Objective To explore the determinants of health-promoting behaviors among older adults with Chronic Obstructive Pulmonary Disease (COPD), and to provide reference for targeted intervention. Methods Employing a descriptive qualitative research design guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured in-depth interviews with 12 older adults with COPD, 15 family caregivers, and 11 medical staff. Interview data were analyzed using directed content analysis based on the official CFIR coding framework. Results We identified seven barriers, seven facilitators, and two neutral factors. Conclusion The factors influencing adherence to health-promoting behaviors in older adults with COPD primarily involve the scientificity and feasibility of the intervention strategies, the intention-behavior gap among patients and their caregivers, and the resources within the healthcare environment where programs are implemented. Tailored interventions addressing these factors may enhance health-promoting behaviors in this population.