The proportion of elderly persons among hospitalized patients, including ICU admissions, is growing rapidly. Because of the severity of their comorbidities, the elderly patients have poorer prognoses than their younger counterparts. Acute respiratory failure (ARF) is the common cause in both ICU and hospital admission, The first method to treat ARF in the elderly is oxygen therapy via a nasal canula, face mask, or high-flow nasal cannula (HFNC) to buy time to reverse the cause of respiratory failure. Non invasive ventilation (NIV) should be the first choice in elderly as in younger when needed to mechanical ventilation for avoiding the need for invasive mechanical ventilation, as well as to prevent its complications. Although NIV could be considered a proper therapeutic tool in elderly population with ARF, some peculiar issues should be considered such as environment, selection of patients, palliative care and “end-of-life” decisions The use of NIV is an important and effective treatment both in de novo, acute on chronic, post-extubation respiratory failure and also, domiciliary and palliative setting in elderly. Age need not be a barrier to NIV treatment. In this review, usage of NIV in elderly in specific conditions will be discussed.