Objective To compare the diagnostic value of age-adjusted D-dimer combined with simplified Geneva score and the combined predictive model which including the RVED（right ventricular end-diastolic diameter）/LVED（left ventricular end-diastolic diameter）in elderly APE. Methods A total of 136 suspected elderly patients with acute pulmonary embolism admitted to the Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University were selected from September 2011 to September 2019. D-dimer were detected, simplified Geneva score was performed, echocardiography was improved and RVED/LVED was calculated. The diagnostic value of age-adjusted D-dimer, simplified Geneva score and RVED/LVED in elderly patients with acute pulmonary embolism was analyzed using CT pulmonary angiography（CTPA）as the "gold standard". The diagnostic value of age-adjusted D-dimer combined with simplified Geneva score and the predictive model which including age-adjusted D-dimer, simplified Geneva score and RVED/LVED was compared. Results The sensitivity, specificity, positive predictive value and negative predictive value of age-adjusted D-dimer in the diagnosis of acute pulmonary embolism in the elderly were 96%, 80%, 91% and 90% respectively. The Geneva simplified score showed 84% sensitivity, 85% specificity, 89% positive predictive value and 74% negative predictive value in the diagnosis of acute pulmonary embolism in the elderly. The sensitivity, specificity, positive predictive value and negative predictive value of the age-adjusted D-dimer combined with simplified Geneva score were 82%, 93%, 96% and 73%, respectively, for the diagnosis of acute pulmonary embolism in the elderly. The sensitivity and specificity of age-adjusted D-dimer combined with simplified Geneva score negative diagnosis of elderly APE were 98%, 72%, respectively，positive predictive value was 87%, negative predictive value was 94%. The ROC curve showed that the AUC of age-adjusted D-dimeric for diagnosing APE was 0.847［95%CI（0.775，0.929），P＜0.001］, the AUC of simplified Geneva score for diagnosing APE was 0.772［95%CI（0.687，0.857），P＜0.001］, the AUC of RVED/LVED for diagnosing APE was 0.657［95%CI（0.560，0.754），P=0.004］, and the REVD/LEVD cutoff value was 0.46. The AUC of age-adjusted D-dimer combined with simplified Geneva score for diagnosing APE was 0.852［95%CI（0.779，0.925），P＜0.001］, and the AUC of the combined predictive model for diagnosing elderly APE which including RVED/LVED was 0.857［95%CI（0.786，0.928），P＜0.001］. Conclusion The combination of age-adjusted D-dimer and simplified Geneva score has a high predictive value for elderly patients with APE, especially the value of combined predictive model which including RVED/LVED for the diagnosis of elderly APE. When age-adjusted D-dimer combined with simplified Geneva score were negative, it has important clinical significance to exclude the diagnosis of APE.