Changes in General and Dental‐Specific Ageism Following Home‐Visit Clinical Training With Older Adults: A Quasi‐Experimental Pre–Post Study

ABSTRACT

Objectives

This study investigated whether interaction‐focused clinical training with older adults reduces ageist attitudes among dental students, compared to treatment‐focused training without interpersonal interaction.

Methods

A quasi‐experimental, non‐randomized, two‐arm pre‐post intervention study was conducted at two dental universities in Japan. Fifth‐year undergraduate students were recruited (n = 120) and analyzed (n = 91). Students participated in either a treatment‐focused (treatment group, n = 34) or interaction‐focused program involving oral care and recreational activities with older adults (interaction group, n = 57). Ageist attitudes were assessed at baseline and end of intervention using Japanese version of Fraboni Scale of the Ageism (FSA‐J) and the Aging Scale for Dental Students (ASDS‐J); higher scores indicate greater ageism. A general linear model (GLM) was used to analyze factors related to score changes (educational intervention, adjusting for baseline score, gender, age, and cohabitation experience).

Results

Ninety‐one students completed all assessments. FSA‐J scores worsened significantly in the treatment group (p = 0.002, Hedges’ g = 0.534), while ASDS‐J scores improved significantly in the interaction group (p = 0.011, Hedges’ g = − 0.313). GLM revealed no main effect of intervention alone, but significant three‐way interactions with gender, age, and cohabitation experience were found for ASDS‐J changes. Age was the only significant factor associated with FSA‐J change. Effect sizes were small across outcomes.

Conclusions

Interaction‐focused training may help reduce dental student‐specific ageism. However, general ageism appear less responsive to brief interventions. With small effects observed, interaction‐focused training offers a modest step toward reducing student‐specific ageism; general ageism showed limited short‐term change.

1. Introduction

Ageism in healthcare is known to adversely affect treatment quality and clinical outcomes for older adults. When elderly patients are subjected to age‐related prejudice by healthcare providers, they face increased risks of delayed diagnosis, inappropriate chronic disease management, and compromised clinical decision‐making [1, 2, 3, 4, 5]. Importantly, these biases are not confined to experienced professionals; rather, ageist attitudes have also been identified among students and trainees in both medicine and dentistry, where they may persist despite formal education [6]. A study among Turkish medical students highlighted multiple predictors of ageism, such as being male, lacking personal contact with older adults (e.g., through cohabitation or caregiving), and having limited exposure to geriatric care settings [7]. Comparable tendencies have been observed in dental education. Our previous research introduced the Aging Scale for Dental Students (ASDS), a validated, dental student‐specific instrument designed to assess dental students’ attitudes toward older patients. The study demonstrated that general ageism, demographic factors, and the extent of prior interaction with older adults were all linked to more negative views of aging in the dental context [8]. These findings underscore the need to incorporate educational strategies that address ageism during clinical training.

Within dental education, three broad approaches have been used to address ageism: Didactic teaching, service‐learning with community‐dwelling or institutionalized older adults, and clinical placements embedded in routine care. Didactic sessions can improve knowledge but have shown modest or inconsistent effects on attitudes [9]. By contrast, the specific impact of service‐learning and routine clinical placements on dental students’ ageism has not, to our knowledge, been systematically examined.

In Japan, home‐visit dentistry is a growing component of undergraduate training, offering dental students opportunities to care for frail, homebound older adults. These encounters may allow students to confront age‐related assumptions and improve their attitudes toward aging. However, it remains unclear whether these real‐world experiences in homecare lead to meaningful reductions in ageism, particularly when considering both general and dental student‐specific dimensions.

We hypothesized that dental students who participated in interaction‐focused home‐visit clinical training, which includes direct interaction with older adults, would show a greater reduction in ageist attitudes—particularly in dental student‐specific ageism—compared to those who received treatment‐focused training without interpersonal engagement.

2. Methods

2.1. Participants and Setting

This was a non‐randomized, two‐arm pre‐post intervention study designed to evaluate the impact of two distinct educational approaches during home‐visit clinical training on dental students’ ageist attitudes. The study was conducted at two dental universities located in Fukuoka Prefecture, Japan. Participants were dental students enrolled in the visiting dental clinical practicum during the study period. Inclusion criteria were: (1) Provision of informed consent and (2) completion of both the pre‐ and post‐intervention questionnaires. Exclusion criteria was declined of consent or failure to complete either time point. Participants were fifth‐year dental students (semesters 9–10) at the participating institutions. This year level was selected because the visiting dental clinical practicum is scheduled during semesters 9–10, providing consistent and relevant clinical exposure for the study. Both universities follow a six‐year curriculum that includes geriatrics, with the visiting‐dental practicum scheduled in semesters 9–10. Shared features included cohort size (approximately 90 students per year) and adherence to Japan's Ministry of Education, Culture, Sports, Science and Technology–designated core curriculum. Contextual differences included clinic case‐mix and infrastructure: University A operates an affiliated long‐term care facility, whereas University B does not. Ethical approval was obtained from the Medical Ethics Committee of Kyushu Dental University (Approval No. 23–43). Each participant was assigned a unique identification code, which was consistently used to link responses across all survey phases. Participation was voluntary, and students were informed that declining or withdrawing from the study would not affect their academic performance or evaluations.

2.2. Data Collection

Data were collected at two points: Before and after the clinical training. Surveys were administered electronically using Microsoft Forms. All items were marked as mandatory to avoid missing data. Completing each survey took approximately 5 min. Students were invited by faculty dentist at each university during the practicum orientation, using a standardized script (Appendix A). Participation was voluntary and non‐participation did not affect academic standing. Recruitment commenced on April 9, 2024, and the last questionnaire was received on January 31, 2025.

2.3. Educational Intervention

Two distinct educational programs were implemented. The home‐visit clinical training (treatment group) consisted of sessions lasting approximately 3–4 h, during which students, under the supervision of one or two experienced dentists, encountered 2–3 patients per session. Clinical activities primarily involved assisting with denture adjustments, oral‐hygiene procedures, and observation of treatment. Although pre‐briefing, debriefing, and direct supervision were provided, this program was procedure‐centered and did not include dedicated components aimed at fostering communication skills, empathy development, or reflective dialogue about aging. In contrast, the long‐term care facility placement (interaction group) was delivered over two days to three‐student groups, preceded by a preparatory lecture on fundamental caregiving skills and characteristics of older adults. Day 1 included practice in basic caregiving, cognitive and dysphagia screening, oral‐care techniques, assisted ambulation and feeding, and wheelchair transfers; Day 2 focused on ADL assessment and hands‐on caregiving (including oral care). This program explicitly incorporated structured communication and recreational activities to facilitate interaction with care‐dependent older adults, followed by a written report and instructor feedback. Thus, the interventions differed in emphasis: Procedure‐centered (treatment) versus interaction‐centered (placement).

2.4. Questionnaire

Ageist attitudes were assessed using two validated scales: The Japanese version of the Aging Scale for Dental Students (ASDS‐J) [8] and the Japanese short version of the Fraboni Scale of Ageism (FSA‐J) [10, 11].

The ASDS‐J consists of 16 items designed to capture dental student‐specific ageism in cognitive, affective, and behavioral domains (Appendix B). It was developed through cross‐cultural adaptation of the original 27‐item ASDS, including translation procedures, expert validation, and psychometric testing in Japanese dental education settings [8]. Items are scored on a 6‐point Likert scale (1 = strongly disagree to 6 = strongly agree), yielding a total score ranging from 16 to 96. Higher scores reflect more negative attitudes toward older patients in clinical dentistry.

The FSA‐J (short form) includes 14 items adapted for measuring general societal ageism in Japan (Appendix C). Responses are rated on a 5‐point Likert scale (1 = strongly disagree to 5 = strongly agree), with total scores ranging from 14 to 70. Higher scores indicate greater ageist bias.

Both scales were administered at all two time points using the same electronic format. Consistent pseudonymized study IDs allowed linkage of repeated measures for longitudinal analysis. In addition, demographic data—age, sex, and whether the student had lived with older adults (defined as individuals aged 65 or older)—were collected at baseline. The internal consistency at baseline among respondents (n = 120) of each scale was assessed using Cronbach's alpha. In the current study, the reliability coefficients were 0.705 for the ASDS‐J and 0.875 for the FSA‐J.

2.5. Sample Size

The required sample size was calculated using G*Power 3.1 [12], based on a paired‐samples t‐test. Assuming a medium effect size (dz = 0.3) [13] with an alpha level of 0.05 and power of 0.80, the required total sample size was estimated to be 90 participants. To preserve power in the presence of expected non‐response/attrition, we approached the full cohort of 174 students. One hundred twenty completed the baseline survey (68.9% response). Twenty‐nine were lost to follow‐up (24.2% attrition from baseline), and ninety‐one students completed both pre‐ and post‐surveys (75.8% retention from baseline; 52.3% of all eligible), meeting the a priori sample‐size target.

2.6. Statistical Analysis

Only participants who completed both pre‐ and post‐training surveys were included in the analysis. Continuous variables were presented as means and standard deviations, while categorical variables were reported as frequencies and percentages. Changes in ASDS‐J and FSA‐J scores were analyzed using paired‐samples t‐tests. Primary outcomes were change scores (Δ = post − pre) for ASDS‐J and FSA‐J; negative values indicate reduced ageism. We modeled Δ using general linear models (GLM) with covariate adjustment (baseline score, educational intervention, gender, age, cohabitation experience). GLM analyses were conducted using Type III sums of squares. All categorical variables were entered as fixed factors, and interaction terms were added based on theoretical relevance and empirical justification. Standardized Mean Difference (SMD) for continuous variables: (mean_completer − mean_dropout) / pooled SD; for binary variables: (p_completer—p_dropout) / $\sqrt{\mathrm{p}(1-\mathrm{p})}$ with pooled p. |SMD| < 0.10 negligible; 0.10–0.20 small; ≥0.20 substantial imbalance. All statistical tests were two‐tailed, and p‐values < 0.05 were considered statistically significant. Analyses were conducted using IBM SPSS Statistics for Windows, Version 28 (IBM Corp., Armonk, NY).

3. Results

Of 120 students who completed the baseline survey (treatment 62; interaction 58), 91 completed the follow‐up (treatment 34; interaction 57). Thus, overall attrition was 24.2% (29/120). Attrition was higher in the treatment group—45.2% (28/62)—than in the interaction group—1.7% (1/58)—corresponding to retention rates of 54.8% and 98.3%, respectively. Table 1 presents the demographic characteristics of the participants. Of the final sample, 49 (53.8%) were male and 42 (46.2%) were female. Most participants (78.0%) were aged between 20 and 29 years. In terms of cohabitation experience, 46 students (50.5%) reported having lived with older adults, and 36 (39.6%) expressed a willingness to provide dental care to older adults in the future. No statistically significant differences in baseline characteristics were observed between the treatment group and the interaction group.

TABLE 1.

Characteristics of participants.

	Treatment group (N = 34)	Interaction group (N = 57)	P a
Gender
Male	19 (55.9)	30 (52.6)	0.830
Female	15 (44.1)	27 (47.4)
Age
<30	28 (82.4)	43 (75.4)	0.602
>30	6 (17.6)	14 (24.6)
Cohabitation experience with older adults
Yes	13 (38.2)	33 (57.9)	0.085
No	21 (61.8)	24 (42.1)
Willingness of practice for older adults
Yes	13 (38.2)	23 (40.4)	1.000
No	21 (61.8)	34 (59.6)

^a Chi‐squared test.

Baseline characteristics of completers (N = 91) and dropouts (N = 29) were broadly similar for cohabitation experience and willingness to practice (|SMD| ≤0.05), with small differences in ASDS‐J (54.7 ± 5.8 vs 53.6 ± 4.7; SMD = 0.20) and gender (SMD = 0.30) (Table S1). Notably, there was substantial imbalance in age (<30 vs ≥30; |SMD| = 0.78) and in baseline FSA‐J (31.6 ± 8.5 vs 35.4 ± 7.3; |SMD| = 0.46).

Changes in ASDS‐J and FSA‐J scores following the educational interventions are summarized in Table 2. In the treatment group, a significant increase was observed in FSA‐J scores, from 34.2 ± 7.9 to 35.9 ± 10.7 (p = 0.002, Hedges’ g = 0.534), indicating a deterioration in general ageism. In contrast, the interaction group demonstrated a significant decrease in ASDS‐J scores, from 55.6 ± 6.2 to 53.7 ± 6.9 (p = 0.011, Hedges’ g = −0.313), suggesting that dental student–specific ageism improved after the intervention (Tables 3 and 4).

TABLE 2.

Pre‐post change of ASDS‐J and FSA‐J each group divided by educational intervention.

	Treatment group (N = 34)				Interaction group (N = 57)
	Pre	Post	p‐value*	Hedges’ g	Pre	Post	p‐value*	Hedges’ g
ASDS‐J	53.2 ± 5.0	52.6 ± 6.9	0.391	−0.047	55.6 ± 6.2	53.7 ± 6.9	0.011	−0.313
FSA‐J	34.2 ± 7.9	35.9 ± 10.7	0.002	0.534	30.1 ± 8.5	29.7 ± 9.1	0.327	−0.059

Note: Higher scores indicate greater ageism. Change score Δ = post − pre (negative values denote improvement).

Total N = 91; Treatment N = 34; Interaction N = 57.

The data are means and standard deviations.

Abbreviations: ASDS = Ageism scale in Dental Students; FSA = Fraboni Scale of Ageism.

^*Paired‐samples t‐test

TABLE 3.

General linear model for ΔASDS‐J score (Model N = 91).

	F‐value	p‐value	η [2]
Main effect
1. Educational intervention	0.509	0.478	0.008
2. Gender	1.341	0.251	0.021
3. Age	1.286	0.261	0.020
4. Cohabitation experience with older adults	1.717	0.195	0.027
5. Willingness of practice for older adults	1.318	0.255	0.021
Interaction effect
1*2	1.028	0.315	0.016
1*3	0.659	0.420	0.011
1*4	0.021	0.886	0.000
1*5	0.378	0.541	0.006
1*2*3	2.995	0.088	0.046
1*2*4	6.370	0.014	0.093
1*2*5	0.035	0.853	0.001
1*3*4	4.747	0.033	0.071
1*3*5	4.120	0.047	0.062
1*4*5	0.024	0.876	0.000

Note: Higher scores indicate greater ageism. Δ = post − pre (negative = improvement). Coding for categorical predictors and reference categories are shown in parentheses. Model includes covariate adjustment for baseline score, school, gender, age, and cohabitation.

Abbreviations: ASDS = Ageism scale in Dental Students; FSA = Fraboni Scale of Ageism.

TABLE 4.

General linear model for Δ FSA‐J score (Model N = 91).

	F‐value	p‐value	η [2]
Main effect
1. Educational intervention	1.515	0.223	0.024
2. Gender	0.069	0.793	0.001
3. Age	4.259	0.043	0.064
4. Cohabitation experience with older adults	3.994	0.050	0.061
5. Willingness of practice for older adults	1.515	0.223	0.024

Note: Higher scores indicate greater ageism. Δ = post − pre (negative = improvement). Coding for categorical predictors and reference categories are shown in parentheses. Model includes covariate adjustment for baseline score, school, gender, age, and cohabitation.

Abbreviations: ASDS = Ageism scale in Dental Students; FSA = Fraboni Scale of Ageism.

To explore which participant characteristics were associated with changes in ASDS‐J scores, a GLM was conducted using the variables shown in Table 3. The analysis revealed no statistically significant main effects for any of the individual characteristics, such as age, gender, cohabitation experience with older adults, or willingness to treat older patients. However, several three‐way interaction effects involving the type of educational intervention were statistically significant. Specifically, significant interaction effects were found for educational intervention by gender by cohabitation experience with older adults (F = 6.370, p = 0.014, η² = 0.093), educational intervention by age by cohabitation experience with older adults (F = 4.747, p = 0.033, η² = 0.071), and educational intervention by age by willingness to practice for older adults (F = 4.120, p = 0.047, η² = 0.062). The adjusted R ² value of the model was 0.185, indicating moderate explanatory power for the multifactorial model. As illustrated in Figure 1, the interaction involving educational intervention, gender, and cohabitation experience with older adults showed notable differences between groups. While most subgroups experienced a reduction in ASDS‐J scores regardless of the type of educational intervention, male students without prior cohabitation experience with older adults in the treatment group exhibited an increase in ageism scores after the intervention.

FIGURE 1.

Changes in ASDS‐J scores by subgroup. Mean pre‐post differences in ASDS‐J scores are shown by stratified interation layers of educational intervention type, gender, and cohabitation experience with older adults. Error bars represent 95% confidence intervals. Parentheses indicate sample sizes (n).

In contrast, the GLM analysis with change in FSA‐J scores as the outcome variable identified age as the only significant main effect; no other main or interaction effects reached statistical significance (Table 4). Descriptively, students aged 30 years or older showed a greater reduction in FSA‐J scores (−1.5 ± 7.5) compared to those under 30 years (−0.2 ± 9.3), suggesting a trend toward improvement in general ageism among older students. Although not statistically significant, a trend was also observed for cohabitation experience with older adults. Students without such experience showed a greater increase in FSA‐J scores (4.4 ± 10.5) than those with cohabitation experience (0.3 ± 9.5), indicating a possible worsening of general ageism among those with no prior close contact with older individuals.

4. Discussion

This study examined the impact of two different educational interventions during home‐visit clinical training on dental students’ ageist attitudes: One focused primarily on treatment delivery (treatment group), and the other included opportunities for communication and recreational engagement with older adults (interaction group). Ageism was assessed using both a general measure (FSA‐J) and a dental student–specific measure (ASDS‐J).

Following the training, general ageism worsened significantly in the treatment group, as indicated by an increase in FSA‐J scores. In contrast, dental student‐specific ageism significantly improved in the interaction group, reflected by a reduction in ASDS‐J scores. These findings suggest that mere clinical exposure without meaningful interpersonal interaction may not only fail to reduce ageist attitudes but may also reinforce negative stereotypes, whereas even brief opportunities for social engagement with older adults can positively influence attitudes toward aging in the dental care context.

However, results from the GLM, which controlled for background variables such as age, gender, cohabitation experience with older adults, and willingness to provide care for older adults, revealed no significant main effect of the educational intervention alone. Instead, significant three‐way interaction effects were found. Specifically, interaction effects between educational intervention, gender, and cohabitation experience; between intervention, age, and cohabitation experience; and between intervention, age, and willingness to provide care for older adults significantly influenced changes in ASDS‐J scores. Notably, male students without cohabitation experience who received the treatment‐only intervention exhibited an increase in ASDS‐J scores after training, indicating a worsening of dental student‐specific ageism. These findings highlight the importance of tailoring educational interventions to students' social backgrounds and prior experiences with older adults.

In contrast, FSA‐J scores were less responsive to the intervention. The GLM revealed a significant main effect of age, with students aged 30 years or older showing greater reductions in general ageism (−1.5 ± 7.5) than younger students (−0.2 ± 9.3). Although not statistically significant, students without cohabitation experience tended to show greater increases in FSA‐J scores (4.4 ± 10.5) compared to those with such experience (0.3 ± 9.5), suggesting a possible worsening of general ageism. The discrepancy between the GLM and univariate t‐test results regarding the age effect on FSA‐J may be attributed to the multivariable nature of the GLM, which adjusts for potential confounders and improves sensitivity. This underscores the importance of using multivariable analysis when investigating complex psychosocial constructs such as ageism.

Students who dropped out had higher FSA‐J at baseline than completers (|SMD| = 0.46), indicating a substantively more ageist subgroup among dropouts. Because attrition disproportionately removed participants with higher baseline general ageism, estimates of pre–post change in FSA‐J among completers may be biased. If higher‐baseline participants had shown larger declines (greater room to improve), their dropout would attenuate observed improvements; if they had been resistant to change, their dropout could inflate improvements. Given this ambiguity, we interpret FSA‐J findings cautiously and emphasize ASDS‐J as the primary outcome.

The original English ASDS was condensed from 27 to 5 items (two components), whereas translated versions (Greek, Brazilian, Romanian, French, Serbian, and Japanese) typically retain 10–16 items with partially overlapping components [8]. In the Japanese version, Dentist–older patient interaction coincides with the Greek component, and Patient compliance aligns with the French component 1. Item “The elderly patient does not live long enough…” appears in all languages, whereas item “…more homecare/nursing‐home treatment if I had more training” is unique to the Japanese version, plausibly reflecting local care‐delivery realities. These structural differences caution against assuming strict comparability across languages and may partly explain differential sensitivity of general vs. dental‐specific attitudes observed here. Given Japan's high share of health expenditure among adults ≥65 years (>60%), system‐level pressures could also shape student attitudes; future work should examine measurement invariance and consider common‐item linking when making cross‐national comparisons.

Prior studies using the ASDS/ASDS‐J in dental education have focused largely on construct and convergent validity and on cross‐sectional correlations of student attitudes [8, 14, 15]. These reports generally indicate that more favorable orientations toward geriatric care and greater contact with older adults are associated with lower ageism scores, yet intervention studies employing ASDS/ASDS‐J remain scarce. Within this literature, our findings add pre–post evidence: A one‐day, interaction‐focused exposure produced limited change in general ageism but clearer improvement in dental‐specific attitudes. This pattern suggests that single‐session contact may be insufficient to shift global stereotypes captured by ASDS/ASDS‐J, and motivates testing multi‐session, combined education‐plus‐contact programs in future work.

Educational interventions to reduce ageism among healthcare students have been increasingly explored. Recent study demonstrated that nursing students who participated in an aging‐focused education and practice program showed significantly greater reductions in negative stereotypes and prejudice toward older adults than medical students who did not receive the intervention [16]. Similarly, the IGNITE (Innovative Gerontological Nursing Intervention Mapping Initiative for Training and Education) program demonstrated substantial improvements in ageism, attitudes toward geriatric care, knowledge about older adults, and behavioral change among graduate‐level nursing students [17]. These findings suggest that highly structured and intensive educational approaches may be necessary to effectively address ageist attitudes. In the present study, the opportunity for communication and environmental immersion with older adults was limited to two days. Given the complexity of ageist attitudes, which are shaped by students’ personal backgrounds, prior exposure, and motivation to provide geriatric care [8], such a brief intervention may have been insufficient to produce meaningful change, particularly in general ageism. Our two‐day, interaction‐focused exposure may not have provided sufficient intensity or duration to shift deeply held attitudes, particularly general ageism. Systematic reviews indicate that multisession, combined education and intergenerational‐contact programs tend to produce larger effects [18]; reported durations vary widely, with a mean of ∼12.6 weeks (SD = 16.6) across studies, and the greatest gains in knowledge‐based interventions ranging from 2–4 weeks to multi‐year curricula [19]. Because a minimum effective duration has not been established, future work should adopt a dose‐finding approach (e.g., multiple sessions over 2–12 weeks) and report contact time explicitly. Undergraduate dental education is already densely packed with required competencies, and it may be more feasible to offer intensive, gerontology‐focused curricula such as IGNITE at the postgraduate level or as part of specialist training. Nevertheless, given the rapidly aging population in Japan and other developed countries, where older adults are projected to comprise nearly 40% of the population, it is essential that general practitioners acquire the skills and attitudes necessary for geriatric care. Therefore, the development of scalable, flexible, and generalizable educational tools for use in undergraduate curricula remains an urgent need.

This study has several limitations. First, the sample was limited to students from two dental universities in a single prefecture, which may restrict the generalizability of the findings. Second, the study design was non‐randomized, and participants were grouped based on institutional affiliation, potentially introducing selection bias or unmeasured institutional effects. Third, the interaction‐focused intervention was relatively brief, which may have limited its ability to affect deeply rooted ageist beliefs, particularly those captured by the general ageism scale. Fourth, although validated instruments were used, all data were based on self‐report and may have been influenced by social desirability bias. Fifth, institutional differences—curriculum design, faculty attitudes toward geriatric care, and the intensity of clinical exposure (visit counts and contact time)—may have influenced the observed effects. To mitigate these confounds, future studies should use institution‐stratified randomization and adjust for baseline scores, exposure time, and facility fixed effects; multilevel models with students nested within institutions will further partition between‐ and within‐institution variance. Sixth, because all outcomes were self‐reported, social desirability and common‐method variance may have inflated effects. Future studies should adopt a multimethod assessment battery combining (a) structured behavioral observations during role‐play/OSCE using predefined rubrics with blinded raters and inter‐rater reliability reporting, (b) peer evaluations of teamwork and communication, (c) older patient or standardized‐patient ratings of communication and respect, and (d) implicit measures of age bias (e.g., Age‐Implicit Association Test). Triangulating these sources with self‐report will reduce single‐method dependence and improve construct validity. Finally, because validated minimally important differences for ASDS‐J and FSA‐J have not been established, the educational significance of these findings remains uncertain; therefore, we refrain from drawing strong conclusions about impact.

5. Conclusion

Clinical training that incorporated opportunities for interpersonal engagement with older adults showed modest effects in reducing dental student‐specific ageism, as assessed with the ASDS‐J. The impact was not uniform and appeared to vary across subgroups (e.g., age, gender, cohabitation experience with older adults). General ageism, as assessed with the FSA‐J, showed no meaningful short‐term change, suggesting it may be less responsive to brief interventions and may require more intensive or sustained educational approaches. Overall, interaction‐focused training has a modest impact on reducing dental student–specific ageism, and further work should refine scalable, curriculum‐embedded strategies to achieve broader and more durable effects.

Author Contributions

Akie Fujimoto contributed to the data curation and drafted the initial manuscripts. Maya Izumi contributed to the conception and design of this study and data curation. Yuko Imai contributed to data curation and Writing—Review & Editing, Nao Taniguchi contributed to Writing—Review & Editing. Sumio Akifusa contributed to the conceptualization and design of this study, data analysis, drafted the final manuscripts and developed the tables. All authors agree and accountable for all aspects of the work and gave their approval for this publication.

Disclosure

This article is based on empirical research. The analysis and interpretations expressed in this piece are solely those of the authors and not intended to represent or reflect the position or viewpoints of the American Dental Education Association, its publisher, or any entities with whom the authors may or may not be affiliated or associated.

Appendix (Recruitment Script)

A1. Original (Japanese)

学生のエイジズムに対する高齢者歯科の臨床実習の教育効果を検証するためのアンケートです。

このアンケートへの参加は自由意思に基づくもので、参加しない場合でも不利益を被ることはありません。

また、回答した後でも回答を撤回することはでき、撤回による不利益も生じません。

アンケートの結果は個人情報を完全に保護した形で発表されます。

以上を踏まえて、アンケートへの参加に同意する場合は「同意する」を選択してください。

A2. English translation (for transparency)

“This survey aims to evaluate the educational impact of geriatric‐dentistry clinical training on students’ ageism. Participation is entirely voluntary, and there is no disadvantage if you choose not to participate. You may withdraw your responses even after submission, and withdrawal will entail no disadvantage. Survey findings will be reported with complete protection of personal information. If you agree to participate, please select ‘I agree’.”

Appendix B

B1. ASDS‐J used in this study

問1	高齢者は通常歯科のアドバイスに応じない
問2	高齢者は自分の歯を大切にしない
問3	高齢者は多くの場合、推奨される治療計画を受け入れない
問４	高齢者は適切な歯科治療が何かについて固定された考えを持っている
問5	在宅療養高齢患者に訪問歯科診療を提供するにはコストがかかりすぎる
問6	費用は歯科治療を求める多くの高齢患者に大きな障壁である
問７	高齢患者の歯科治療は時間がかかりすぎる
問8	高齢者に歯科治療を提供するのは政府の責任である
問9	高齢の患者は高価な歯科治療にお金を投資する価値を持たせるほど長生きしない
問10	高齢患者は複雑な歯科治療に時間と労力を投資する価値を持たせるほど長生きしない
問11	もしもっとトレーニングを積めば、私はもっと多くのホームケアや老人ホームでの歯科治療を提供するだろう
問12	高齢患者は、老人歯科における高度な訓練を受けた人によって治療されるべきである
問13	私は若い歯科の患者よりも、むしろ高齢の歯科の患者を治療したい
問14	高齢の患者は、私が提供する歯科治療に対して若い患者よりも感謝してくれる傾向がある
問15	私は若い患者よりも高齢の患者に同情する傾向がある
問16	私は若い患者よりも高齢の患者に注意を払う傾向にある

B2. ASDS‐J translated into English

Q1	Elderly patients do not usually comply with dental advice
Q2	Elderly people do not take good care of their teeth
Q3	Elderly patients often won't accept recommended treatment plans
Q4	Elderly patients have fixed ideas about what is proper dental treatment
Q5	It is too costly to provide out‐of‐office dental care to homebound elderly patients
Q6	Cost is a major barrier to many elderly patients seeking dental care
Q7	Dental treatment of elderly patients is too time‐consuming
Q8	It is the government's responsibility to provide dental care for elderly people
Q9	The elderly patient does not live long enough to make it worthwhile to invest money in expensive dental treatment
Q10	The elderly patient does not live long enough to make it worthwhile to invest time and effort in complex dental treatment
Q11 (i)	I would provide more home care or nursing home dental treatment If I had more training
Q12 (i)	Elderly patients should be treated by a someone with advanced training in geriatric dentistry
Q13 (i)	I would rather treat elderly patients than younger dental patients
Q14	Elderly patients tend to be more appreciative of the dental care I provide than younger patients
Q15	I tend to have more sympathy toward my elderly patients than my younger patients
Q16	I tend to pay more attention toward my elderly patients than my younger patients

i: inverse item

Items are scored on a 6‐point Likert scale (1 = strongly disagree to 6 = strongly agree), yielding a total score ranging from 16 to 96. Higher scores indicate more negative attitudes toward older patients in clinical dentistry.

Appendix C

C1. Japanese Version of Fraboni Scale of Ageism Used in This Study

問1	多くの高齢者は、けちでお金を貯めている
問2	多くの高齢者は古くからの友人とかたまって、新しい友人をつくることに興味がない
問3	多くの高齢者は過去に生きている
問4	高齢者と会うと、時々目を合わさないようにしてしまう
問5	高齢者が私に話しかけても、私は話したくない
問6	高齢者は、若い人の集まりに呼ばれたときは感謝すべきだ
問7	もし招待されても、自分は老人クラブの行事には行きたくない
問8	個人的には、高齢者とは長い時間過ごしたくない
問9	高齢者には地域のスポーツ施設を使ってほしくない
問10	ほとんどの高齢者には、赤ん坊の面倒を信頼して任すことができない
問11	高齢者は誰にも面倒をかけない場所に住むのが一番だ
問12	高齢者との付き合いは結構楽しい
問13	できれば高齢者と一緒に住みたくない
問14	ほとんどの高齢者は、同じ話を何度もするのでイライラさせられる

C2. Original Fraboni Scale of Ageism

Q1	Many old people are stingy and hoard their money and possessions
Q2	Many old people are not interested in making new friends preferring instead the circle of friends they have had for years.
Q3	Many old people just live in the past.
Q4	I sometimes avoid eye contact with old people when I see them.
Q5	I don't like it when old people try to make conversation with me.
Q6	Old people should feel welcome at the social gatherings of young people.
Q7	I would prefer not to go to an open house at a senior's club, if invited.
Q8	I personally would not want to spend much time with an old person.
Q9	Old people don't really need to use our community sports facilities.
Q10	Most old people should not be trusted to take care of infants.
Q11	It is best that old people live where they won't bother anyone.
Q12 (i)	The company of most old people is quite enjoyable.
Q13	I would prefer not to live with an old person.
Q14	Most old people can be intimidating because they tell the same stories over and over

i: inverse item

Items are scored on a 5‐point Likert scale (1 = strongly disagree to 5 = strongly agree), with total scores ranging from 14 to 70. Higher scores indicate more negative attitudes toward older adults.

Supporting information

Supporting Information