BackgroundPrevious research has demonstrated the effectiveness of virtual reality (VR) technology in many application areas. However, there is a clear gap in the literature regarding its effects on depression and anxiety in older adults with chronic diseases.AimsThis review aimed to assess the effectiveness of VR interventions for depression and anxiety in older adults with chronic diseases.MethodsSeven electronic databases were systematically searched from their inception to April 9, 2024. Two researchers evaluated methodological quality using RoB (version 2.0) and performed meta‐analyses using RevMan (version 5.4) and Stata (version 16.0) software.ResultsThis review included 19 randomized controlled studies. Meta‐analysis revealed that VR significantly improved depression (standard mean difference [SMD] = −0.67, 95% confidence interval [CI] [−0.90, −0.45], p < .00001) and anxiety (SMD = −0.76, 95% CI [−0.95, −0.57], p < .00001) in older adults with chronic diseases, improved their quality of life (SMD = 0.39, 95% CI [0.17, 0.61], p = .0006) and positive emotions (SMD = 5.65, 95% CI [3.61, 7.69], p < .00001), and relieved stress (SMD = −1.08, 95% CI [−1.52, −0.64], p < .00001). However, the difference in self‐efficacy was statistically non‐significant (SMD = 1.01, 95% CI [−0.48, 2.50], p = .19).Linking Evidence to ActionThe results of this systematic review provide important evidence for developing interventions to improve the mental health of older adults with chronic diseases.