This exploratory study combines the elderly-friendly post-use evaluation theory with the specific context of traditional residential buildings in typical Tujia ancient towns in the Western Hunan region, namely, Furong, Liexi, Xichehe, and Liye. A post-use low satisfaction evaluation model of traditional residential buildings in ancient towns was constructed, and the importance ranking of evaluation factors, along with the importance analysis of secondary indicators, was discussed using statistical methods. The subjective evaluations of elderly residents in different ancient towns toward the living environment and the importance ranking of factors for low satisfaction were examined. The findings of this study showed that we should focus on safety, convenience, health, privacy, belonging and cultural factors, and factors influencing sustainable livability for improving the quality of life of elderly residents in Tujia ancient towns in Western Hunan. Finally, the study proposes targeted improvement strategies to guide the construction of elderly-friendly environments in Tujia ancient towns and provide a reference for low satisfaction evaluations of ancient towns in similar economically underdeveloped areas.