Objective To evaluate the efficacy and safety of decitabine in the treatment of acute myeloid leukemia (AML) in the elderly. Methods Retrospective analysis was conducted on 29 elderly AML patients admitted in our hospital from Jan. 2013 to Feb. 2016. They were divided into decitabine treatment group and conventional treatment group. Clinical outcomes and adverse reactions were observed and compared between the 2 groups. Results The complete remission (CR) rate was 60.0%(6/10) in the decitabine group, and 35.7%(5/14) for the conventional group, with significant difference between the 2 groups (P<0.05). Significant difference was also seen in the overall survival between them (44.9 vs 13.6 months, P<0.05). Various adverse events (AE) were identified in 80.0% patients from the decitabine group. Only 30.0% (3 patients) were Ⅲ-Ⅳ grade of AE, mainly manifested as neutropenia and thrombocytopenia. Conclusion Decitabine-based chemotherapy regimen is of higher response rate and prolongs survival in the treatment of AML in the elderly.