In French Caribbean nursing homes, male represent half of the older adult population. We hypothesized that this distribution could be attributed to a higher prevalence of psychotic disorders among men or to sociocultural factors. This cross-sectional study aimed to assess gender differences in clinical characteristics of older adults residing in these facilities (n = 332). Compared to females, males were younger (78.4 ± 9.6 years versus 84.1 ± 9.8; p < 0.001), more frequently childless (51.9% vs. 36.7%; p = 0.007) and more often single (62.5% vs. 53.4%; p = 0.012). The prevalence of major cognitive impairment (Mini Mental State Examination score ≤ 18) was similar (M/F: 73.6% vs. 76.2%). Delusions (40.8%) and hallucinations (32.5%) were common in both groups; however, males were more likely to receive antipsychotic treatment (42.9% vs. 29%; p = 0.009). Females exhibited a higher prevalence of depression (24.5% vs. 12.9%; p = 0.007) and anxiety (51.2% vs. 38.2%; p = 0.026). Familial isolation and the presence of psychotic disorders may contribute to the skewed sex ratio in nursing homes. Healthcare services should prioritize the management of psychotic disorders when planning future long-term care facilities in the Caribbean. © The Author(s) 2025.< Leer menos