Objective To summarize the clinical characteristics of death from novel coronavirus pneumonia (COVID-19 pneumonia) in the advanced elderly. Methods Clinical data of 31 patients over 80 years old diagnosed with COVID-19 and then dead due to the infection in our hospital from November 4,2022 to January 8,2023 were collected and analyzed retrospectively. SPSS statistics 23.0 was used for statistical analysis. Multivariate linear regression was employed to analyze the specific indicators for the progression of COVID-19 in them. Results The average age of the 31 deceased patients was (92.61±4.40) years. There was one case (3%) of mild to severe illness, nine cases (29%) of ordinary to severe illness, 12 cases (39%) of severe to severe illness, and nine cases (29%) of severe illness at onset. The time from first onset to admission was 1-20 (5.81±4.28) d, and the course of the disease was 2-25 (10.42±5.81) d. All patients had underlying diseases, including 27 cases of coronary heart disease (87%), 24 cases of encephalopathy (77%), and 23 cases of lung disease (74%). All patients experienced multiple organ dysfunction, mainly in the lungs. When compared with the levels at admission, their white blood cell count (WBC), neutrophil count, pH value, partial pressure of carbon dioxide, blood oxygen saturation, and levels of procalcitonin, C-reactive protein, D-dimer (D-D), lactate dehydrogenase and B-type natriuretic peptide were significantly increased, while the absolute value of lymphatic cells, lymphocyte percentage, platelet (PLT) count, and arterial blood oxygen pressure were obviously reduced in the last test before death (all P<0.05). Multivariate linear regression analysis indicated that WBC count (β=0.482, P<0.05) showed a positive effect on neutrophil-to-lymphocyte ratio (NLR), while D-D (β=-0.421, P<0.05) and PLT (β=-0.423, P<0.05) had a negative effect on it. Conclusion The advanced elderly infected with COVID-19 are characterized by acute onset, severe illness and short course of disease. Old age and underlying diseases are important factors for mortality in advanced elderly with COVID-19 infection. They also often have bacterial infection at the same time. WBC, PLT and D-D levels are specific indicators of disease progression in the advanced elderly.