Oropharyngeal dysphagia affects substantial portions of older adults with neurological conditions, creating cascading risks including aspiration pneumonia, malnutrition, and increased mortality rates. The condition presents distinct patterns depending on underlying neurological pathology, with acetylcholinesterase inhibitors proving beneficial in myasthenia gravis cases while dopaminergic medications help Parkinson's patients. This neurological framework challenges the traditional one-size-fits-all rehabilitation approach to swallowing difficulties. Rather than treating dysphagia as a uniform geriatric syndrome, targeting the specific neural circuits disrupted in each condition could yield superior outcomes. The implications extend beyond swallowing mechanics to fundamental quality of life preservation in aging populations. Current speech therapy protocols, while valuable, may miss opportunities for neurologically-targeted interventions that address root pathophysiology rather than just compensatory strategies. This represents a paradigm shift toward precision medicine in geriatric care, where understanding the neural basis of swallowing dysfunction could unlock more effective treatments. The approach also highlights how swallowing assessment might serve as an early biomarker for neurological decline, potentially enabling earlier intervention when neural plasticity remains higher.