Objective To analyze the status quo and influencing factors of quality of life in elderly patients with hemiplegia after discharge due to acute ischemic stroke (AIS). Methods Clinical data of 408 elderly AIS hemiplegic patients admitted to our department from January to December 2022 were collected. Stroke Specific Quality of Life Scale (SSQOL) was used to assess the quality of life of these patients one month after discharge. According to the SSQOL score, they were divided into a good life-quality group (SSQOL score ≥123, n=225) and a poor life-quality group (SSQOL score <123, n=183). SPSS 23.0 statistical software was employed for data analysis. Independent sample t test or Chi-square test was utilized for intergroup comparison depending on different data type. Multivariate logistic regression analysis was applied to identify risk factors affecting the quality of life of elderly AIS hemiplegic patients after discharge. Results The SSQOL score of 408 elderly patients with AIS hemiplegia at one month after discharge was (136.35±5.38), and the standardized score was (56.30±5.21)%, which was at a moderate level. There were statistically significant differences between poor life-quality group and good life-quality group in terms of payment method of medical expense, marital status, main caregivers, Ashworth spasm grade of affected side, activity of daily living and depression symptom (P<0.05). Multivariate logistic regression analysis showed that self-paying of medical expense (OR=2.573,95%CI 1.550-4.271), affected side at Ashworth spasm grade Ⅱ (OR=2.085,95%CI 1.030-4.223), heavy dependence on daily life (OR=3.435,95%CI 2.285-5.163), and depression symptom (OR=3.114,95%CI 1.919-5.054) were risk factors for poor quality of life in elderly patients with AIS hemiplegia after discharge, and married status (OR=0.573,95%CI 0.031-0.892) and spouse as the main caregiver (OR=0.642,95%CI 0.109-0.980) were protective factors (all P<0.05 ). Conclusion Medical economic burden, high muscle tension of affected side, limited ability of daily life and depression are important influencing factors of quality of life in elderly patients with AIS hemiplegia after discharge, and spouse companionship and care are beneficial to improving their quality of life.