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[Abstract] Aim: The main objective of this study was to identify determinants of poor self-rated health. We hypothesized that poor self-rated health reflects not only health, but also physical, functional, psychological and social factors. Methods: We conducted a cross-sectional analysis of a representative Spanish population sample of 600 subjects aged 65 years and older. Self-rated health status was measured and dichotomized into good (excellent and good) and poor (fair and poor). Univariate and multiple logistic regression analyses were used to determine these independent variables modifying poor self-rated health. Results: Of the participants, 43.9% perceived their health as poor. Depressive symptoms were a factor that showed the strongest relation to poor self-rated health (odds ration [OR] 5.06), even when distributed by sex (women, OR 4.70 and men, OR 5.19), followed by the need for caregiver support 24 h a day in both the total population (OR 3.67) and women (OR 3.53), but having a connective tissue disease was the second strongest factor in men (OR 2.07). When depressive symptoms and the need for caregiver support were present, the likelihood for poor self-rated health was 91.5% in the total population and 94.4% in women. In men, the likelihood reached 78.4% in the presence of depressive symptoms and connective tissue disease. Conclusions: Self-rated health is a multidimensional construct, which includes physical, psychological, functional and social variables. To recognize and intervene on the different factors involved, especially depressive symptoms, caregiver support and connective tissue disease, may contribute to improving self-rated health and ultimately the welfare for this group.