PROJECT SUMMARY We will illustrate how the COVID pandemic effected neuropsychiatric symptoms (NPS) and their management among nursing home (NH) residents with Alzheimer's Disease and Related Dementias (ADRD). NPS are frequent and difficult to manage under normal circumstances, and we hypothesize that COVID-prompted NH visitor restrictions and staffing reductions stimulated an increase in NPS and, consequently, in antipsychotic medication prescribing to manage NPS. The scientific premise of this proposal is that the COVID pandemic provides a unique opportunity to understand the dynamic between staffing, social isolation, NPS, and psychotropic medication use among NH residents with ADRD. The overall objective of this proposal is to measure the impact of COVID on resident behaviors and, in turn, the risk-benefit decisions to prescribe psychotropic medications in response. Our central hypothesis is that NH residents will have higher disruptions to daily care leading to more NPS and greater use of psychotropic medications during the COVID pandemic, especially within facilities with higher COVID infection rates. Our approach capitalizes on two data sources to establish trends in NPS and psychotropic use: national Minimum Data Set (MDS) assessments and electronic medical records (EMR) from a large NH chain with facilities in 30 states (Genesis Healthcare). Our aims are to: (1) evaluate changes in NPS among NH residents with ADRD during the COVID pandemic; (2) examine changes in psychotropic medication prescribing among NH residents with ADRD during the COVID pandemic; and (3) identify the proportion of NH residents with ADRD who remain long-term antipsychotic users during and post-COVID. The COVID pandemic has highlighted the tremendous needs of NH residents with ADRD. Ours will be the first large-scale investigation of factors that influence changes in NPS and psychotropic prescribing among NH residents with ADRD in the U.S. during COVID, identifying critical targets for future interventions and informing an evidence base for policy-making efforts to address future pandemics. This COVID-related supplement would extend the aims funded through Project 4 of P01AG027296, “Behavioral Control and Alzheimer's Disease: Policies, Medication Use, and Health Effects Across Care Settings.”