Background: As Sudan's population ages, addressing the needs of the elderly becomes crucial for their health and quality of life. Despite a younger population overall, Sudan is projected to see significant growth in its elderly demographic, requiring proactive measures to meet their needs.Aim: This study investigate the health-related quality of life (HRQoL) among elderly rural residents and their caregivers in Gezira State, Sudan. to provide insights to policymakers and healthcare providers for improving elderly care.Method: A cross-sectional study was conducted using a multi-stage stratified sampling approach, recruiting 1000 elderly participants and their caregivers from rural Gezira. Data were collected through face-to-face interviews with validated questionnaires, and a pilot-study involving 10% of the sample informed instrument refinement. Descriptive, inferential statistics, and regression analysis, were used to analyze the data, which were coded and analyzed using SPSS version 20.Results: The study found that the elderly participants, aged 60 and above, with many having completed primary or secondary education. Chronic conditions, particularly diabetes and hypertension, were prevalent. Healthcare utilization was moderate, with transportation and cost being major barriers. HRQoL scores indicated poorer physical and emotional health among those with chronic-conditions. Caregiver support was associated with better mental and social health. Additionally, caregiver burden was negatively correlated with HRQoL across most of domains. Regression analysis identified healthcare access, caregiver-burden, and sociodemographic factors as significant HRQoL predictors.Conclusion: The findings highlight the need for targeted healthcare interventions, and stronger social support systems to improve the well-being of elderly individuals in rural communities.