Objective：To compare the long-term prognosis of the elderly patients with unruptured intracranial aneurys（UIA），treated by observation，cliping or coiling，and analyze the risk factors. Methods：The clinical data of 177 cases of patients（≥65 years old） with unruptured intracranial aneurysms admitted in our hospital from January，2012 to August，2018 were retrospectively analyzed. In all，65 patients were treated with coiling，and 38 patients were treated with clipping. The remaining 74 patients were placed under conservative observation. The modified Rankin scale（mRS） was used to assess prognosis（≥1 year）. Risk factors were explored through univariable and multivariable logistic regression analysis. Results：There was no significant difference of long-term prognosis in patients with UIA among observed（12.16%），coiling（6.15%） and clipping group（5.26%，P=0.324）. However the mortality of observed group was significantly higher than others（9.46% vs. 3.08% vs. 0.00%，P=0.031）. The annual rupture rate of observation group was 3.3%. The multivariate analysis showed that aneurysm size（P=0.022，OR=0.111，95%CI=0.017-0.731） and morphology （P=0.021，OR=10.032，95%CI=1.417-71.035） were independent risk factors for unfavorable outcome of UIA in observed group Symptomatic cerebral infarction（P=0.022，OR=64.750，95%CI=1.834-2 286.561） and aneurysm size（P=0.047，OR=17.867，95%CI=1.041-306.749） were also significantly associated with unfavorable outcome of UIA managed with operation. Conclusion：Aggressive treatment of high-risk unruptured aneurysms in elderly patients should be considered positively. Coiling and clipping are both safe and effective treatment methods，and age is not the contraindication.