This study analyzed the geographical patterns of heat-related mortality among the population aged 65 and over within the metropolitan area of Sydney, Australia between 1993 and 2004, and evaluated the role of some physical and socio-demographic risk factors associated with it. The effect of temperature on all-cause mortality during unusually hot days was investigated using spatial analytic techniques, such as cluster analysis and spatial regression analysis. Generalized Linear Models (GLMs) were used to investigate the role of daily average temperature, ozone (O3) and particulate matter of diameter less than 10 μm (PM10) at the regions that showed a significant increase in mortality on unusually hot days. Spatial variation in mortality on unusually hot days was observed among the population 65 and over. Elderly people living within 5-20 km south-west and west of the Sydney Central Business District (CBD) were found to be more vulnerable. However, analysis using GLMs showed temperature to be a significant modifier of daily mortality in the region to the south-west of the CBD only. O3 and PM10 were found to be non-significant factors in the regions where air pollutants were studied. Socio-economic status and the proportion of vegetation or developed land in each Statistical Local Area (SLA) were also not a significant factor explaining the increased mortality. A combination of social and environmental factors may be at play. Our results suggest an effect of temperature on mortality of the elderly population in Sydney Statistical Division at the SLA level. More spatially-based research would be beneficial once climate datasets with improved spatial coverage become available.