Studies on depression aggravation in hospitalized elderly patients with chronic heart failure (CHF) are scarce. This study analyzed the influencing factors for depression and depression aggravation in elderly CHF patients in China. A total of 196 elderly CHF patients admitted to Xuanwu Hospital from March 2019 to October 2022 were consecutively selected. Information such as demographics, comorbidities, primary disease and etiology, elderly hospitalization assessment, laboratory test outcomes, cardiac function, oral medications for CHF, and management during hospitalization were collected on admission. The patients were divided into the depressed and nondepressed groups according to their depression scores, and the independent predictors for depression were analyzed using multivariable logistic regression. Another depression assessment was performed at discharge, and independent factors for worsened depression during hospitalization were also analyzed. A high frailty index score was an independent predictor for depression in elderly CHF patients. The overall depression score of the patients at discharge was significantly higher than that on admission. Low educational attainment, a low left ventricular ejection fraction, long hospitalization, and admission to the intensive care unit (ICU) were independent predictors for depression exacerbation during hospitalization. Clinical assessment of depression is necessary for elderly hospitalized CHF patients, particularly for those who have low education, a high frailty index score, a low left ventricular ejection fraction, ICU admission, and long hospitalization. The findings of this study may deepen our understanding of depression in elderly CHF patients.