Urban populations are increasing at a rate that challenges existing public health infrastructures, while contemporary literature proliferates in the attempt to identify links between city neighbourhoods and health and well-being. Despite this, there have been few attempts to synthesize research into neighbourhood features perceived by elderly residents to affect their health and well-being. The primary objective of this review is to establish whether and, if so, how the perception of urban environment features acts as health and well-being determinants in an ageing population. Data extracted from 49 eligible articles into five key neighbourhood domains and thematic analysis show that poor health and reduced activity are associated with negatively perceived environments. In addition, urban social cohesion, crime and safety influences activity choices. Higher activity is associated with more compact and varied land-use mix with appealing aesthetics. Isolating individual perceived neighbourhood features as directly associated health determinants among the elderly is complex due to inter-relations and overlap between domains. Identification of perceived environment health and well-being barriers or facilitators by the elderly are under-represented and warrants further investigation. Participatory objective and subjective research will contribute towards a more robust evidence base for public health professionals and policymakers by identifying knowledge gaps.