Introduction: Hong Kong older adults have been found to accumulate high levels of walking compared to their Westerns counterparts living in low-density cities. These differences in walking could be attributed to differences in destination accessibility. However, between-city differences in older adults’ walking and perceived destination accessibility have not been quantified. This study examined differences in walking and patterns of perceived destination accessibility within 5-, 10-, and 20-minute walk from home between older adults aged ≥65 years in Brisbane and Hong Kong. Methods: We used data from epidemiological studies conducted in Brisbane (n = 793) and Hong Kong (n = 484) using comparable measures of perceived distance to 12 destinations and weekly minutes of walking for transport and recreation. Regression models accounting for neighbourhood-level clustering were used to estimate between-city differences in walking and access to specific destinations. Latent class analyses were used to identify city-specific patterns of destination accessibility. Results: Hong Kong older adults accumulated significantly more minutes of walking than their Brisbane counterparts and also reported higher accessibility to most destinations. The between-city differences in percentage of older adults with access to a diversity of destinations were particularly large for shorter distances (5- and 10-minute walk from home). Conclusion: Low-density cities should provide ageing-friendly housing in the city centre with high levels of accessibility to relevant destinations and/or promote the implementation of urban planning policies that support the development of mixed land use and higher levels of residential density.