Objective To investigate the prognosis of middle-aged and elderly patients with aspiration pneumonia and related influencing factors in integrated medical and elderly care institutions. Methods A total of 604 elderly patients with aspiration pneumonia were selected from integrated medical and elderly care institutions from January 2016 to December 2020. The prognosis of the patients was counted, and the prognostic factors were analyzed by univariate and multivariate logistic regression equations. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze the predictive value of logistic regression model for the prognosis of elderly patients with aspiration pneumonia. Results Univariate analysis showed that Alzheimer's disease, severe pneumonia, ability of daily living (ADL), and the number of rescues were related to the prognosis of elderly patients with aspiration pneumonia (P<0.05). Logistic regression model showed that the death risk of patients with Alzheimer's disease was 2.883 times higher than that of patients without Alzheimer's disease, the death risk of patients with severe pneumonia was 3.292 times higher than that of patients without severe pneumonia, the death risk of patients with severe dependence in ADL was 3.719 times higher than that of patients with mild dependence, the death risk of patients with moderate dependence in ADL was 2.558 times higher than that of patients with mild dependence, and the death risk of patients with rescue times ≥ 2 times was 2,922 times higher than that of patients without rescue times (P < 0.05). Logistic regression equation: logistic (P=-8.264+2.883)×Alzheimer disease ≥60 years old + 3.292×severe pneumonia + 3.719×severe dependence in ADL+2.558×moderate dependence in ADL +2.922× number of rescues. The predicted prognosis AUC of elderly aspiration pneumonia was 0.907 (95%CI: 0.848-0.966). When logistic(P>12.97), the predictive value was the best, with the predictive sensitivity being 83.87%, and the specificity being 84.15%. Conclusion Alzheimer's disease, severe pneumonia, moderate and severe dependence in the ability of daily living and rescue times ≥ 2 are related to the prognosis of middle-aged and elderly patients with aspiration pneumonia in the integrated medical and elderly care institutions, which can be used as a prognostic plan for clinical treatment and nursing management. At the same time strengthening the intervention of patients with the above characteristics will help to promote the improvement of prognosis.