Against the backdrop of global population aging, the impact of urban built environments on the physical and mental health of older adults is receiving increasing attention. As the world’s largest developing nation, China, is simultaneously undergoing rapid urbanization and significant demographic aging. This dual trend makes it particularly imperative to investigate the relationship between the built environment and senior health. This study employs a meta-analysis methodology to quantitatively evaluate the relationship between urban built environment characteristics and physical and mental rehabilitation among older adults. Empirical studies were systematically screened from the CNKI and Web of Science databases using weighted Z-scores. Methodological quality, sample size, and heterogeneity were assessed to ensure the robustness of the analysis. Thirteen environmental indicators were categorized into objective built environment attributes and perceived environmental attributes. Results indicate that land use diversity and green coverage significantly correlate positively with better physical health outcomes, while safety, road quality, and environmental aesthetics significantly correlate positively with mental health. In contrast, some indicators, such as intersection density and NDVI, did not show significant correlations. This study explores the synergistic and complex effects of objective and perceived environmental characteristics in Chinese cities on the physical and mental rehabilitation of older adults within the context of dual-trend superposition. The findings not only provide scientific evidence for future urban planning and renewal in China but also offer valuable references for addressing the tension between urbanization and the health of older adults in Asia and other developing regions.