OBJECTIVE: The purpose of this study is to explore the potential categories of demoralization syndrome (DS) in elderly maintenance hemodialysis (MHD) patients, analyze the characteristic differences among different categories of MHD patients, and identify the independent influencing determinants of these characteristic differences. METHODS: From April to October 2024, a total of 350 elderly MHD patients from three hospitals in Baoding City, Hebei Province were selected using convenience sampling. General information questionnaires and the Chinese version of the DS scale were used for data collection. Latent profile analysis was conducted using Mplus 8.3, and differences in characteristics among different categories of these patients were compared using SPSS 27.0. RESULTS: These elderly MHD patients with DS were classified into three potential categories: low-level group (18.26%), medium-level group (45.78%), and high-level group (35.96%). Average monthly household income, hemodialysis duration, complications, and self-management ability were found to be predictive determinants influencing the latent profile categories of DS in elderly MHD patients (all p<0.05). CONCLUSION: Elderly MHD patients with DS may be categorized into three groups, with distinct characteristic differences among these categories. Based on the three identified DS sub-types (low/moderate/high), we recommend stratified interventions tailored to each group's characteristics.