Clinical characteristics of patients with Alzheimer’s disease and caregiver burden, mental health, and sleep quality: A cross-sectional comparative study in psychiatric hospitals and nursing homes

As Alzheimer's disease (AD) care shifts to institutions, differences between psychiatric hospitals and nursing homes remain unclear. We compared AD patients and professional caregivers across these settings and explored institution-specific links between caregiver burden, mental health, and sleep quality. A cross-sectional study (January to November 2024) enrolled 121 AD patients and 123 caregivers from 2 psychiatric hospitals and 2 nursing homes in Shanghai. Assessments used standardized scales. Analyses included nonparametric tests, χ2 tests, Spearman correlations, and stepwise regression. Post hoc power was adequate for moderate-to-large effects. AD patients in psychiatric hospitals are more severe, and caregivers face greater burden and psychological risk. Tailored, institution-specific mental health interventions are needed. Psychiatric hospital patients had poorer cognition and greater functional dependence (P < .001). Hospital caregivers reported higher burden, depression, anxiety, and worse sleep in specific domains (P < .05; effect sizes r = 0.18-0.47). Burden correlated positively with depression, anxiety, and poor sleep (r = 0.397-0.458). In the total sample, anxiety and poor sleep predicted burden (adjusted R2 = 0.285). In psychiatric hospitals, sleep quality was the dominant predictor (β = 0.483). In nursing homes, anxiety and workload predicted burden (adjusted R2 = 0.418); sleep quality was a negative predictor (β = -0.222), likely from floor effects and adaptive coping.