Purpose: To explore the application effect of “family-centered” communication model in the treatment of critically ill elderly patients in emergency department. Methods: Composition of research subjects: a total of 90 critically ill elderly patients, case selection time: January 2024 to December 2025, randomly divided into two groups, including control group and experimental group, each with 45 cases. During the treatment process, the control group received routine emergency care, while the experimental group received emergency critical care with a “family-centered” communication model. The nursing effects of the two groups were evaluated and compared. Results: (1) During the treatment of critically ill elderly patients, after different modes of intervention, the rescue success rate of the experimental group (97.78%, 44/45) was higher than the control group (84.44%, 38/45), P < 0.05; statistics of rescue time and hospitalization time showed that the experimental group was shorter, P < 0.05; (2) In terms of the incidence of doctor-patient disputes, the statistical data of the control group and the experimental group were respectively 17.78% (8/45) and 4.44% (2/45). The comparison results showed that the experimental group was lower, P < 0.05; (3) The cooperation degree and satisfaction of family members in medical decision-making were statistically analyzed. Compared with the control group (81.54 ± 2.06 points, 82.47 ± 1.93 points), the experimental group (92.09 ± 1.88 points, 92.54 ± 2.01 points) was higher, P < 0.05. Conclusion: During the emergency treatment process, the “family-centered” communication model is effective. It can not only improve the success rate of rescue for critically ill elderly patients, shorten the rescue time and hospitalization time, but also improve the cooperation and satisfaction of family members in medical decision-making. It can effectively reduce the incidence of doctor-patient disputes and is worthy of vigorous clinical promotion.