Objective To evaluate the predictive value of pre-endoscopy Rockall score (pRS), Full-Rockall score (fRS), Glasgow-Blatchford score (GBS) and AIMS65 scoring system for blood transfusion, endoscopic or surgical treatment, death and rebleeding in the elderly patients with acute non-varicose upper gastrointestinal bleeding (ANVUGIB). Methods The data were collected of 284 elderly patients (≥ 65 years old) with ANVUGIB in Huadong Hospital Affiliated to Fudan University from January 2013 to December 2018. The patients were divided into blood-transfusion (BT) group, non-blood-transfusion (NBT) group, endoscopic-or-surgical (EoS) group, and drug therapy (DT) group. Each patient was scored using the above-mentioned four scoring systems. The area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of the four scoring systems for blood transfusion, endoscopic or surgical treatment, death and rebleeding in the elderly ANVUGIB patients. SPSS statistics 19.0 was used for data analysis. Results The scores of pRS, fRS, GBS and AIMS65 were (2.73±1.39), (4.77±1.44), (8.17±1.62) and (1.60±0.69) points in transfusion group, and (1.96±1.08), (3.37±1.55), (4.68±3.29) and (1.12±0.32) points in non-transfusion group (all P<0.05). The scores of fRS and GBS were (6.69±1.75) and (7.69±2.39) points in endoscopic or surgical treatment group, and (3.58±1.60) and (5.20±3.34) points in drug-treated group (all P<0.05). The scores of pRS and AIMS65were (2.46±1.39) and (1.31±0.48) points in endoscopic or surgical treatment group, and (2.08±1.17) and (1.20±0.45) points in drug-treated group (all P>0.05). The predictive value of GBS for blood transfusion therapy was better than that of pRS, fRS, AIMS65 (0.817 vs 0.668,0.749,0.689; P＜0.05). The predictive value of GBS for endoscopic or surgical treatment is better than that of pRS, fRS, AIMS65(0.717 vs 0.577,0.680,0.562; P＜0.05). The predictive value of GBS for death was the same as that of fRS (0.785 vs 0.774; P＞0.05). There was no significant difference in the predictive value of pRS, fRS, GBS, AIMS65 for rebleeding (0.551 vs 0.545 vs 0.542 vs 0.551; P>0.05). Conclusion The GBS has good predictive value for the blood transfusion, endoscopic or surgical treatment and death of ANVUGIB in the elderly, and it is worthy of clinical promotion.