Background <p>Rehabilitation of age-related dysphagia in older adults remains a complex clinical challenge. The Danish occupational therapy intervention ACTING (ACTivity-based Skill Training of INGestion) was developed employing an occupation-centred approach. Before large-scale evaluation, a proof-of-concept study is needed to explore its potential in real-world practice.</p> Objectives <p>To evaluate clinically meaningful outcomes of ACTING and assess implementation fidelity in municipal occupational therapy for dysphagia rehabilitation.</p> Materials and methods <p>A proof-of-concept case-series (<i>N</i> = 5) with pre–post outcome assessment was employed. Primary outcomes included mealtime task performance, dietary variety and perceived change. Secondary outcomes included dysphagia severity, ingestion-related muscle function, nutritional status, interference with joy of life, quality of life, and aspiration pneumonia. Structural and process fidelity data were collected.</p> Results <p>All participants increased dietary variety, and four achieved clinically meaningful improvements in mealtime performance, accompanied by perceived improvements in eating and drinking. Secondary outcomes showed trends towards improvement. However, outcome variability and inconsistent fidelity were observed, and intervention delivery was influenced by context, resources, and clinician training.</p> Conclusion and significance <p>ACTING shows promise as a potential occupation-centred approach to dysphagia rehabilitation in municipal practice. Findings support further development, with attention to strengthening implementation fidelity and clinician training before larger-scale testing.</p>