Minimal data exists to predict which elders with dementia in nursing homes will maintain circadian sleep-wake rhythms during senescence and which elders with dementia in nursing homes will experience sleep-wake rhythm deterioration. This circadian deterioration is one of the background factors identified in the Needs-driven Dementia-compromised Behavior Model. The objective of this study was to determine predictors of circadian sleep-wake rhythm maintenance in elders with dementia residing in nursing homes. This secondary analysis identifies predictors of maintaining circadian sleep-wake rhythm in a convenience sample of 171 elders with dementia residing in seven nursing homes in the Southern United States. An autocorrelogram of the circadian sleep-wake rhythm for each participant determined whether or not the rhythm had deteriorated. Using measures of depression, cognitive function, physical and psychosocial activity, medications, and sleep apnea, as well as demographic characteristics of the sample, logistic regression determined the best predictors of rhythm maintenance. The best predictors of circadian sleep-wake rhythm maintenance in elders with dementia residing in nursing homes were physical activity (p = 0.00) and psychosocial activity (p = 0.00). The interaction term between these variables was not significant (p = 0.24). These findings suggest that providing meaningful daytime physical and psychosocial activity may assist in maintaining circadian sleep-wake rhythmicity. Additional research is needed to determine if these interventions would improve circadian sleep-wake rhythm in elders with dementia residing in nursing homes.