The authors of this paper propose that significant changes in the delivery of services, including speech and language therapy management of swallowing difficulties, may be required. Among the most common causes of dysphagia in older adults are stroke, progressive neurological diseases (e.g. Parkinson’s disease, multiple sclerosis), frailty and dementia. Presbyphagia is the result of changes in the anatomy and physiology of the head and neck, muscle loss (sarcopenia), reduced functional reserve, and onset of age. The onset of illness or disease can exacerbate the signs of presbyphagia, increasing the risk of dysphagia. The authors of this paper report that swallowing screening tools, despite their variable evidence base across communication and residential settings, may be a useful guide to identifying individuals who require an onward referral for a clinical swallow examination. The authors then outline the risk factors for dysphagia to consider when a speech and language therapist takes a case history, this will provide guidance on how cautious or liberal their management should be. Collecting information from the person and their caregivers is important to gain an insight to provide information on the individuals health and their understanding of swallowing difficulties so recommendations can be tailored individual needs. An instrumental exam may in many cases not be warranted. Many exercises and interventions have been proven to be effective in improving swallow function in older adults, such as tongue strengthening exercises. This review provides a useful resource to support the planning of clinical speech and language therapy services for older adults, which are often under-resourced and under-utilised by potential referrers.