To investigate the impact of age at onset, National Institutes of Health Stroke Scale (NIHSS) score at admission, and the C-reactive protein to albumin ratio (CAR) on the short-term prognosis of patients with acute cerebral infarction (ACI) aged over 60 years. Methods: This study employed a retrospective cohort design. Patients with ACI aged over 60 who were admitted to the Department of Neurology at Beijing Friendship Hospital, Capital Medical University, between January 2021 and December 2021 and met the inclusion and exclusion criteria were enrolled. Demographic data, risk factors, admission National Institutes of Health stroke scale (NIHSS) scores, etiology of cerebral infarction, and hematological and biochemical indicators were collected, and the CAR was calculated. Prognosis was assessed using the modified Rankin Scale (mRS) score at discharge (mRS score >2 indicated poor prognosis, while a score ≤2 indicated good prognosis). Logistic regression analysis was used to identify the influencing factors of patient prognosis. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of age, baseline NIHSS score at admission, and CAR for the short-term prognosis of ACI patients aged over 60. Results: A total of 276 eligible patients were included, comprising 94 with poor short-term prognosis (poor prognosis group) and 182 with good short-term prognosis (good prognosis group). Logistic regression and correlation analyses revealed that age at admission (OR 1.080, 95% CI 1.031-1.132, P=0.001), admission NIHSS score (OR 1.768, 95% CI 1.494-2.092, P<0.001), and CAR (OR 4.294, 95%CI1.747-10.558, P=0.001) were positively correlated with the short-term prognosis of ACI patients aged over 60. ROC curve analysis demonstrated that the combination of admission NIHSS score and CAR provided higher accuracy in evaluating the short-term prognosis of ACI patients aged over 60 compared to using baseline NIHSS or CAR alone. Conclusion: Age at onset, admission NIHSS score, and CAR are positively correlated with the short-term prognosis at discharge in ACI patients aged over 60. The combination of baseline NIHSS score and CAR demonstrates high accuracy in assessing the short-term prognosis of these patients.