Aim We aimed to evaluate the manifestations observed in older patients new to haemodialysis (HD) and the subsequent influence on health insurance. Methods Two hundred and fifty‐five new patients (130 were younger than 65 years and 125 were older than 65 years) who had received conventional HD for at least 1 year were reviewed. Results Older patients had significantly more arteriovenous (AV) shunt failures (0.7 ± 0.1 vs 0.4 ± 0.07, P = 0.006) and hospitalisations (0.8 ± 0.1 vs 0.4 ± 0.09, P = 0.03). Stepwise multivariate linear regression analysis showed that the events of AV shunt failure were an independent risk factor for hospitalisation events. Conclusions Older HD patients had significantly more AV shunt failures and hospitalisations than younger patients did. AV shunt failure is an independent risk factor of hospitalisation, which is a major additional expenditure of an HD program in terms of health insurance.