Objective To investigate the current status and typology of productive engagement among older adults with chronic diseases, and to provide empirical evidence for intervention strategies for enhancing productive participation of elderly chronic disease patients. Methods Using convenience sampling method, 364 elderly patients with chronic diseases hospitalized from July to December 2024 were selected as the survey objects. The Productive Engagement Scale, the Connor-Davidson Resilience Scale-10 item, and the Social Support Rating Scale were used for questionnaire surveys. Results The productive engagement score of elderly patients with chronic diseases was 37.00 (30.00, 46.00). According to the productive engagement score, the patients could be divided into three latent profiles: low participation-low positive emotion group (39.8%), moderate participation-vitality group (33.0%), high participation-high energy group (27.2%). The older age, urban residence, longer disease duration, poor self-rated health, and irregular physical exercise were associated with a higher probability of elderly chronic disease patients being classified in the low participation-low positive affect group. Conversely, higher levels of psychological resilience and greater social support were associated with a higher probability of patients being classified in the moderate participation-vitality group and the high participation-high energy group (all P<0.05). Conclusion There is obvious group heterogeneity in the productive engagement of elderly patients with chronic diseases. Medical staff can carry out targeted intervention according to the characteristics and influencing factors of each profile to improve their level of productive engagement.