OBJECTIVES: Psychotropics have been widely used in nursing homes. Case reports and review articles have implicated that atypical antipsychotics may enhance the risk of urinary incontinence (UI); a condition prevalent in more than half the nursing home residents (NHR). With antipsychotics being the most extensively prescribed psychotropic medication in nursing homes, the objective of this study was to investigate the effect of atypical antipsychotics on UI in NHR using psychotropic medications. METHODS: The 2004 National Nursing Home Survey (NNHS) was used as the data source. Logistic regression was performed to determine relationship between UI and use of atypical antipsychotics, in presence of other covariates.  Sample data was weighted and data analysis was performed using SAS 9.1.  RESULTS: From the original 13507 NNHS residents, 64.57% (n=8722) used psychotropic medications; of which 27.22% (n=2366) used atypical antipsychotics and 57.58% (n=5005) were incontinent. Among those using psychotropics, incontinent residents were older than their continent counterparts (81.48±12.01years versus 77.45±13.67years, p<.0001). Regression analysis shows that residents on atypical antipsychotics had 81.5% increased risk of being incontinent (OR=1.815, p<0.0001). Concomitant use of other medications which may increase incontinence risk was not significantly associated with UI (p=0.1016). Presence of comorbidities enhanced UI risk by 58.9% (OR=1.589, p<.0001). Residents who were ADL dependent (OR=1.224, p<.0001) or used bedrails (OR=1.264, p<0.0157), chairs (OR= 1.708, p<0.0118) or truncal restraints (OR= 1.501, p<0.0238) also had higher risks of being incontinent. Advancing age (OR=1.022, p<0.0001) and female gender (OR=1.160, p=0.0353) were also found to be other risk factors. CONCLUSIONS: The study results indicate that use of atypical antipsychotics leads to increased UI risk. Since coping with UI continues to be a challenge in elderly population, newer antipsychotic medications should be developed to ensure safer treatments. In addition, closely monitoring the resident’s functional status and use of physical restraints would also help minimize incontinence episodes.