An older adult nursing home resident with constipation and a new PEG tube — which formula would be the best choice?

• A. Concentrated 2 kcal/mL
• B. Standard 1 kcal/mL with fiber
• C. High nitrogen formula
• D. Predigested formula

Answer: (B)

The main idea here is that adding fiber through an enteral formula is a practical way to help manage constipation in an older adult with a PEG tube. Fiber increases stool bulk and can improve bowel regularity when there is adequate hydration and functional GI tract. A standard-density formula with added fiber provides a balanced energy delivery (1 kcal/mL) while supporting bowel function, which is particularly useful in nursing home patients who are prone to constipation.

A concentrated 2 kcal/mL formula raises calories per mL but doesn’t inherently address stool bulk or transit and can increase the osmolar load, potentially causing GI intolerance in older adults. A high-nitrogen formula focuses on meeting protein requirements and may be needed in catabolic states, not specifically for bowel regularity. A predigested formula helps with digestion and absorption in cases of malabsorption or severe GI intolerance, but it doesn’t target constipation.

So, the standard 1 kcal/mL formula with fiber best aligns with the goal of easing constipation while meeting daily energy needs in this patient.