Objective To explore the correlation between attributional style, psychological distress and quality of life in the elderly patients with breast cancer. Methods A total of 290 patients with breast cancer admitted to Mianyang Central Hospital from July 2021 to December 2022 were selected as the study subjects. According to age, the patients were divided into young and middle-aged group (18-＜60 years; n=123) and elderly group (≥60 years; n=167). Attributional style questionnaire (ASQ), distress thermometer (DT) and Chinese version of functional assessment of cancer therapy-breast (FACT-B) were used to investigate the attributional style, psychological distress and quality of life of the patients in the two groups. Data analysis was conducted using SPSS 19.0. According to the data type, comparison between groups was performed using t test, analysis of variance or Chi-square test respectively. Pearson correlation analysis was used to analyze the correlation between attributional style, psychological distress, and quality of life in the elderly patients with breast cancer. Results In the elderly group, the score of negative event of attributional style was lower, and the total score on ASQ scale was higher; the DT score was lower, and the incidence rate of significantly psychological distress was lower; the scores of physiological status and functional status and total score of FACT-B scale were lower than those in the young and middle-aged people group (P<0.05). Pearson correlation analysis indicated that the total score of positive events of attributional style in the elderly group was weakly negatively correlated with psychological distress (r=-0.263; P<0.001) and was weakly positively correlated with quality of life (r=0.214; P<0.001). The total score of negative events had a weak positive correlation with psychological distress (r=0.255; P<0.001) and a weak negative correlation with quality of life (r=-0.277; P<0.001). Psychological distress was negatively correlated with quality of life (r=-0.267; P<0.001). In the young and middle-aged group, the total score of positive events of attributional style was moderately negatively correlated with psychological distress (r=-0.553; P<0.001) and was moderately positively correlated with quality of life (r=0.633; P<0.001). The total score of negative events was moderately positively correlated with psychological distress (r=0.494; P<0.001) and was moderately negatively correlated with quality of life (r=-0.511; P<0.001), and psychological distress was moderately negatively correlated with quality of life (r=-0.577; P<0.001). Patients with better self-rated marital quality, higher the monthly income, better the emotional regulation ability had higher score for quality of life, and those with more chronic diseases had lower score for quality of life. In addition, the patients receiving endocrine therapy and chemotherapy after surgery scored higher for quality of life than those who did not (P<0.05). Conclusion Compared with the middle-aged and young patients with breast cancer, the elderly patients with breast cancer have healthier attributional style and milder psychological distress but worse quality of life. There is a weak correlation between quality of life and attributional style and psychological distress in the elderly patients with breast cancer. Additionally, comorbid chronic diseases, monthly income, postoperative endocrine therapy and chemotherapy, self-rated marital quality and emotional regulation are the factors affecting the postoperative quality of life in the elderly patients with breast cancer.