Aim Nursing and healthcare‐associated pneumonia (NHCAP) is a modified category of healthcare‐associated pneumonia adjusted for the healthcare system of Japan. The clinical characteristics and risk factors for mortality have not been well characterized in elderly patients with NHCAP. Methods We retrospectively investigated 960 consecutive patients aged ≥65 years admitted for pneumonia. Baseline characteristics, severity, pathogen distribution, outcomes and risk factors for mortality were compared between patients with community‐acquired pneumonia (CAP) and those with NHCAP. The applicability of age, dehydration, respiratory failure, orientation disturbance, and low BP (A‐DROP) score, a standard severity index for CAP in Japan, was also evaluated in NHCAP. Results The study participants consisted of 373 patients (38.8%) with CAP and 587 (61.2%) with NHCAP. The patients with NHCAP were older and had poorer performance status (PS) and more comorbidities than those with CAP. The frequency of potentially drug‐resistant (PDR) pathogens and in‐hospital mortality were found in 10 (2.7%) and 17 patients (4.6%) with CAP, and 60 (10.2%) and 83 patients (14.1%) with NHCAP, respectively (P < 0.0001). The incidences of PDR pathogens and mortality were not significantly different among the criteria for NHCAP. The higher mortality was associated with PS, comorbidity with Charlson Comorbidity Index ≥3, and the coexistence of congestive heart failure, chronic kidney disease and malignancy. A‐DROP score was poor at predicting mortality in most patients with NHCAP. Conclusion The current criteria for NHCAP seem to be appropriate for differentiating patients with poor outcomes from community‐acquired pneumonia patients. It is essential to assess individual underlying conditions, such as PS and comorbidity, when caring for patients with NHCAP. Geriatr Gerontol Int 2013; 14: 362–371.