**3. Influential factors associated to eating**

Eating is indispensable for subsistence. Therefore, it is a crucial component of the evolution of the human kind. As part of the essential evolutionary process, eating has taken various forms and adaptation has been linked to our survival.

Food choices and eating patterns are affected by several key elements such as biological influences (appetite, taste, hunger), psychological influences (mood or stress), socio-cultural determinants (family, peers, income, skills) and learnt behaviors [118, 119]. Côté et al. have depicted multiple factors to consider when providing adapted foods to the elderly. These factors remain intact, if not more important, once dysphagia becomes symptomatic (**Figure 3**) [120].

In the context of texture-modified foods and thickened fluids for the nutritional treatment of dysphagia, the appreciation of foods is often described as a burden [49, 66, 70, 71, 86, 121]. The reasons behind this present state of affairs are very complex and possibly imbedded in human survival programming itself.

#### **Figure 3.**

*Interaction model of key factors affecting feeding in the context of dysphagia in the older adult population.*
