Objective To explore the influencing factors of cognitive impairment and their impact on quality of life in elderly patients with chronic schizophrenia. Methods A total of 90 elderly patients with chronic schizophrenia admitted to our hospital from January 2019 to December 2022 were subjected as an observation group, and another 90 healthy elderly individuals in the physical examination center were selected as the control group. The Chinese version of the Repeatable Neuropsychological State Test (RBANS) was used to evaluate the cognitive function of the two groups of subjects. According to the results of RBANS, the observation group was divided into a non-cognitive impairment subgroup (n=51) and a cognitive impairment subgroup (n=39). And their clinical data were compared between the two groups. Multivariate logistic regression analysis was used to analyze the influencing factors of cognitive impairment decline in elderly chronic schizophrenia patients. SPSS statistics 20.0 was used for statistical analysis. Data comparison between two groups was performed using student′s t test or Chi-square test depending on data type. Results The total score of the RBANS scale was significantly lower in the observation group than the control group [(85.14±6.32) vs (95.14±6.25) points, P<0.05). The cognitive impairment group had obviously larger proportions of patients aged ≥70 years, education level below junior high school, disease course of ≥10 years, non-participation in social activities, and ≥3 times of hospitalization, but smaller proportion of married patients and lower score of quality of life when compared with the non-cognitive impairment group (P<0.05). Age ≥70 years (OR=3.602,95%CI 1.902-6.823), education level of junior high school and below (OR=3.446,95%CI 1.855-6.401), non-participation in social activities (OR=2.308,95%CI 1.341-3.972), hospitalization frequency (OR=4.432,95%CI 1.215-7.528), and course of disease≥10 years (OR=5.208,95%CI 1.325-8.471) were risk factors for cognitive impairment in elderly patients with chronic schizophrenia (P<0.05), while married status (OR=0.176,95%CI 0.110-0.758) and quality of life (OR=0.093,95%CI 0.011-0.763) were protective factors for cognitive impairment in the patients (P<0.05). Conclusion There is a certain correlation between cognitive function and quality of life in elderly patients with chronic schizophrenia. Early screening of patients with high-risk factors for cognitive impairment and early preventive intervention can help improve their quality of life and prognosis.