Tracheotomy in the elderly has both advantages and disadvantages, and the need for tracheotomy needs to be decided by the doctor after assessing the condition. The advantages are that it facilitates assisted breathing, facilitates airway care, relieves airway obstruction, and saves lives; the disadvantages are that it can damage the trachea, reducing the quality of survival as well as surgical complications such as bleeding, subcutaneous emphysema, pneumothorax, and extubation difficulties. When the elderly have low respiratory function due to sequelae of cerebrovascular disease, lung infection, tumor, etc., and have symptoms of hypoxia or respiratory difficulties, causing laryngeal obstruction, or even life-threatening, they need to undergo tracheotomy, which opens up the airway to keep the respiratory tract open, facilitates the expulsion of sputum, prevents asphyxia, and saves their lives. At the same time, there are some disadvantages of tracheotomy for the elderly. Because tracheotomy is a traumatic operation, bleeding, pneumothorax, and subcutaneous emphysema may occur after the operation, and extubation difficulties may occur after the primary disease is relieved. Difficulty in pronation and change in dietary pattern of the patient after tracheotomy may also reduce the quality of survival of the patient, but it usually improves after extubation. In conclusion, the need for tracheotomy in the elderly should be decided by a specialist after assessment of the patient’s specific condition.