Participants will be invited to take part in a facial exercise program and will be assessed before the intervention, immediately after the intervention, and one month after the intervention.

Older adults aged 60 years and above who are able to communicate in Mandarin or Taiwanese and who participate in activities at adult day-care centers or community care centers will be eligible for inclusion. Individuals with severe visual or hearing impairment, moderate to severe dementia, inability to communicate verbally, obvious facial wounds or lesions, or medical conditions affecting swallowing function (e.g., stroke) will be excluded from participation.

A total of approximately 130 participants will be recruited and assigned to one of two groups:

Intervention Group (n ≈ 65): Participants will perform facial exercises using the Smart Facial Coaching System.

Control Group (n ≈ 65): Participants will perform facial exercises by following a video-based facial exercise program.

After providing informed consent and meeting the eligibility criteria, participants will complete baseline structured questionnaires and the Repetitive Saliva Swallowing Test (RSST).

Participants in both groups will then perform facial exercises for five consecutive days, with each session lasting approximately 10-15 minutes.

Upon completion of the 5-day facial exercise program, participants will complete the structured questionnaires and perform the Repetitive Saliva Swallowing Test (RSST).

One month after the intervention, participants will complete a follow-up questionnaire, which will take approximately 15-20 minutes.

Program description is as follows:

Intervention Group (n ≈ 65): Participants will perform facial exercises using the Smart Facial Coaching System. The program consists of four components, and each session will last approximately 10-15 minutes.

• Eye Exercises: Gentle eye closure, forceful eye closure, eye opening, and lateral eye stretching exercises to promote eye muscle activity (approximately 2-3 minutes).
• Mouth Opening Exercises: Maximum mouth opening and repetitive mouth-opening exercises to promote perioral muscle activity (approximately 3-4 minutes).
• Oral Function Exercises: Articulation exercises, cheek exercises, tongue exercises, salivary gland massage, and swallowing exercises to promote oral function (approximately 3-5 minutes).
• Smiling Exercises: Viewing happy facial expression images, facial relaxation exercises, and smile imitation exercises to promote facial muscle activity (approximately 1-2 minutes).

Control Group (n ≈ 65): Participants will perform facial exercises by following an oral health exercise video available on YouTube. The exercise program includes facial muscle exercises, tongue exercises, salivary gland massage, swallowing exercises, and articulation exercises.

YouTube video: https://youtu.be/\_Q4DwWXJ4S4?si=Ld10bgiklFLwTHPc

Inclusion Criteria:

• Willing to participate in this study voluntarily.
• Able to provide written informed consent.
• Aged 60 years or older.
• Able to communicate in Mandarin Chinese or Taiwanese.

Exclusion Criteria:

• Severe visual or hearing impairment.
• Diagnosis of moderate to severe dementia.
• Inability to communicate verbally.
• Presence of obvious structural or pathological lesions of the face.
• Diseases or conditions affecting swallowing function (e.g., stroke).

Individual participant data will not be shared because there is no data-sharing plan for this study.