Objective To analyze the epidemiological characteristics of the elderly patients in the emergency department of a grade-A tertiary hospital in Beijing and to explore the optimal medical service process of diagnosis and treatment. Methods A retrospective study was conducted of the general information and visit data of 30900 elderly patients who visited the Emergency Department of Xuanwu Hospital of Capital Medical University from January 2017 to December 2020, analyzing their general characteristics, visit distribution, distribution of visit time, and epidemiological characteristics. SPSS statistics 24.0 was used for data analysis. Depending on data type, analysis of variance or Kruskal-Wallis test was used for comparison between groups. Results Of 305900 elderly patients, the mean age was (72.34±9.27) years, the male/female ratio was 0.86∶1.00, and 54.85% (16778/305900) were from other areas than Xicheng District, where the hospital is located. The elderly patients in Grade Ⅰ,Ⅱ and Ⅲ numbered 263635, accounting for 0.37% (1132/305900), 5.97% (18265/305900) and 79.84% (244231/305900), respectively. The visits peaked from October to December and from January to February. Patients accompanied by family members or others accounted for 77.29%(236430/305900), and 3.70% (11318/305900) were transported to hospital by ambulance. The top three departments visited were the Department of Internal Medicine [46.66% (231272/305900)], the Neurology Department [31.55% (96507/305900)], and Surgical Department [11.15% (34107/305900)]. Cerebrovascular diseases, cardiovascular diseases and trauma ranked the top three on the disease spectrum, and the data collection rate was 100.00%. Conclusion The number of emergency visits by the elderly patients increases year by year with distinctive distribution characteristics. It is necessary to optimize the process of visit and rational allocation of resources at the emergency department. In the meanwhile, the overall treatment experience of the elderly emergency patients needs to be improved by strengthening education of the elderly patients in the disease knowledge and promoting the rational application of medical resources.