Research on correlates of health-related quality of life (HRQOL) among older patients with schizophrenia has been very limited. This study evaluated the relative impact of positive, negative, and depressive symptoms, movement disorders, and cognitive impairment on HRQOL among middle-aged and older patients with schizophrenia or schizoaffective disorder. Participants were 199 patients aged 45 to 85 years. The study was cross-sectional. The primary outcome measure was the Quality of Well-Being scale, and correlates were measures of positive and negative symptoms, depression, abnormal movements, and cognitive performance. Severity of depressive symptoms and of cognitive impairment correlated significantly with HRQOL and independently affected HRQOL scores. The initiation/perseveration subscale of the Dementia Rating Scale had the largest impact. These findings suggest that depressive symptoms and cognitive functioning should be part of the routine assessment of older people with schizophrenia and may be targets for psychopharmacological and psychosocial interventions to improve HRQOL.