Older people are among the most vulnerable in major disasters. In their aftermath, it is crucial to institute efforts that will maintain a high level of elders' quality of life (QoL). This paper presents QoL assessments of elderly survivors five years after the Bam earthquake in Iran, and evaluates the determinants. A cross-sectional analysis of 210 randomly-selected survivors was carried out in 2008 using the WHOQOL-BREF questionnaire. A comparison of the results with data on the general population showed that experiencing the earthquake may adversely affect psychological dimensions of QoL even five years after, but paradoxically the earthquake resulted in better social relationships in affected communities than in the general population. Lower QoL associated with female gender, higher age, living alone, severe earthquake-related injury, poor quality of living conditions, increased dependency in the activities of daily living, living in an urban area, and being temporarily housed. Recovery experts and donors should carry out long-term monitoring of health status and QoL in disaster-affected communities, with a focus on psychological wellbeing. Intervention programmes that emphasise post-disaster quality of care and satisfactory housing may lead to better QoL of the victims and may shorten the recovery phase.