Background The Good Spirit Good Life (GSGL) tool is a culturally aligned quality of life tool for use with older Aboriginal and Torres Strait Islander peoples. This study uses GSGL to explore how dementia, frailty, depression and anxiety relate to a good life for older Aboriginal and Torres Strait Islander peoples and identify domains where additional support may be needed. Methods We conducted a retrospective analysis of cross-sectional data from 83 Aboriginal and/or Torres Strait Islander participants aged >50 years who completed Comprehensive Geriatric Assessments through the Let's CHAT study. Measures included cognition, frailty (Frailty Index), depression, anxiety and GSGL. Wilcoxon rank-sum tests compared GSGL scores across groups with or without dementia, frailty, depression and anxiety. Results Participants median age was 74 years [interquartile range (IQR): 64, 78]; 55.4% were women. Median [IQR] GSGL score was 36 [32, 40]. Participants with dementia (n=16) reported similar GSGL scores compared to those without these conditions. Those experiencing frailty had higher GSGL scores (38 [32, 42] than other robust participants (36 [29, 37]), p-value=0.01. Participants experiencing depression and anxiety had non-significantly lower GSGL scores than those without these conditions. Notably, across all conditions, the Country domain consistently scored <2 out of 4 (63.9%). Discussion Our findings challenge dominant biomedical assumptions that conditions such as dementia and frailty inevitably diminish quality of life. Older Aboriginal and Torres Strait Islander peoples living with these conditions reported comparable, and in some cases higher GSGL scores. Our results highlight the value of culturally grounded, strengths-based approaches that support living well.