Objective To analyze the correlation between nutritional risk and prognosis in the elderly stroke patients. Methods A total of 88 elderly stroke patients admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2020 to December 2022 were selected as the study objects. Their baseline data, nutritional level, neurological impairment level, prognosis and other information were collected. A comparison was made of nutrition-related indexes in elderly stroke patients between on admission, on day 7 after admission and on the day of discharge. A multivariate logistic regression analysis was performed for the factors with statistical significance in the univariate analysis. SPSS 22.0 was used for statistical analysis. Data comparison between two groups was performed using t test, Fisher exact test or χ² test, depending on the data type. Results Malnutrition was recorded in 14 (15.9%) cases on admission, 35 (39.8%) on day 7 after admission, and 33 (37.5%) on the day of discharge. The proportion of serum albumin <35 g/L on the 7th day after admission and on the day of discharge was higher than that on admission, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that malnutrition on admission was an independent risk predictor of malnutrition on day 7 after admission (OR=0.57,95%CI 1.49-13.71; P<0.05), that National Institutes of Health Stroke Scale (NIHSS) scores on admission (OR=1.05,95%CI 1.02-1.08) and on day 7 after admission (OR=6.54,95%CI 1.16-36.87) were independent risk predictors of adverse events (both P<0.05), and that malnutrition on day 7 after admission (OR=1.76, 95%CI 1.14-2.72) and NIHSS score on admission (OR=2.08,95%CI 1.30-3.33) and day 7 after admission (OR=4.28,95%CI 1.12-16.36) were independent risk predictors of poor prognosis (all P<0.05). Conclusion Due emphasis should be laid on the assessment of nutritional risk factors in the elderly stroke patients, and timely attention should be paid to the correlation between nutritional risk factors and individual prognosis.