2025 Volume 4 Pages 34-42
Swallowing disorders are associated with serious complications such as aspiration pneumonia, malnutrition, and dehydration, and they substantially affect quality of life and prognosis in older adults. Appropriate assessment and risk management are therefore essential in long-term care facilities. However, unlike medical settings, these facilities often have limited access to instrumental examinations, and assessment practices tend to be heterogeneous and insufficiently standardized. This narrative review summarizes current practices and key challenges of swallowing assessment in long-term care facilities and reconsiders practical, implementable approaches under conditions of limited availability of speech-language-hearing therapists. In daily practice, multiple simple and non-invasive assessments and observations are combined to (1) describe eating outcomes, (2) detect swallowing-related risks at the bedside, and (3) understand background factors such as oral function, nutritional status, and general condition. Nevertheless, several challenges remain, including uncertainty regarding what each test actually reflects (construct validity), overreliance on single findings, inter-assessor variability, and limited feasibility in the oldest-old and individuals with cognitive impairment. Because long-term care facilities are primarily living environments, swallowing assessment should not be limited to functional classification. Instead, it should serve as a basis for multidisciplinary decision-making that supports risk management, care planning, and longitudinal monitoring. In particular, mealtime observation combined with ongoing monitoring of respiratory signs and body weight is essential, especially given the possibility of silent aspiration. Future efforts should focus on developing purpose-oriented, shareable systems that integrate multiple simple assessments into daily routines, including documentation formats, staff education, and clear triggers for referral to specialist or instrumental assessment. This review does not evaluate the effectiveness of individual instruments; rather, it provides a conceptual framework to support the implementation of swallowing assessment in long-term care settings.
