Based on the theory of perceptual engineering, the work aims to obtain the evaluation of color perceptual images of patients in geriatric wards on the basis of K-Means color clustering. Firstly, the design cases of geriatric wards in modern hospitals were collected and screened, and the color samples of geriatric wards were established by K-Means clustering method for color extraction. Secondly, the semantic difference method was used to quantify the perceptual image cognition of color in geriatric wards, and then the factor analysis was carried out to the obtained evaluation results by SPSS software. Finally, the main factors influencing the evaluation of color images were extracted, and the correspondence between each perceptual image and color samples was discussed. By quantifying the perception of color perceptual imagery of patients in the geriatric wards, it could be seen that the elderly patients were more inclined to choose the color of medium and high brightness and warm tones as the main color of the ward space. Through this process, a scientific and objective color matching scheme can be obtained, which is helpful to alleviate the disease pressure of elderly patients, promote the rehabilitation process, and also provide new ideas and methods for the field of medical environment design.