dental anxiety and their underlying structure evolve dynamically with advancing age. This phenomenon indicates a trend of "focus convergence" on core treatment-related stimuli among the very older adults population. This finding underscores the significant academic and practical value of shifting from a holistic "older adults" perspective to an "age-stratified" perspective, providing critical empirical evidence for developing precise and age-tailored intervention strategies. 4.4 Limitations Despite the meaningful findings obtained, this study still has several limitations. As for the study sample, due to time and funding constraints, the sample was drawn solely from a single large dental hospital, without covering institutions in regions with varying levels of economic development or primary healthcare settings. The single-source sample may limit the generalizability of the research results. Future research should incorporate multi-center and multi-regional samples to verify the broader applicability of the conclusions. In terms of research design, this study used a cross-sectional survey design, which only captured the evaluation results of the older adults at a specific time point. This makes it difficult to infer causal relationships and reflect how the evaluation results of the older adults evolve dynamically with increases in visit frequency, increases in familiarity with the hospital environment, and other subjective changes, which may lead to a lack of foresight and sustainability in derived strategies. Future research could use longitudinal tracking or experimental intervention to further verify the causal mechanism between sensory stimuli and anxiety, thereby providing more dynamically adaptive insights. Methodologically, this study relied primarily on self-reported questionnaires for data collection, which may introduce subjective bias. Although the team provided assistance during the survey, older participants, particularly the very older adults, may still have provided responses influenced by age-related declines in hearing, vision, and cognitive processing abilities. Future research could consider employing more objective and diverse methods to collect response data from the older adults, such as measuring physiological indicators (e.g., heart rate variability) and conducting behavioral observations, to enrich the data and enhance the accuracy and comprehensiveness of the analysis. 5 Conclusion Paying attention to and improving the multi-sensory experience in the dental environment, especially conducting precise interventions based on the differentiated needs of older adults patients of different ages, is an important way to alleviate their dental anxiety, improve visit compliance, and ultimately improve oral health levels. By integrating the Five-Sense Theory with the Kano-IPA model, this study took the Hospital of Stomatology Xi’an Jiaotong University and Affiliated Stomatological Hospital of Xuzhou Medical University as a case setting to systematically identify anxiety-inducing sensory factors and their severity levels among older adults patients during dental visits, while clarifying age-specific needs differences and intervention priorities. The main conclusions are as follows: (1) Treatment-related direct sensory experiences, such as pain, noise from device noise, and the visual impression of medical devices, constitute core sources of anxiety in older adults patients, with anxiety levels intensifying with age; (2) The very older adults patients tend to focus more on basic functional and safety-related needs during treatment, with simplified expectations regarding environmental comfort; (3) Non-treatment-related environmental factors, such as medical staff image and medical staff voice, can enhance the experience but are not the main drivers of anxiety; (4) age group-based analysis provides empirical evidence for formulating precise and differentiated strategies for optimizing the dental environment and improving services. This study innovatively combines multi-sensory theory with decision analysis models, moving beyond the conventional approach of treating the older adults as a homogeneous group. It offers evidence-based support for environmental upgrades and human-centered service improvements in dental healthcare institutions. Future research should expand sample the diversity of samples, incorporate longitudinal tracking, and integrate objective physiological measures to further validate and deepen the findings of this study. Abbreviations Kano IPA Kano Model-Importance-Performance Analysis Declarations Ethics approval and consent to participate Confirm that all experiments were performed in compliance with the Helsinki Declaration Consent for publication: Not applicable Competing interests: The authors declare that they have no competing interests Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution Mengting Li，Kexin Wei, Meng Zhou, Yameng Si: Writing–original draft, Methodology, Formal analysis, Data curation, Conceptualization. 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23:13:04","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17033,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7695253/v1/50d91c99efbbf30736f7dc61.png"},{"id":94047194,"identity":"d9b1826d-5532-4489-b37e-f1260599eb26","added_by":"auto","created_at":"2025-10-21 23:13:04","extension":"xml","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":105100,"visible":true,"origin":"","legend":"","description":"","filename":"0a49a960a25642799ccf5fc0154d5eb21structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7695253/v1/09063bc9bcaca52e08ab6bc2.xml"},{"id":94048199,"identity":"b0116b97-5fec-417a-88b3-1ee5638afbd0","added_by":"auto","created_at":"2025-10-21 23:21:04","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":119104,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7695253/v1/c55c2963157c6d13e5755fab.html"},{"id":94047184,"identity":"b3dd531f-ac26-4bb0-9775-e1e31fc8031a","added_by":"auto","created_at":"2025-10-21 23:13:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":285501,"visible":true,"origin":"","legend":"\u003cp\u003eKano-IPA Four-Quadrant Chart\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7695253/v1/447dc572b00d677eac2c7f86.png"},{"id":94047186,"identity":"341a5280-8329-463f-bcbd-c40861a03b54","added_by":"auto","created_at":"2025-10-21 23:13:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":157251,"visible":true,"origin":"","legend":"\u003cp\u003eKano-IPA results for the 60–69 age group\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7695253/v1/c953191d618bc60d4e887ee1.png"},{"id":94047192,"identity":"f94ad22b-c15c-4011-ac8a-109a50b93e35","added_by":"auto","created_at":"2025-10-21 23:13:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":156730,"visible":true,"origin":"","legend":"\u003cp\u003eKano-IPA results for the 70–79 age group\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7695253/v1/0d6dfe0f77d28d4f4b4fdc91.png"},{"id":94047198,"identity":"9dd4069c-2182-4baa-8aeb-d8c0dd06e268","added_by":"auto","created_at":"2025-10-21 23:13:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":156157,"visible":true,"origin":"","legend":"\u003cp\u003eKano-IPA results for the 80+ age group\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7695253/v1/546b24ad393425e2867e0a0b.png"},{"id":103252284,"identity":"d2fa12ec-0fe0-4fd6-b3e5-3299f8e3d19f","added_by":"auto","created_at":"2026-02-23 16:14:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1742973,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7695253/v1/e671c1e1-ff70-4eed-885e-a0cbc33cd8b0.pdf"},{"id":94048198,"identity":"03b1ec4e-cbfe-41ea-a37f-66a47b97239f","added_by":"auto","created_at":"2025-10-21 23:21:04","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":30900,"visible":true,"origin":"","legend":"","description":"","filename":"file.docx","url":"https://assets-eu.researchsquare.com/files/rs-7695253/v1/61f796c176b8812948bf9927.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sensory Drivers of Dental Phobia in the older adults: A Cross-age Study Based on an Integrated Kano-IPA Model","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eIn recent decades, the number of the older adults in China has increased significantly, reaching 260\u0026nbsp;million people aged 60 and above (accounting for 22% of the total population)\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. This has influenced the expansion of research targeting this age group, particularly the research concerning maintaining the health and quality of life of the older adults. The maintenance of quality of life in the older adults is inseparable from their own health status\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The connection between oral health and overall health is particularly evident in the older adults\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Poor oral health can exacerbate general health risks and directly lead to impaired chewing in the older adults, thereby reducing nutritional intake\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Similarly, the high prevalence of polypharmacy in this group may further complicate the impact on oral health\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Embarrassment about tooth shape or missing teen, discolored, or damaged teeth can negatively affect the social interactions and mental health of the older adults\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Taking China as an example, according to the results of the 4th National Oral Health Survey, adults aged 65 and above account for 50% to 60% of patients visiting dental hospitals or dental departments. The average number of missing teeth per person among adults aged 65 to 74 is 7.5, and the proportion of total anodontia is 4.5%. Approximately 63.2% of agomphious older adults wear dentures\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Their periodontal health rate is only 9.3%, while the caries prevalence is as high as 98%\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn10\" id=\"#FNLinkFn10\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. This survey indicates that the aging of China's population is closely related to oral health demands. Therefore, addressing the oral healthcare of the older adults is a key public health issue that the field of oral healthcare must consider.\u003c/p\u003e\u003cp\u003eRegular dental check-ups are very important for maintaining oral health. However, anxiety about dental services and treatment is a significant obstacle to maintaining good oral health\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn11\" id=\"#FNLinkFn11\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. In the context of dental visits, dental anxiety (DA) or dental phobia (DF) is a prevalent psychological disorder\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn12\" id=\"#FNLinkFn12\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, characterized by persistent, excessive nervousness, phobia, or avoidance of dental treatment and related environment\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn13\" id=\"#FNLinkFn13\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Studies have shown that high levels of dental anxiety not only lead patients to delay or cancel treatment, worsening oral diseases\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn14\" id=\"#FNLinkFn14\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn15\" id=\"#FNLinkFn15\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, and forming a vicious cycle of \"phobia-worsening condition-more phobia\", but also cause significant negative impacts on their overall health and quality of life\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn16\" id=\"#FNLinkFn16\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. This is a global public health problem and widely affects people of all ages and regions\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn17\" id=\"#FNLinkFn17\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn18\" id=\"#FNLinkFn18\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePrevious research on dental anxiety has mostly focused on children or general adult populations. Existing research indicates that the occurrence of dental anxiety is related to multiple factors, including psychological traits, past experiences, and environmental stimuli\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn19\" id=\"#FNLinkFn19\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn20\" id=\"#FNLinkFn20\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn21\" id=\"#FNLinkFn21\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn22\" id=\"#FNLinkFn22\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn23\" id=\"#FNLinkFn23\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Current research findings on dental anxiety in the older adults mainly focus on socioeconomic status, gender, and satisfaction with dental care services\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn24\" id=\"#FNLinkFn24\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn25\" id=\"#FNLinkFn25\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn26\" id=\"#FNLinkFn26\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Pain from treatment and self-perceived oral health status are considered main factors leading to dental anxiety in the older adults\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn27\" id=\"#FNLinkFn27\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn28\" id=\"#FNLinkFn28\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. However, although the aforementioned research reveals the importance of demographic characteristics and psychological factors, a key dimension remains under-explored: the stimulating impact of the dental diagnosis and treatment environment on older adults patients. The dental visit is an intense multi-sensory process\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn29\" id=\"#FNLinkFn29\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, involving the visual environment of the clinic, auditory stimuli during treatment, the vulnerable posture sitting in the dental chair, and even unpleasant odors and the smell of blood from treatment are examples of environmental factors influencing dental anxiety\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn30\" id=\"#FNLinkFn30\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn31\" id=\"#FNLinkFn31\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn32\" id=\"#FNLinkFn32\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Sensory functions of older adults adults, such as vision and hearing generally degenerate\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn33\" id=\"#FNLinkFn33\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn34\" id=\"#FNLinkFn34\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. This may alter their perception and processing of stimuli in the dental diagnosis and treatment environment, thereby exacerbating discomfort and phobia triggered by certain specific sensory inputs, and may differ significantly from young people. Therefore, there is an urgent need for a more integrated theoretical perspective to deeply analyze the multi-sensory factors of dental anxiety in the older adults within the dental diagnosis and treatment environment and their priorities.\u003c/p\u003e\u003cp\u003eThis study intends to introduce the Five Senses Theory to construct specific and measurable sensory dimension questions, thereby enabling more precise identification of root causes of problems. This theory originates from fields such as environmental psychology, customer praxiology, and neurosciences\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn35\" id=\"#FNLinkFn35\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Its core argument is that cognitive, emotional, and behavioral responses of humans to the environment are not determined by a single sense but are co-shaped by information received through the five sensory channels: vision, hearing, touch, smell, and taste\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn36\" id=\"#FNLinkFn36\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn37\" id=\"#FNLinkFn37\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The Five Senses Theory emphasizes that multi-sensory experience is the foundation for constructing overall perception and emotional valence (positive or negative)\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn38\" id=\"#FNLinkFn38\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Especially among the older adults, who are more sensitive to the environment, the connection between sensory experience and emotional response is more significant. In the context of dental visits, older adults people often have their dental anxiety induced or exacerbated by multiple sensory stimuli. This anxiety not only affects their visit experience but may also lead to avoidance behavior, thereby affecting oral health status. Therefore, analyzing the impact mechanism of various environmental sensory factors on the emotions of older adults patients has important practical significance. This study introduces and modifies the Kano-IPA model, and employs a questionnaire survey approach based on the Five Senses Theory framework, to systematically investigate the phobia factors and the severity caused by the environment across sensory dimensions for older adults patients of different ages during dental visits. This study systematically explores the following core questions:\u003c/p\u003e\u003cp\u003e(1) Identify the key multi-sensory stimulus sources that trigger dental anxiety in the older adults and their severity during dental visits;\u003c/p\u003e\u003cp\u003e(2) Explore whether there are significant differences in the sensory drivers of phobia among the older adults of different ages;\u003c/p\u003e\u003cp\u003e(3) Determine the priority for environmental and service interventions targeting dental anxiety in the older adults.\u003c/p\u003e\u003cp\u003eThe expected outcomes of this study will help deepen the understanding of the multi-dimensional causes, differences, and priorities for intervention of dental anxiety in the older adults within the dental visit environment from a multi-sensory environmental perspective. It will provide an efficient and reliable method for investigating phobia factors suitable for the older adults, and offer empirical evidence for dental medical institutions to optimize the diagnosis and treatment environment, improve service processes, and develop personalized phobia alleviation interventions, ultimately enhancing the patient experience and oral health levels of older adults patients.\u003c/p\u003e"},{"header":"2 Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study samples\u003c/h2\u003e\u003cp\u003eA cross-sectional survey design was adopted in this study. Data will be collected at the Hospital of Stomatology Xi\u0026rsquo;an Jiaotong University and Department of Geriatrics, Affiliated Stomatological Hospital of Xuzhou Medical University from January 2025 to August 2025. The study subjects were older adults people aged 60 and above requiring dental treatment. A total of 1,000 questionnaires were distributed, and 968 valid questionnaires were collected. Inclusion criteria for study objects: 1) Age\u0026thinsp;\u0026ge;\u0026thinsp;60 years; 2) Clear consciousness and ability to complete questionnaires; 3) No severe cognitive impairment; 4) History of dental visits. Exclusion criteria: 1) History of severe mental illness; 2) Neurodegenerative diseases (e.g., Alzheimer's disease); 3) Inability to communicate effectively. This study was approved by the Xuzhou Stomatological Hospital Ethics Committee (No. 2024-KY-001-01), and all subjects signed informed consent forms.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Methodology and process\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1 Indicator system\u003c/h2\u003e\u003cp\u003eIndicators for this study were selected from 3 sources. (1) Existing research literature and design cases\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn39\" id=\"#FNLinkFn39\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn40\" id=\"#FNLinkFn40\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn41\" id=\"#FNLinkFn41\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn42\" id=\"#FNLinkFn42\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn43\" id=\"#FNLinkFn43\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. (2) Interviews related to the sampled older adults population. A total of 30 older adults patients visiting the Hospital of Stomatology Xi\u0026rsquo;an Jiaotong University and Department of Geriatrics, Affiliated Stomatological Hospital of Xuzhou Medical University were selected for interviews, in which they were guided to describe the anxiety factors in the dental hospital environment. (3) Expert interviews. A total of 25 medical staff from the Hospital of Stomatology Xi\u0026rsquo;an Jiaotong University, Affiliated Stomatological Hospital of Xuzhou Medical University and experts and scholars in the field of environmental design from universities were invited for interviews, in which they described factors causing anxiety in the older adults in the hospital environment across different sensory levels and the descriptions were recorded. After data screening and categorization, 20 indicators across 5 dimensions were extracted to construct the indicator system (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eQuestionnaire Evaluation Indicators\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFive senses indicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eVP (visual perception)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP1 color\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVisual perception of cool colors such as white, gray, blue in the hospital\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP2 lighting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVisual perception of LED cool lighting and bright light environments, etc., in the hospital\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP3 medical devices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVisual perception of devices such as needles, dental drills, forceps\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP4 facilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVisual perception of facilities such as metal chairs, plastic facilities, electronic guides, glass partitions\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP5 medical staff image\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVisual perception of medical staff's white coats, masks, etc.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP6 human behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVisual perception of other patients receiving treatment, other patients waiting for treatment, medical staff activities\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAP (auditory perception)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAP1 tool noise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSounds produced by drills or other treatment devices\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAP2 human noise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSounds generated by conversations of other patients, etc.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAP3 background sound\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEnvironmental sounds such as calling numbers, music in the hospital, broadcasts\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAP4 medical staff voice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedical staff's service attitude, tone, speech rate, etc.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOP (olfactory perception)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOP1 medicinal odor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOdors from disinfectant, treatment medicines\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOP2 air circulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOdors in environment, lack of air purification\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOP3 treatment activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOdors caused by treatment behaviors like tooth grinding\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGP (gustatory perception)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGP1 chemicals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGustatory sensations from agents such as anesthesia, mouthwash\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGP2 devices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOdors from cotton balls, gauze, medical gloves\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGP3 treatment behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGustatory sensations such as blood taste, burning sensation during treatment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eTP (tactile perception)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTP1 devices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eForeign body sensation from medical devices such as mouth mirrors, probes, saliva ejectors\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTP2 treatment sensation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTactile discomfort such as pain from anesthesia injections, soreness from dental drills\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTP3 facility sensation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDiscomfort from facilities such as dental chairs, seats\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTP4 proprioceptive sensation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDiscomfort such as muscle soreness from prolonged mouth opening during treatment, and muscle tension from nervousness\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2 Questionnaires\u003c/h2\u003e\u003cp\u003eQuantitative analysis based on questionnaire survey was adopted in this study, during which respondents were required to indicate their perceptions of the listed items. The questionnaire consisted of three parts: The first part was the demographic details of the respondents, such as age, gender, dental treatment experience, etc. The second part was the evaluation questionnaire on the importance of five-senses stimuli regarding the 20 indicators across 5 dimensions. The third part was the evaluation questionnaire on the satisfaction regarding five-senses stimuli. Regarding the 20 indicators. Each indicator was scored using a Likert 5-point scale. A score of 1 indicated very minimal influence or very dissatisfaction with the current state of the indicator, A score of 5 indicated very important influence or very satisfied with the current state of the indicator. The questionnaire was filled out one-on-one. For patients with reading difficulties, the investigators filled it out on their behalf according to their wishes to ensure their true intentions were accurately recorded. Finally, the data were statistically analyzed with SPSS 26.0.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3 Kano-IPA Model\u003c/h2\u003e\u003cp\u003eThe Kano model is a methodology for systematically understanding user needs and expectations (Xie Z et al. 2024)\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn44\" id=\"#FNLinkFn44\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. This model categorizes user needs into five typical types: Must-be Quality (M), One-dimensional Quality (O), Attractive Quality (A), Indifferent Quality (I), and Reverse Quality (R). This model can classify need types, thus allowing for a reasonable classification of needs in design.\u003c/p\u003e\u003cp\u003eThe IPA model is a comprehensive analysis method consisting of two dimensions: importance and performance. The IPA is divided into four quadrants, typically measured on the horizontal axis by the level of user-perceived importance and on the vertical axis by the level of user-perceived satisfaction\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn45\" id=\"#FNLinkFn45\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eKurt Matzler et al. proposed the Kano-IPA model\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn46\" id=\"#FNLinkFn46\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. The Kano-IPA model combines the Kano model's consideration of implicit importance and the IPA model's non-linear and asymmetric relationship between element performance and overall satisfaction\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn47\" id=\"#FNLinkFn47\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. It is particularly suitable for analyzing multi-dimensional and non-linear environmental elements. Data collection is concise and easy to understand, and the analysis framework is clear and explicit, which enables decision-makers to clarify the priority of element improvement, thereby allocating resources more effectively\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn48\" id=\"#FNLinkFn48\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn49\" id=\"#FNLinkFn49\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe results of the five-senses stimulus importance evaluation questionnaire were used as the horizontal (X) axis, and the results of the five-sense stimulus satisfaction evaluation questionnaire were used as the vertical (Y) axis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The average value of these two dimensions was used as the coordinate origin\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn50\" id=\"#FNLinkFn50\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Factors located in the first quadrant are one-dimensional elements (O), with high satisfaction and importance. They are the factors older adults patients fear most, but that are currently well addressed. Factors in the second quadrant are attractive elements (A), with high satisfaction. However, their importance is not high enough to indicate that such needs are over-concerned. This indicates that current older adults patients are not deeply fearful of these indicators and that the current situation is well handled. Indicators in the third quadrant are indifferent elements (I), with low satisfaction and importance. They are factors older adults patients find less anxiety-inducing and have not yet been properly addressed or intervened. Indicators in the fourth quadrant are must-be elements (M), with low satisfaction but high importance. It indicates that such indicators are more anxiety-inducing for older adults patients and currently cause dissatisfaction. Based on the Kano-IPA model, the relative priority of environmental elements is sorted from high to low as follows: must-be elements, one-dimensional elements, attractive elements, and indifferent elements.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Socio-demographic characteristics\u003c/h2\u003e\u003cp\u003eA total of 968 respondents participated in this study (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among them, 388 were aged 60\u0026ndash;69, 347 was aged 70\u0026ndash;79, and 233 aged 80 and above. The average age of the respondents was 70.97 years old. 467 respondents were male, and 501 were female. 679 respondents were agomphious, accounting for over 70%. 906 respondents had varying degrees of dental diseases such as periodontal disease and caries. Only 39 older adults people rated their oral condition as \"basically normal\", accounting for only 4.03%. 639 respondents, i.e., over 66%, had visited the hospital more than 10 times. 329 respondents had visited the hospital between 1\u0026ndash;10 times. In previous visit experiences, over 72% of respondents, 697 older adults people, believed that the dental visit experience was dominated by negative emotions such as phobia, fright, and anxiety. Overall, the surveyed older adults were mainly from the younger older adults population, with a balanced gender distribution. This population commonly experienced dental diseases and agomphosis, had frequent visit experiences, and the vast majority held negative emotions towards previous dental visit experiences.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic Characteristics Questionnaire Results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of people\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.24%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51.76%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e388\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40.08%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u0026ndash;79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e347\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35.85%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.07%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOral condition\u003c/p\u003e\u003cp\u003e(Multiple choice)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBasically normal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.03%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAgomphiasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e679\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e70.14%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresence of dental diseases such as periodontal disease and caries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e906\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e93.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNumber of visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;5 visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.64%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10 visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.35%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 10 visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e639\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66.01%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePrevious visit experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMainly negative emotions such as phobia, fright and anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e697\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMainly positive emotions such as reassurance, relaxation, comfort\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.89%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral or no feeling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22.11%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Evaluation results of five-senses stimulus importance and satisfaction\u003c/h2\u003e\u003cp\u003eThis study conducted a comprehensive evaluation of the importance and satisfaction of five-sense stimuli in the dental hospital environment for 968 older adults people. Overall (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), the sensory stimulus factors considered most likely to cause anxiety and most important by the older adults group were all highly related to direct treatment experience.\u003c/p\u003e\u003cp\u003eAmong all 20 indicators, TP2 in tactile perception, such as pain from anesthesia injections and soreness from dental drills, and VP3 in visual perception, such as the visual impression of needles and dental drills, tied for the most important sources of anxiety (both 4.39). Followed closely were AP1 in auditory perception, such as sounds produced by drills or other treatment devices (4.29), VP6 in visual perception, such as scenes of other patients receiving treatment, other patients waiting for treatment, and medical staff activities (4.24), and TP4 in tactile perception, such as discomfort such as muscle soreness from prolonged mouth opening during treatment, and muscle tension from nervousness (4.21). The last three indicators in terms of importance were VP4 in visual perception, such as metal chairs, plastic facilities, electronic guides, glass partitions (2.63), AP3 in auditory perception, such as calling numbers, music in the hospital, broadcasts (2.86), and TP1 in tactile perception, such as foreign body sensation from medical devices including mouth mirrors, probes and saliva ejectors (2.95)\u003c/p\u003e\u003cp\u003eIn contrast, older adults people's satisfaction with the current environment of the Hospital of Stomatology Xi\u0026rsquo;an Jiaotong University and Department of Geriatrics, Affiliated Stomatological Hospital of Xuzhou Medical University was generally lower than the importance, indicating a significant experience gap. The indicators with the lowest satisfaction were also concentrated on the core treatment experience, with TP2 satisfaction (2.19) being the lowest among all indicators. The satisfaction of AP1 (2.59) and VP3 (2.59) were also extremely low. Conversely, the satisfaction with VP5, such as medical staff's clothing, masks and other image elements (3.82), OP2, such as air purification effectiveness (3.55), and AP4, such as medical staff's service attitude, tone, speech rate, etc. (3.52) was relatively high.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEvaluation Results of Five-senses Stimulus Importance and Satisfaction for the Older adults of Different Age Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eFive senses indicators\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003cp\u003eimportance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003cp\u003esatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eLow age group\u003c/p\u003e\u003cp\u003e(60\u0026ndash;69 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eMid age group\u003c/p\u003e\u003cp\u003e(70\u0026ndash;79 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003eHigh age group\u003c/p\u003e\u003cp\u003e(80 years and above)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eImportance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eImportance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eImportance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eVisual perception\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAuditory perception\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAP4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOlfactory perception\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGustatory perception\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eTactile perception\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e3.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTP4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Kano-IPA model analysis results for the older adults of different ages\u003c/h2\u003e\u003cp\u003eBased on the Kano-IPA model analysis method, a four-quadrant coordinate system was established in this study, with the average values of importance and satisfaction of the three age groups as the coordinate origin. This system was used for detailed classification evaluation of the 20 five-sense stimuli indicators, and to deeply analyze the need differences and priorities of each age group.\u003c/p\u003e\u003cp\u003eLow age group (60\u0026ndash;69 years)(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e): With the average value of importance (3.67) and the average value of satisfaction (3.05) as the origin of the coordinate system, the results showed:\u003c/p\u003e\u003cp\u003eOne-dimensional elements (O) involved only 5 indicators, including OP2, AP4, OP1, VP2, and TP3. Their high satisfaction indicates that the current performance of the hospital in these aspects meets the expectations of this age group. Attractive elements (A) involved 4 indicators, including GP1, AP3, GP2, VP5. These are not core concerns for this group, but the current situation is satisfactory. Indifferent elements (I) involved 4 indicators, including VP1, VP4, AP2, OP3. These elements do not attract significant attention or dissatisfaction from this group. Must-be elements (M) involved 7 indicators, including TP1, TP4, VP6, GP3, VP3, AP1, and TP2. These elements are the core sources of anxiety for younger older adults patients, but their satisfaction levels were all below the average of this group, especially TP2 having the lowest satisfaction.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMiddle age group (70\u0026ndash;79 years)(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e): With the average value of importance (3.77) and the average value of satisfaction (3.00) as the origin of the coordinate system, the results showed:\u003c/p\u003e\u003cp\u003eOne-dimensional elements (O) involved 5 indicators, including VP1, OP1, TP3, VP2, and AP4. Attractive elements (A) involved 6 indicators, including OP2, VP5, AP2, GP2, AP3, and VP4. Indifferent elements (I) involved only 2 indicators, including GP1, OP3. Must-be elements (M) involved 7 indicators, including GP3, TP1, VP6, TP4, AP1, TP2, and VP3. Notably, the satisfaction with treatment sensation (TP2) plummeted to the lowest of all indicators in this age group (2.06), indicating that pain management is the worst experienced aspect for 70-79-year-olds.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eHigh age group (80 years and above) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e): With the average value of importance (3.82) and the average value of satisfaction (2.94) as the origin of the coordinate system, the results showed:\u003c/p\u003e\u003cp\u003eOne-dimensional elements (O) involved 4 indicators, including VP1, TP3, AP4, and VP2. Their satisfaction slightly rebounded, indicating that a professional image is crucial for stabilizing the emotions of the very older adults. Attractive elements (A) involved 6 indicators, including OP1, OP2, AP2, GP2, AP3, and VP5. Indifferent elements (I) involved only 3 indicators, including VP4, GP1, and OP3. Must-be elements (M) still involved 7 indicators, including GP3, TP1, TP4, VP6, VP3, AP1, and TP2.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe comparison indicated that as age increases, the number of must-be elements hardly differs, but the quantitative values change. TP2, VP3, AP1, VP6, GP3, TP4, and TP1, these seven elements with high importance and low satisfaction, were categorized as must-be elements in all age groups, indicating that they are the core sources causing dental visit anxiety in older adults patients and should be prioritized for improvement. The number of one-dimensional elements decreased. The importance scores of these 7 indicators mostly increase with age, such as VP3, which increases from 4.23 in the low age group to 4.51 in the high age group, indicating that the older the age, the higher the sensitivity and anxiety towards these factors.\u003c/p\u003e\u003cp\u003eFrom the low age group to the high age group, the number of one-dimensional elements decreased, and their composition changed. In the low age group, VP2, OP1, AP4, OP2, TP3 were one-dimensional elements. However, in the middle age group, OP2 was not an one-dimensional element, and VP1 became a one-dimensional element. In the high age group, OP1 was not the one-dimensional elements, leaving only four one-dimensional elements. This change indicates that as age increases, older adults patients' expectations for environmental comfort become more focused on basic visual clarity, communication quality, and facility comfort, while their expectations for air environment and medicinal odors relatively decrease.\u003c/p\u003e\u003cp\u003eThe number of attractive elements gradually increases from 4 items in the low age group to 6 items in the middle and high age groups. This trend shows that as age increases, more environmental factors are seen as good added value rather than core needs. Notably, VP5 always remains in the category of attractive elements, and its satisfaction score was relatively high, indicating that a professional medical staff image is a bonus point for enhancing the visit experience at any age.\u003c/p\u003e\u003cp\u003eIndifferent elements decreased from 4 items in the low age group to 2 items in the middle age group, and then to 3 items in the high age group, showing slight changes. GP1 and OP3 always belong to indifferent elements, indicating that older adults patients of different ages have relatively low attention and requirements for these factors. The gap between the satisfaction levels of other added indicators VP4 and VP1 and the average satisfaction of their group was not large, showing dynamic changes between indifferent elements (I) and one-dimensional elements (O). This indicates that these two indicators are neither pain points nor highlights.\u003c/p\u003e\u003cp\u003eOverall, the older the age, the more sensitive and critical older adults patients become towards the dental environment. More types of sensory stimuli can trigger their anxiety, and dissatisfaction with the current situation is more common.\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Influencing factors of Kano-IPA model analysis results for the older adults of different ages\u003c/h2\u003e\u003cp\u003eIn dental medical institutions, creating a calm and comfortable environment for the older adults and reducing their anxiety from different sensory levels to pursue better diagnosis and treatment outcomes remains a severe challenge. This study systematically analyzed the impact of different sensory stimuli in the dental visit environment on the anxiety of older adults patients based on the Five Senses Theory framework.\u003c/p\u003e\u003cp\u003eThe results of this study show that direct sensory experiences related to treatment, such as tactile injection pain, device operation soreness, visual impressions of medical devices, auditory device noise, and olfactory odors brought by treatment, are the most core factors inducing anxiety in older adults patients. This finding is highly consistent with previous research emphasizing that direct sensory discomfort is the result of causing dental anxiety\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn51\" id=\"#FNLinkFn51\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Existing research has confirmed that fear of bleeding, treatment pain, and self-perceived oral health status\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn52\" id=\"#FNLinkFn52\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e are the main factors of dental anxiety in the older adults. Factors such as odor\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn53\" id=\"#FNLinkFn53\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, device noise\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn54\" id=\"#FNLinkFn54\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, and the visual image of medical devices\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn55\" id=\"#FNLinkFn55\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e have also been confirmed to significantly impact dental anxiety. This study further clarifies specific sensory channels and their severity from a multi-sensory integration perspective. VP3 is the most important factor among all elements (severity of inducing anxiety), indicating that the visual image of medical devices causes relatively severe anxiety in older adults patients. The other indicators TP2, AP1, VP6, GP3, TP4, and TP1 caused varying degrees of anxiety in older adults patients and were factors they were particularly dissatisfied with. These factors were categorized as \"must-be elements\" (M) in all age groups, i.e., high importance-low satisfaction elements. This indicates that they are common root causes of anxiety. High levels of dental anxiety can lead patients to delay or cancel treatment\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn56\" id=\"#FNLinkFn56\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, and they are also the aspects that should be prioritized for environmental and service improvement.\u003c/p\u003e\u003cp\u003eAs age increases, older adults patients' sensitivity and anxiety towards such direct and threatening stimuli significantly rise. For example, the importance score of the visual perception \"medical devices\" (VP3) in the 80 years and above group was as high as 4.51, significantly higher than that in the low age group. This may be related to the widespread sensory function degeneration\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn57\" id=\"#FNLinkFn57\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, decline in cognitive flexibility\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn58\" id=\"#FNLinkFn58\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, and enhanced perception of their own health vulnerability\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn59\" id=\"#FNLinkFn59\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e in the very older adults population. They focus more on the basic functional and safety needs during the treatment process, while their expectations for \"comfort\" or \"value-added\" elements in the environment, such as background music and space decoration, tend to be simplified. This finding resonates with previous research on the oral health-related quality of life of the older adults, namely that the older adults population pays more attention to functionality\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn60\" id=\"#FNLinkFn60\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn61\" id=\"#FNLinkFn61\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. This study confirms the dynamic change pattern of this trend through age grouping. This result provides key evidence for dental medical institutions to implement precise intervention strategies specific to different age groups.\u003c/p\u003e\u003cp\u003eFurthermore, non-treatment-related space environment elements, such as medical staff image (VP5), medical staff voice (AP4), and air purification (OP2), were classified as \"Attractive\" or \"One-dimensional\" elements in most groups. Although these elements can enhance visit satisfaction and trust, they are not the main sources of dental visit anxiety for the older adults population. This differs from conclusions found for child groups, where environmental design such as colors and smells can effectively reduce anxiety in children\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn62\" id=\"#FNLinkFn62\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. It illustrates the differences in anxiety drivers between the older adults and child groups, and emphasizes the necessity of research targeting specific populations. This may be related to the fact that phobia in the older adults is more based on experience, knowledge, and real risks\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn63\" id=\"#FNLinkFn63\"\u003e\u003c/a\u003e\u003csup\u003e][\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn64\" id=\"#FNLinkFn64\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Their needs are more focused on safe and efficient solutions to the illness and getting through the treatment process. In addition, sensory function degeneration also affects their perception of the impact of environmental factors such as colors and sounds\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn65\" id=\"#FNLinkFn65\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, causing changes in how they interact with the environment. Improving the dental visit experience for the older adults requires multi-dimensional efforts. Although efforts to alleviate anxiety should prioritize focusing on core treatment, space environment elements also need attention from older adults patients. These elements can, to some extent, alleviate patients' anxiety and other negative emotions, such as appropriate fragrance\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn66\" id=\"#FNLinkFn66\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, comfortable colors\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn67\" id=\"#FNLinkFn67\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, a kind and neat medical staff image\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn68\" id=\"#FNLinkFn68\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, slow and gentle verbal guidance\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn69\" id=\"#FNLinkFn69\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e, etc.\u003c/p\u003e\u003cp\u003eIt is worth noting that the specific evaluation scores of these elements may be highly related to the subjective definition differences among the older adults. Taking background sound (AP3) as an example, judging from the numerical values, the satisfaction value of this indicator in the evaluation results of the three age groups is close to the average score and did not cause significant visit anxiety in the older adults. This may be related to the subjective feelings of the older adults towards the background broadcasts and music. In the research by Potter et al. (2017), some older adults people found the sound of music disturbing, while others found it interesting\u003csup\u003e[\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn70\" id=\"#FNLinkFn70\"\u003e\u003c/a\u003e\u003csup\u003e]\u003c/sup\u003e. Considering that these elements are greatly influenced by subjective feelings, comprehensive improvement may still struggle to meet the emotional needs of all older adults people. Therefore, research on improving these elements needs to be further explored.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Practical design improvements based on research results\u003c/h2\u003e\u003cp\u003eBased on the research results, the following development suggestions are proposed for the Hospital of Stomatology Xi\u0026rsquo;an Jiaotong University and Affiliated Stomatological Hospital of Xuzhou Medical University. Interventions should prioritize targeting high-anxiety core aspects, such as encouraging the comprehensive implementation of \"painless treatment\" techniques, popularizing painless anesthesia techniques, and informing patients of possible sensations before the operation, giving patients psychological expectations and a sense of control. Optimize device design, consider using devices with softer colors and more rounded shapes to reduce the coldness and sharpness of traditional devices. Prioritize low-noise treatment devices, use sound-absorbing and sound-insulating materials in clinic decoration, and consider providing patients with active noise cancellation (ANC) headphones to play light music or white noise, thus effectively neutralizing device noise. Optimize space layout and process management, reduce crowding in waiting areas and patient waiting time, and provide drinking water, reading materials and soothing videos to distract patients. Standardize the use of powerful suction devices to ensure timely removal of saliva, blood, and debris, thereby minimizing the chance for patients to sense odors. During long operations, medical staff should actively inform patients that they can close their mouth to rest and arrange short rest intervals. Provide comfortable neck pillows, lumbar supports, optimize the ergonomic support of dental chairs, and reduce physical strain.\u003c/p\u003e\u003cp\u003eFurthermore, from a long-term perspective, use colors friendly to the older adults, such as beige, gray, and wood tones, to create a harmonious visual environment. Use wooden, fabric, or leather facilities, coupled with an emphasis on cleanliness and full functionality, to help advance the development of age-friendly dental clinics. Simultaneously enhance ventilation, increase the use of air purifiers, select neutral fragrances to improve the olfactory environment, and eliminate odors generated from treatment. Under the premise of equivalent efficacy, prioritize the use of mouthwashes or medications with more palatable flavors such as fruit, instead of traditional options with strong chemical tastes, so as to improve tolerability and reduce sensory irritation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Innovations\u003c/h2\u003e\u003cp\u003eDental anxiety involves multiple complex factors, and the perspective of the older adults is often overlooked in current research. Existing research on dental anxiety mostly focuses on children and general adults, and seldom involves environment-related analysis. Due to the intensifying social aging, the oral health of the older adults demographic is receiving growing concern. From the perspective of environmental psychology, systematically identifying the multi-sensory causes of dental anxiety in the older adults and determining their order of priority is crucial for promoting the dental health of older patients.\u003c/p\u003e\u003cp\u003eCompared with previous research, this study innovatively integrates the Five Senses Theory from environmental psychology with the Kano model and Importance-Performance Analysis (IPA) from management decision science, thus constructing an interdisciplinary and systematic analytical framework for multi-sensory anxiety in the older adults. Different from previous research that mainly relied on a single perspective of psychology or clinical medicine, this framework regards dental anxiety as a product of the synergistic effect of multiple sensory inputs such as visual perception, auditory perception, tactile perception, olfactory perception, and gustatory perception, thus achieving a paradigm shift from \"single-dimensional causal analysis\" to \"exploration of multi-sensory interaction and integration mechanisms\", therefore deepening the understanding of the formation mechanism of dental anxiety. Meanwhile, this study has made adaptive improvements to the classic Kano-IPA model. By defining the \"importance\" dimension as \"the severity of sensory stimulus inducing anxiety\" and the \"satisfaction\" dimension as \"the satisfaction with the management of that sensory stimuli\", this study enables the quantitative measurement and visual representation of patients' negative emotions and perceptual experiences. This method effectively categorizes various sensory demands into attribute types (e.g., must-be, one-dimensional, attractive, indifferent) and reveals their relationship with overall anxiety levels. It further identifies key design improvement points and establishes clear priorities, thereby providing objective, detailed decision-making support and practical guidance for environmental upgrades, service process optimization, and human-centered enhancements in dental healthcare institutions.\u003c/p\u003e\u003cp\u003eFurthermore, this study breaks away from the traditional limitation of viewing the older adults as a homogeneous group by conducting a detailed stratified age-based comparison (60\u0026ndash;69 years, 70\u0026ndash;79 years, 80 years and above). This design reveals that the sensory drivers of dental anxiety and their underlying structure evolve dynamically with advancing age. This phenomenon indicates a trend of \"focus convergence\" on core treatment-related stimuli among the very older adults population. This finding underscores the significant academic and practical value of shifting from a holistic \"older adults\" perspective to an \"age-stratified\" perspective, providing critical empirical evidence for developing precise and age-tailored intervention strategies.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Limitations\u003c/h2\u003e\u003cp\u003eDespite the meaningful findings obtained, this study still has several limitations. As for the study sample, due to time and funding constraints, the sample was drawn solely from a single large dental hospital, without covering institutions in regions with varying levels of economic development or primary healthcare settings. The single-source sample may limit the generalizability of the research results. Future research should incorporate multi-center and multi-regional samples to verify the broader applicability of the conclusions.\u003c/p\u003e\u003cp\u003eIn terms of research design, this study used a cross-sectional survey design, which only captured the evaluation results of the older adults at a specific time point. This makes it difficult to infer causal relationships and reflect how the evaluation results of the older adults evolve dynamically with increases in visit frequency, increases in familiarity with the hospital environment, and other subjective changes, which may lead to a lack of foresight and sustainability in derived strategies. Future research could use longitudinal tracking or experimental intervention to further verify the causal mechanism between sensory stimuli and anxiety, thereby providing more dynamically adaptive insights.\u003c/p\u003e\u003cp\u003eMethodologically, this study relied primarily on self-reported questionnaires for data collection, which may introduce subjective bias. Although the team provided assistance during the survey, older participants, particularly the very older adults, may still have provided responses influenced by age-related declines in hearing, vision, and cognitive processing abilities. Future research could consider employing more objective and diverse methods to collect response data from the older adults, such as measuring physiological indicators (e.g., heart rate variability) and conducting behavioral observations, to enrich the data and enhance the accuracy and comprehensiveness of the analysis.\u003c/p\u003e\u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003ePaying attention to and improving the multi-sensory experience in the dental environment, especially conducting precise interventions based on the differentiated needs of older adults patients of different ages, is an important way to alleviate their dental anxiety, improve visit compliance, and ultimately improve oral health levels. By integrating the Five-Sense Theory with the Kano-IPA model, this study took the Hospital of Stomatology Xi\u0026rsquo;an Jiaotong University and Affiliated Stomatological Hospital of Xuzhou Medical University as a case setting to systematically identify anxiety-inducing sensory factors and their severity levels among older adults patients during dental visits, while clarifying age-specific needs differences and intervention priorities. The main conclusions are as follows:\u003c/p\u003e\u003cp\u003e(1) Treatment-related direct sensory experiences, such as pain, noise from device noise, and the visual impression of medical devices, constitute core sources of anxiety in older adults patients, with anxiety levels intensifying with age; (2) The very older adults patients tend to focus more on basic functional and safety-related needs during treatment, with simplified expectations regarding environmental comfort; (3) Non-treatment-related environmental factors, such as medical staff image and medical staff voice, can enhance the experience but are not the main drivers of anxiety; (4) age group-based analysis provides empirical evidence for formulating precise and differentiated strategies for optimizing the dental environment and improving services.\u003c/p\u003e\u003cp\u003eThis study innovatively combines multi-sensory theory with decision analysis models, moving beyond the conventional approach of treating the older adults as a homogeneous group. It offers evidence-based support for environmental upgrades and human-centered service improvements in dental healthcare institutions. Future research should expand sample the diversity of samples, incorporate longitudinal tracking, and integrate objective physiological measures to further validate and deepen the findings of this study.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKano\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIPA Kano Model-Importance-Performance Analysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\u003cp\u003eConfirm that all experiments were performed in compliance with the Helsinki Declaration\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent for publication:\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMengting Li，Kexin Wei, Meng Zhou, Yameng Si: Writing\u0026ndash;original draft, Methodology, Formal analysis, Data curation, Conceptualization. Zhenzhen Wang: Writing \u0026ndash;Supervision ,Methodology, Formal analysis, Data curation. Jiabin Xu: Writing\u0026ndash;Visualization, Supervision, Methodology, Conceptualization.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical trial number\u003c/b\u003e: Not applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNational Bureau of Statistics. Bulletin of the Seventh National Population Census (2021). https://www.gov.cn/guoqing/2021-05/13/content_5606149.htm.2021.\u003c/li\u003e\n\u003cli\u003eSombateyotha K., Mahaweerawat U., ORAL HEALTH STATUS AND ORAL IMPACT ON DAILY PERFORMANCE IN OLDER ADULTS IN NORTHEASTERN REGION THAILAND. 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S., Light conditions for older adults in the nursing home: Assessment of environmental illuminances and colour temperature. Building \u0026amp; Environment 46 (2011) 1917–1927.\u003c/li\u003e\n\u003cli\u003eAntje, Haehner, Henriette, et al., Influence of room fragrance on attention, anxiety and mood. Flavour and Fragrance Journal 32(1) (2016) 1132–1136.\u003c/li\u003e\n\u003cli\u003eMu J., Kang J., Indoor Environmental Quality of Residential Older adults Care Facilities in Northeast China. Frontiers in Public Health 10 (2022) 860976.\u003c/li\u003e\n\u003cli\u003eQi Y., Yan Y., Lau SS., Tao Y., Evidence-based design for waiting space environment of paediatric clinics—three hospitals in Shenzhen as case studies. International Journal of Environmental Research and Public Health 18 (2021) 11804.\u003c/li\u003e\n\u003cli\u003eHojjatoleslami S., Sadeghi A., Negarandeh R., Soltanian A.R., Borzou S.R., Nurses’ Healing Presence: A Panacea for the Comfort of Acute Coronary Syndrome Patients in CCU, A Qualitative Study. Nurs. Open 10 (2023) 3744–3753.\u003c/li\u003e\n\u003cli\u003ePotter R., Sheehan B., Cain R., Griffin J., Jennings P.A., The Impact of the Physical Environment on Depressive Symptoms of Older Residents Living in Care Homes: A Mixed Methods Study. Gerontologist 58 (2018) 438–447.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Kano-IPA model, the older adults, dental hospital, dental anxiety","lastPublishedDoi":"10.21203/rs.3.rs-7695253/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7695253/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWith 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.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eGuided 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.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e\u003cp\u003eA 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\u0026rsquo;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\u0026ndash;69, 70\u0026ndash;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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThis 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 \u0026gt;\u0026thinsp;4.2) and the satisfaction scores being the lowest (all \u0026lt;\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIn 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.\u003c/p\u003e","manuscriptTitle":"Sensory Drivers of Dental Phobia in the older adults: A Cross-age Study Based on an Integrated Kano-IPA Model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-21 23:12:59","doi":"10.21203/rs.3.rs-7695253/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-21T10:27:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-19T07:38:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-18T15:16:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309373011230127346904875065794855484611","date":"2025-10-13T10:42:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68322870270845053682233358730594932762","date":"2025-10-13T10:36:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-13T04:04:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259913784531639016243562016536297277424","date":"2025-10-10T15:12:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T20:17:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155091623290135716351859553601926261373","date":"2025-10-08T15:31:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246857117870616558632921607360904212412","date":"2025-10-08T13:15:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303575774734112638481226907395259121750","date":"2025-10-08T10:36:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31705202385003764095473992434153653079","date":"2025-10-08T10:33:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-08T10:20:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-06T09:11:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-04T02:51:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-10-04T02:48:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e2ceac24-1be4-416c-ac85-e6c39a8e4174","owner":[],"postedDate":"October 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:11:27+00:00","versionOfRecord":{"articleIdentity":"rs-7695253","link":"https://doi.org/10.1186/s12877-026-07177-4","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-02-20 15:58:51","publishedOnDateReadable":"February 20th, 2026"},"versionCreatedAt":"2025-10-21 23:12:59","video":"","vorDoi":"10.1186/s12877-026-07177-4","vorDoiUrl":"https://doi.org/10.1186/s12877-026-07177-4","workflowStages":[]},"version":"v1","identity":"rs-7695253","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7695253","identity":"rs-7695253","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}