Objective To analyze the features of adverse drug reaction (ADR) in the elderly (＞65 years old) in order to improve its surveillance and coping strategies. Methods All ADR reports in the elderly patients from the First Affiliated Hospital, Nanjing Medical University during the years of 2012 to 2014 in the National Center for ADR Monitoring Database were collected and retrospectively analyzed. Results There were 212 ADR reports in the elderly patients (accounting for 21.3% of the total ADR reports). They were 91 males and 121 females, at an average age of (75.25±6.43)years. Ninety-one ADRs (42.9%) occurred in the outpatient or emergency department, and 114 reports occurred in the non-ICU inpatients. There were totally 98 drugs involved. The most ADRs were caused by anti-infective drugs (30.66%) and central nervous system drugs (26.42%). The common route of administration (86.32%) was venous injection. The system-organs involved by ADR in the cohort were mainly systematic damages (23.10%), and the damages in the skin and its appendages (19.49%). And the most common manifestations were hypersensitivity reactions and rash. Conclusion This study concludes the drugs and administration routes which are more likely to cause ADR and the main signs and symptoms of ADR in the elderly. We should focus on the patients receiving high-risk drugs administration and keep close monitoring during their whole course of medication. Attention should also be paid to the medication safety and the safety of oral drugs in the elderly in outpatient and emergency departments and in those outside a hospital. Due to the presence of uncounted ones, the rate in our report only partially reflects the incidence of ADR in the elderly. ADR surveillance and report for the elderly should be emphasized and strengthened.