Background <p>Telehealth offers promising solutions to healthcare challenges in older adults, particularly in those with mobility constraints or limited access. However, the evidence regarding its cost-effectiveness and patient satisfaction remains unclear.</p> Objectives <p>To evaluate the cost-effectiveness and patient satisfaction of telehealth interventions in adults aged ≥ 65, with a focus on those aged ≥ 80.</p> Methods <p>A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science databases were searched for studies published between 2013 and 2024. The inclusion criteria focused on primary studies assessing the impact of telehealth on cost and satisfaction in geriatric care. Quality appraisal was performed using Cochrane, NOS, and CASP tools.</p> Results <p>Ten studies met inclusion criteria (1 RCT, 2 observational studies, 7 reviews). Telehealth interventions reduced costs by USD 223–3,846 per event, with up to 94% savings in low-income settings. Satisfaction was generally high and comparable to in-person care. Older adults aged ≥ 80 faced more barriers due to digital literacy and usability challenges.</p> Conclusion <p>Telehealth is a potentially cost-effective and acceptable approach for geriatric care. However, broader implementation requires inclusive design, digital support, and further empirical evidence, particularly in underserved populations.</p>