Against the backdrop of rapid population ageing and widespread urbanisation, this review explores older people’s needs in urban disaster response. We conducted a systematic review of 120 publications across several related fields – disaster management, gerontology, and urban governance. We identified five needs of older people in disaster response: health, socioeconomic, evacuation and settlement, information and communication, and cultural needs. We find that older adults’ needs were insufficiently met for four main reasons. First, a lack of understanding of the relationships between different needs poses challenges to coordinating disaster response, particularly when relief aid targets different needs in an uncoordinated fashion. Second, standard disaster response often provides unsuitable aid to older people, leaving them feeling uncomfortable, unequal, and undignified. Third, there is a discrepancy between policy expectations and actual disaster response, resulting in inadequate incorporation of older people’s needs into disaster response at local, national, and international levels. Fourth, there is a relative lack of advocacy that directly gives voice to older people rather than indirectly reflecting their needs through carers and disaster responders. To address research and knowledge gaps, we propose five directions for future research: (1) a need for conceptually informed, contextually salient, and transparent working definitions of older people, (2) a need for nuanced intersectional understandings of older people’s needs, (3) a holistic understanding of the disaster ecology of older people’s different needs, (4) a focus on secondary disasters arising from primary disasters, and (5) a need for more theoretically informed and empirically rigorous research.