Objective To investigate the clinical characteristics and treatment of brain abscess in elderly patients. Methods Clinical data of elderly patients with brain abscess treated in neurosurgery department in a hospital from January 2008 to December 2016 were collected, clinical characteristics, treatment methods and prognosis were analyzed. Results A total of 64 elderly patients who underwent operation for brain abscess, including 14 cases (21.9%) with fever, 9 cases (14.1%) with a definite history of infection, 6 cases (9.4%) with meningeal irritation sign, laboratory examination indicated that 11 cases (17.2%) might be infected. The average time from onset to consultation was (43.3±20.4) days. Imaging findings were lesions of cystic (17 cases), cystic-solid (38 cases) or solid (9 cases). Enhanced scan showed no obvious envelope in 9 cases, thin wall(<2 mm) in 11 cases, and thick wall(>2 mm) in 44 cases; lesion envelope showed circular enhancement or inhomogeneous enhancement. 48 cases underwent abscess resection and 16 cases underwent abscess puncture. Two weeks after operation, the Glasgow outcome scale(GOS) was 1 point (death) in 4 cases, 2-3 points in 11 cases and 4-5 points in 49 cases. Except for 4 cases of death and 6 cases of loss to follow-up, the other 54 patients were followed up for an average of (25.7±16.4) months, GOS were 1 point in 2 cases, 2-3 points in 1 case, and 4-5 points in 51 cases. Conclusion Elderly patients with brain abscess lack symptoms of systemic infection, clinical symptoms of intracranial hypertension are not obvious, interval between onset and first consultation is long, imaging manifestations show brain abscess with typical thick-walled cystic-solid mass and circular enhancement, individualized treatment principle should be followed, and good prognosis can be obtained.