Objective To investigate the causes of the failed eradication of Helicobacter pylori(Hp)infection in the elderly. Methods Data were collected of 200 patients aged 60 years or older who underwent Hp eradication in Beijing Geriatric Hospital from January 2017 to June 2018. A carbon 13 breath test was performed on the follow-up visit at 1 month after the completion of the eradication treatment, 36 patients who failed in the eradication with positive Hp were taken as study group, and 40 patients who were selected from those with successful eradication as control group. Using a self-developed questionnaire, data were collected of their social status, digestive diseases, past medical history, multiple drugs use, smoking, alcohol consumption, adverse reactions, eradication protocols, compliance, taking antibiotics or proton pump inhibitor (PPI) before eradication, and willingness for eradication. Data were processed with SPSS statistics 17.0. Depending on data type, t-test or χ² test was used for comparison. Logistic regression was performed for the analysis of risk factors for the failure of Hp eradication. Results Multiple drugs use (OR=0.102,5%CI 0.025-0.419; P=0.002), compliance (OR=0.112,95%CI 0.016-0.779; P=0.027), and taking PPI (OR=5.903,5%CI 1.193-29.215; P=0.030) or bismuth-based quadruple regimen with amoxicillin(OR=0.095,5%CI 0.012-0.744; P=0.025) before the eradication were independently associated with success of Hp eradication. Conclusion The treatment of Hp infection in the elderly should be individualized and standardized.