Objective: To investigate the ultrasound diagnosis results and related factors of nonalcoholic fatty liver disease (NAFLD) in people over 65 years old. Methods: A retrospective analysis was conducted on 1032 cases of elderly people over 65 years old who underwent physical examination in hospitals from January 2024 to December 2024. The detection rate of NAFLD was determined based on the results of abdominal hepatobiliary ultrasound. Various data were compared between NAFLD group and non-NAFLD group, and factors influencing the occurrence of NAFLD were analyzed. Results: Among the 1032 patients, 421 were diagnosed with NAFLD, and the incidence of NAFLD was 40.79%. Univariate analysis showed that there were statistically significant differences in body mass index, total cholesterol, low-density lipoprotein, uric acid, white blood cells, etc. between the NAFLD group and the non-NAFLD group (P<0.05). Multivariate Logistic regression analysis showed that body mass index, total cholesterol, low-density lipoprotein, and uric acid were independent risk factors in the development of NAFLD (P<0.05). Conclusion: The rate of NAFLD detected by ultrasound in people over 65 years old is high. Its occurrence is closely related to patient"s body mass index, total cholesterol, low-density lipoprotein, uric acid, etc., and should be paid special attention.