The global aging of the population has led to an increase in the number of elderly patients with heart failure (HF). The elderly patients with HF are characterized by (1) impaired diastolic function, (2) diverse comorbidities, easy progression of (3) disuse, (4) sarcopenia, and (5) cognitive dysfunction. Because of aging-related changes and increased comorbidities associated with aging, pulmonary, and skeletal muscle function are reduced. The prevalence of anemia is also increased. Therefore, elderly patients have reduced ventilatory function in diverse aspects compared to younger patients. Adequate oxygenation and positive pressure ventilation may be helpful for elderly HF patients with hypoxemia. However, elderly HF patients are at very high risk for sarcopenia because of the added burden of HF to aging-related loss of muscle mass and strength. Oxygen therapy can also be a risk factor for disuse, sarcopenia, and progression of cognitive dysfunction, as oxygen administration can be behaviorally limiting in the elderly. Therefore, careful attention should be paid to the selection of an appropriate oxygen supply and ventilator, and the prompt discontinuation of unnecessary oxygen administration. It is also anticipated that the use of palliative noninvasive ventilation will increase in the future. The palliative use of noninvasive ventilation for elderly HF patients should be used with an understanding of its advantages and disadvantages.