Chemotherapy-induced nausea and vomiting (CINV) is a common and distressing adverse effect in elderly patients with gynecological cancer undergoing paclitaxel and carboplatin therapy. The present study aimed to identify predictors of CINV in this population. A retrospective analysis was conducted of 209 elderly patients with gynecological cancer treated with paclitaxel and carboplatin chemotherapy at The Affiliated Hospital, Southwest Medical University (Luzhou, China) between May 2019 and July 2023. The Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) was used to assess the presence, frequency, and severity of CINV. Patients were categorized into the CINV group (n=76) and non-CINV group (n=133) based on the MAT results. Age, hypertension, pre-chemotherapy sleep duration and pre-chemotherapy anxiety level were identified as significant predictors of CINV in the univariate analysis. In the multivariate analysis, age, pre-chemotherapy sleep duration and pre-chemotherapy anxiety level remained significant predictors. In conclusion, age, pre-chemotherapy sleep duration and pre-chemotherapy anxiety level are significant predictors of CINV in elderly patients with gynecological cancer undergoing paclitaxel and carboplatin therapy. These findings could help in tailoring preventative strategies for CINV in this population.