OBJECTIVE: Post-traumatic stress disorder (PTSD) is a prevalent condition characterized by prolonged psychological distress following traumatic events encompassing serious health threats, domestic abuse, and natural disasters. The onset and persistence of PTSD can be attributed to advanced age. This study aimed to explore the occurrence and influencing factors of enduring post-traumatic stress disorder (PTSD) in survivors aged 60 years and over in the main area of the 2008 Wenchuan earthquake 10 years after the disaster. METHODS: Data were collected using a multistage sampling method from individuals aged 60 years and older living in the main impacted areas of Wenchuan 10 years after the Wenchuan earthquake. The PTSD Checklist-Civilian Version (PCL-C) was used to evaluate PTSD symptoms. We evaluated participants based on their PTSD symptoms: those exhibiting and those without. The latter group was four times the size of the former and was matched based on gender and age (within ± 2 years). Conditional logistic regression was used to discern the risk factors. RESULTS: Out of the total, 56 participants were recognized as having probable PTSD as per the PCL-C checklist, leading to a rate of 9.4% (56/588). The univariate conditional logistic regression values showed that playing Mahjong/poker (odds ratio (OR) = 0.394, 95% confidence interval (CI) = 0.171-0.911) and displacement (OR = 0.446, 95% CI = 0.220-0.907) were protective factors for the long-term mental health of survivors in the hard-hit areas, while the presence of a 2-week illness (OR = 3.605, 95% CI = 1.751-7.424), possessing insurance (OR = 0.250, 95% CI = 0.072-0.864), suffering from a chronic ailment (OR = 3.132, 95% CI = 1.2-8.174), and having an injured family member (OR = 2.26, 95% CI = 1.136-4.496) emerged as risk factors for PTSD symptoms. Multivariate analysis indicated that the absence of insurance and prevalence of 2-week illness correlated with increased PTSD symptoms. CONCLUSIONS: Ten years after the Wenchuan earthquake, the prevalence of probable PTSD remained significantly high in the elderly population. The major risk factors were the absence of insurance and the occurrence of a 2-week illness. Policymakers should incorporate these findings when devising strategies for aging societies.