OBJECTIVES: Psychotropic use in nursing homes has been a concern due to extensive misuse of these agents in the elderly. Very little is known about recent national level utilization in nursing homes especially after the introduction of newer psychotropic agents. Therefore, this study examined psychotropic drug use patterns among elderly nursing home residents at the national level by using the 2004 National Nursing Home Survey (NNHS) data. METHODS: This study involved retrospective, cross-sectional analysis of the 2004 NNHS. The study sample included patients aged 65 years or older. Psychotropic drugs were classified as antidepressants, sedative/hypnotics, anti-anxiety, antipsychotics, and stimulants based on existing literature.  Psychotropic polypharmacy was defined as concomitant use of two or more psychotropic drugs. SAS survey procedures were used for descriptive domain analysis and to calculate 95% Confidence Intervals (CI) of weighted estimates. RESULTS: According to the 2004 NNHS, an estimated 0.83 (95% CI, 0.82-0.85) million elderly nursing home residents received at least one psychotropic medication for an overall prevalence of 63.18% (95% CI, 62.16 - 64.21), while 25.85% (95% CI: 24.92%-26.77%) received two or more psychotropic medications. Antidepressant agents (46.22%, 95% CI: 45.16%-47.27%) were the most prescribed psychotropic drug class followed by antipsychotics agents (24.84%, 95% CI: 23.92%-25.76%).  Psychotropic polypharmacy within the antidepressant class was highest (5.92%, 95% CI: 5.43%-6.41%) followed by antipsychotics (1.17%, 95% CI: 0.94%-1.39%). CONCLUSIONS: Nearly two-third elderly nursing home residents received psychotropic medications, while more than one in four residents were receiving two or more psychotropic drugs. With increasing concerns of inappropriate psychotropic drug use, there is a strong need to monitor their usage in this vulnerable population.