Background and aims: World’s older population is growing, and attention is being directed to the improvement of their health-related quality of life (HRQoL). This article was conducted to investigate the HRQoL and associated factors in rural elderly residents in west of Iran. Methods: By using the multistage sampling method, 346 elders from rural areas of Shahindezh were enrolled in this population-based, cross-sectional study conducted in 2014. To assess the HRQoL of the elderly people, the Leiden-Padua (LEIPAD) questionnaire was used. The economic status was classified into 3 categories (good, moderate, and low) using the principal component analysis. Descriptive statistics, independent t test, ANOVA, and Spearman correlation coefficient were used to analyze data. Multivariate linear regression was performed to determine predictive factors. Results: The mean values and confidence intervals of total core scale and total moderator scale were 38.6 (36.7-40.6) and 31.2 (29.6-32.6), respectively. Univariate analysis showed age, marital status, economic status, occupation, income source, and ethnicity were associated with HRQoL (P<0.05). Multivariate analysis showed the married, the illiterate, widows/widowers and the divorced, people with low economic status, and the self-employed had low HRQoL with respect to total scale and total core scale models (P<0.05). Conclusion: HRQoL varies according to socioeconomic factors. Its determinants should be addressed in social and health policies designed to improve the health of older people, especially the most vulnerable groups.