Objective To analyze the current status and its influencing factors of medication compliance in elderly patients with chronic diseases, and explore relevant interventions to provide reference for promoting rational drug use and implementing high-quality pharmaceutical services. Methods A stratified sampling was used to select elderly patients with chronic diseases from 15 medical institutions at different levels in many regions of China. Questionnaire surveys and Morisky medication adherence assessment were conducted for their general information, medication cognition, and medication compliance to analyze the influencing factors of medication adherence. SPSS statistics 27.0 was used for data analysis. Student′s t test or Chi-Square test was used for intergroup comparison depending on different data type. Logistic regression analysis was adopted to analyze the influencing factors of medication compliance in elderly patients with chronic diseases. Results A total of 1 007 valid questionnaires were collected, and the medication compliance rate of the elderly patients was 44.2%. Logistic regression analysis showed that marital status, education level and drug recognition level were the influencing factors of medication compliance in these elderly patients ( OR=0.653,95%CI 0.454-0.941, P=0.022; OR=0.740,95%CI 0.550-0.994, P=0.046; OR=0.591,95% CI 0.438-0.797, P=0.001). Conclusion The medication compliance is quite poor in elderly patients with chronic diseases, and the reasons for this are complex and varied. Medication education and strengthening follow-up visits can improve the medication cognition and treatment attention of the elderly patients, and thereby improve medication adherence and promote rational medication use.