Objective To explore the status quo and risk factors of venous thromboembolism (VTE) in the elderly patients with advanced lung cancer. Methods A total of 270 elderly patients with advanced lung cancer admitted to the Second Hospital of Air Force Medical University between January 2019 and January 2022 were enrolled as the study subjects. The incidence rate and clinical characteristics of VTE were statistically analyzed. SPSS 20.0 was used for data analysis. According to the data type, t test orχ² test was used for comparison between the groups. Multivariate logistic regression model was employed to analyze the influencing factors of the VTE occurrence in the elderly patients with advanced lung cancer. Results Among 270 elderly patients with advanced lung cancer, VTE occurred in 78 (28.89%), among whom most [62(79.49%)] developed simple DVT, and most of them [52(66.67%)] were located in the lower extremities. VTE was found in most patients [71(91.02%)] within 6 months after the diagnosis of lung cancer, presenting various clinical manifestations. Most patients [54(69.23%)] were treated with low molecular weight heparin injection. Multivariate logistic regression analysis revealed that lung adenocarcinoma (OR=2.177,95%CI 1.515-3.129), chemotherapy (OR=11.531,95%CI 2.988-44.498), central venous catheterization (OR=4.531,95%CI 1.524-13.474), D-dimer (OR=5.562,95%CI 2.796-11.067) and performance status(PS) score (OR=2.149,95%CI 1.301-3.549) were risk factors affecting the VTE occurrence in the elderly patients with advanced lung cancer, and that serum albumin (OR=0.430,95%CI 0.227-0.813) was a protective factor. Conclusion The elderly patients with advanced lung cancer have a high incidence rate of VTE, presenting no specific manifestations. The VTE occurrences peak within 6 months after the diagnosis of lung cancer. In addition, lung adenocarcinoma, chemotherapy, central vein catheterization and high PS score increase the risk of VTE. Active detection of plasma D-dimer and serum albumin is significant in the early diagnosis of VTE and improved prognosis of the patients.