Abstract This study aimed to quantify the age-specific risk and burden of fall-related mortality attributable to ambient temperature among older adults in China. Using data in 2759 counties/districts during 2005–2022, we found that both high and low temperatures significantly increased the risk of fall-related mortality, with a notably higher risk associated with high temperatures, particularly among the oldest old and people in Southern China. Projections indicate that the fall-related mortality burden associated with temperature will increase in the future, primarily affecting the oldest old, and the increase is mainly driven by climate change. These findings highlight the need for effective adaptation strategies to reduce the impact of temperature on fall-related mortality among older adults, particularly facing double challenges of climate change and population aging.