Objective To understand the current situation of clinical nursing difficulty in elderly patients with dementia and analyze its main influencing factors, and to provide references for accurately implementing nursing services and scientifically and reasonably allocating nursing human resources.Methods A total of 248 elderly patients with dementia and 112 clinical nurses were enrolled, and general information questionnaires, Nursing Difficulty Evaluation Scale, Mini-Mental State Examination (MMSE), and the Neuropsychiatric Inventory Questionnaire (NPI-Q) were used for the survey.Results The average score of clinical nursing difficulty in 248 elderly patients with dementia was (34.30±5.46), indicated a high level of difficulty.Multiple linear regression analysis showed that the patient′s nursing level, age, living situation, cognitive ability, and the severity of psychiatric and behavioral symptoms were the main factors affecting the nursing difficulty of elderly patients with dementia (all P＜0.05).Conclusion The clinical nur-sing difficulty of elderly patients with dementia is at a high difficulty level.Nurses should pay more attention to patients who are elderly, under first-class nursing, living in elderly care institutions, have low cognitive ability, and severe mental and behavioral symptoms, so as to provide them with precise nursing services.