Professional foster families for dependent older adults are a housing model perceived as an alternative to nursing homes in the French West Indies. The clinical profile of older adults in foster families remains to be determined, particularly concerning neuropsychiatric symptoms (NPS) in the presence of major cognitive disorders. In this cross-sectional analysis from twin studies conducted in foster families (n = 107, mean age: 81.8 years, male/female ratio: 38/62) and nursing homes (n = 332; (mean age: 81.3 years, male/female ratio: 51/49), we compare the prevalence and severity of NPS, along with psychotropic drugs prescription, between older adults (≥ 60 years) living in both arrangements. The prevalence of major cognitive disorders and the total number of NPS (3.4 ± 2.7 in foster families vs. 3.4 ± 2.5; p = 0.946) were similar between the two groups. The prevalence of each NPS was similar except for apathy (20.0% in nursing homes vs. 8.5% in foster families, p = 0.006), aberrant motor behavior (22.1% in nursing homes vs. 36.2% in foster families, p = 0.004) and eating disorders and appetite (23.0% vs. 9.3%, respectively, p = 0.002). The use of antipsychotics was more frequent in nursing homes (36.7% vs. 26.2%, p = 0.046). This study suggests that the foster families' environment may be well suited for managing older adults with psycho-behavioral disorders. © 2025. The Author(s).< Leer menos