Objective To investigate the clinical features and treatment efficiency of acute pancreatitis (AP) in the elderly. Methods The clinical data of 164 consecutive elderly patients (elderly group, aged over 60 years) with confirmed AP and 309 non-elderly AP patients (control group, younger than 60 years old) treated in our center in recent 3 years were collected and analyzed retrospectively. The clinical features and treatment efficiency were compared between the 2 groups. Results The most common etiology of AP in the elderly patients was biliary diseases, followed by hyperlipidemia. Compared to control group, the proportion of biliary AP was significantly higher (84.15% vs 59.55%, P＜0.001); meanwhile, the percentage of hyperlipidemic AP was obviously lower (9.14% vs 31.07%, P＜0.001). The main systemic complication was organ failure in both groups (20.12% vs 18.77%, P＞0.05), but the incidence of systemic infection and persistent systemic inflammatory response syndrome was significantly higher in the elderly group than in the control group (P＜0.05), and the incidence of local complications had no statistical difference between the 2 groups (P＞0.05). The incidence of severe AP was similar in the two groups (18.90% vs 18.77%), however, the elderly group had significantly higher mortality (7.93% vs 3.56%, P＜0.05). Conclusion The elderly patients with AP are prone to have systemic complications due to their comorbidities, and then the AP may deteriorate into severe AP with extremely high mortality. Early diagnosis and effective treatment could improve the prognosis of the elderly patients with AP.