Objective To analyze the clinical characteristics and risk factors of aspiration pneumonia (AP) in very elderly patients with pulmonary infection. Methods A retrospective study was conducted of a total of 212 elderly patients (≥80 years old) with pulmonary infection who were hospitalized in the Geriatric Department of Xijing Hospital from January 2013 to January 2016. They were divided into two groups:AP group (n=61) and non-AP group (n=151). Clinical data of the patients were collected, including gender, age, BMI, underlying diseases, medication history, etc., for the analysis of the clinical characteristics and risk factors of aspiration pneumonia in very elderly patients. SPSS statistics 18.0 was used for data analysis. Results Of the 212 elderly patients with pulmonary infection, 61(35.4%) developed aspiration pneumonia. Sputum cultures were mainly Gram-negative in both groups. The length of hospital stay in the AP group was significantly longer than that in the non-AP group [(21.4±2.1) vs (15.7±3.1)d,P=0.034], and the mortality rate was significantly higher than that in the non-AP group (24.6% vs 8.0%, P=0.002). The subjects in the observation group had more cognitive impairment, swallowing dysfunction, hypothyroidism, and a history of long-term use of angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker (ACEI/ARB) antihypertensive drugs (P<0.05). Multivariate logistic regression analysis found that advanced age (OR=4.897,5%CI 3.556-7.878), cognitive impairment (OR=6.799,5%CI 2.931-9.443), swallowing dysfunction (OR=8.345,5%CI 1.062-5.133), and acid-suppressing drugs (OR=4.667,5%CI 4.283-8.343), sedatives (OR=3.886,5%CI 1.944-7.174), nitrates (OR=3.445,5%CI 2.977-6.437), calcium antagonist (OR=3.568,5%CI 4.345-7.868), ACEI/ARB (OR=6.876,5%CI 2.192-9.458) were independent risk factors for AP in elderly patients with pulmonary infection (P<0.05). Conclusion [JP+1]The incidence of AP is high in elderly patients. Advanced age,cognitive impairment, swallowing dysfunction and long-term use of ACEI/ARB antacids, sedatives, nitrates, calcium antagonists, and ACEI/ARB antihypertensive drugs are independent risk factors for the occurrence of AP in elderly people with pulmonary infection.