Objective: To analyze the rationality of benzodiazepine drug use in elderly patients with schizophrenia and its influencing factors. Methods: The clinical data of 68 elderly schizophrenia patients who visited rugao mental health center from January 2023 to May 2025 were retrospectively collected. All patients were treated with benzodiazepine drugs. The rationality of drug use was comprehensively evaluated according to the drug efficacy, indications, and safety grading standards in the "Guidelines for the Prevention and Treatment of Schizophrenia", and the patients with rational drug use were classified as the rational group, while the others as the irrational group. Single-factor and multi-factor analyses were conducted to evaluate the influencing factors of irrational drug use. Results: The proportion of patients≥ 70 years old, the proportion of those with a lower education level, the duration of illness≥ 10 years, and the proportion of combined medication in the irrational group were all higher than those in the rational group (P<0.05). After multi-factor analysis, age, education level, duration of illness≥ 10 years, and combined medication were all independent influencing factors for irrational drug use in elderly patients with schizophrenia (P<0.05). Conclusion: There is irrational drug use in elderly patients with schizophrenia, mainly influenced by high age, low education level, duration of illness≥ 10 years, cognitive impairment, and combined medication. Clinically, corresponding measures can be taken based on relevant risk factors for intervention to ensure rational and safe drug use.