Background Older adults are at greater risk for becoming severely ill from COVID-19; however, the impact of the pandemic on their economic activity and non-COVID-19-related healthcare utilisation is not well understood. The aim of this study was to examine the prevalence and predictors of COVID-19-related unemployment and healthcare utilisation in a sample of older adults across 27 European countries. Methods We used data from the Survey of Health, Ageing and Retirement in Europe COVID-19 Survey, collected between June and August 2020. Participants (n=52 061) reported whether they lost a job, forwent medical treatment and whether their appointment was postponed due to COVID-19. Three-level models were estimated for each outcome to test the effects of individual, household and country-level characteristics. Results The mean prevalence of reported job loss, and forgone and postponed medical care was 19%, 12% and 26%, respectively. Job loss was associated with female sex, lower education and household income, and older age in women. For example, the OR of job loss, comparing primary versus tertiary (college) education, was 1.89 (95% CI 1.59 to 2.26). Forgone and postponed medical care was associated with older age in men, female sex and higher education. At the country level, postponed medical care was associated with more stringent governmental anti-COVID measures. Conclusion Job loss and lower healthcare utilisation for non-COVID-19-related reasons were common among older adults and were associated with several sociodemographic characteristics. Job loss appeared to disproportionally affect already economically vulnerable individuals, raising concerns about the exacerbation of social inequalities.