The climate is an important factor influencing residents’ travel behavior. Many studies have focused on travel in areas with gentle terrain, with high-altitude regions receiving increased research attention due to their unique climatic conditions. Pilgrimage is a daily travel activity for many residents, and studying pilgrim flow patterns helps enrich the theory of travel behavior in high-altitude regions. In the context of population aging, it is crucial to help policymakers and transportation planners recognize the travel mobility needs of elderly pilgrims. This paper comprehensively analyzes the socio-demographic, travel and personal health attributes related to the mobility of elderly pilgrims and establishes plateau climate as an important factor influencing the travel behavior of this group. This study considers the actual situation of the Tibetan Plateau to fit the theoretical gap related to the travel behavior of urban residents in the plateau. Using travel diary data from selected cities on the Tibetan Plateau, a Random Coefficient Multinomial Logit Model is used to analyze the mobility patterns of elderly pilgrims. Considering the realities of China and based on specific research findings, policies developed by transportation practitioners and urban planners need to encourage older adults to use active transportation modes with lower carbon emissions and public transportation.