Table 3 Content of the swallowing assessment. Abbreviations: 3 oz water swallow test (3-oz WST), Water Swallow Test (WST), McGill Ingestive Skills Assessment (MISA)

Part I

3-oz WST [26]

• Resident is asked to drink a glass of 3 oz. of water at room temperature while seated

• SLT assesses whether glass is emptied without interruption and without signs of impaired swallowing such as impaired oropharyngeal bolus transit, oral cavity pooling, coughing, drooling, and voice change

Part II

Structured observation of oral intake

• Observation during a meal including solid as well as liquid products

• SLT focuses on maintenance of body posture, self-feed ability, and signs of impaired swallowing, and observations will be documented

Part III

WST with different thickness levels

• Water boluses with different thickness levels are prepared: water + thickening powder

• Resident is asked to swallow at least three subsequent sips of the thickened bolus.

• SLT determines the appropriate thickening of liquids for safe swallowing, i.e. the thickness at which the resident is able to swallow without showing signs of impaired swallowing

Part IV

Modified version of the MISA [27]

• Evaluation of functional ingestive skills of older persons: maintenance of symmetrical body posture and adequate head position for feeding, ability to grasp and use utensil and cup/glass functionally, appropriately-sized mouthfuls, voice quality after drinking, airway clearance after drinking, quantity of food remaining in mouth after swallowing, location of food remaining in mouth after swallowing, voice quality after earing, airway clearance after solids, ability to eat regular solids, soft solids, puree and pudding, and ability to drink water, thin juices, nectar, honey and pudding