Background <p>Family caregivers are pivotal in the care of elderly patients with pressure injuries (PIs). Their preparedness is crucial for patient outcomes, yet its determinants are not fully understood. This study aimed to assess preparedness among family caregivers of elderly PIs patients and identify its key predictors.</p> Methods <p>We conducted a cross-sectional study in a general hospital from May 2024 to March 2025. A total of 428 family caregivers of elderly patients with PIs completed structured questionnaires, including the Caregiver Preparedness Scale (CPS), Zarit Burden Interview (ZBI), and Pressure Ulcer Knowledge Assessment Scale (PUKAS). Data were analyzed using descriptive statistics, correlation analysis, and multiple linear regression.</p> Results <p>The mean CPS score was 28.04 ± 4.03 (range 0–32), indicating moderate-to-high preparedness. Caregiver burden was negatively correlated with preparedness (<i>r</i>=-0.333, <i>p</i> &lt; 0.05), while PI knowledge was not significantly associated. Multiple regression revealed that higher caregiver education (β = 0.215–0.254, <i>p</i> = 0.002), receipt of moderately detailed disease-related education (β = 0.152, <i>p</i> = 0.002), and urban residence (vs. town, β=-0.127, <i>p</i> = 0.005) were significant predictors of preparedness, whereas higher burden predicted lower preparedness (β=-0.302, <i>p</i> &lt; 0.001).</p> Conclusions <p>Family caregivers of elderly PIs patients in China report generally high preparedness, which is influenced by educational level, residence, received education, and caregiver burden. Interventions should move beyond knowledge transfer to include hands-on training, emotional support, and burden alleviation, with particular attention to socioeconomically disadvantaged caregivers.</p> Clinical trial number <p>Not applicable.</p>