Aims: The aim of this study was to examine the prevalence of psychological distress in survivors aged 60 years old and older by sex and analyse risk factors for psychological distress in male and female older survivors 2 years after the Wenchuan earthquake. Methods: This was a cross-sectional study. Two hundred and fifty-seven older people were involved and a multistage random sampling method was utilised. Logistic regression analysis was used to determine risk factors for psychological distress among older men and women. Results: A higher prevalence of psychological distress was observed in older women than in older men. Loss of family members and displacement from pre-earthquake residence were significant risk factors for psychological distress in older men. Significant risk factors for psychological distress in older women were low educational level, chronic diseases, loss of family members, and displacement from original residence. Conclusions: Health-care providers should develop gender-based strategies to improve mental health among older survivors in a long-term post-disaster recovery programme.