Atrial fibrillation is the most common arrhythmia in the elderly patients. The incidence of frailty in patients with atrial fibrillation increases with age as manifested by decreased physical functional reserve, increased complications, and effect on the safety of anticoagulation therapy. Considering the high risk of embolization in elderly patients with atrial fibrillation, it is necessary, in addition to assessment of embolism, to assess frailty and individualize anticoagulation regimen. Anticoagulation should not be refused for the elderly with frailty, and the gains might be better with new oral anticoagulants. This article reviews the anticoagulation strategies in elderly patients with atrial fibrillation.