This study adopts EQ-5D-3L，Pittsburgh sleep quality index，GHQ-12，and Morse fall scale （MFS）to investigate older adults in M County and to explore the interaction mechanism between sleep quality and quality of life of the older adults in rural areas. The mediating and moderating effects were tested by the Bootstrap method. The results found that mental health partially mediated between sleep quality and quality of life among older adults（effect size -0.197，95% confidence interval -0.331 to-0.072），with the mediating effect accounting for 43.8% of the total effect. The mediating effect was affected by the risk of falls（R = -0.020， P ＜ 0.01），with a more significant effect observed in older adults with a higher risk of falls. Therefore，fall risk in rural older adults moderates the mediating role of mental health on the association between sleep quality and quality of life. Reducing fall risks may improve the quality of life among older adults with poor sleep and mental health.