Background: A 70% vaccination rate against COVID-19 in the general population was required for re-opening Phuket tourist industry. However, prior to this research, 39.61% of older people remained unvaccinated. This study aimed to examine perceptions and intentions around COVID-19 vaccination amongst older people and to explore the reasons and factors influencing their decisions to receive or refuse vaccination. Methods: This was a mixed-methods approach with a sequential explanatory design. We conducted an online survey and semi-structured qualitative interview with a subsample. Multinomial logistic regression was applied and thematic content analysis was conducted. Results: 92.4% of participants reported intention to receive the vaccine. Multinomial regression analysis revealed that perceived barriers (AdjOR = 0.032; 95% CI: 0.17–0.59), perceived benefit (AdjOR = 2.65; 95% CI: 1.49–4.71), good health (AdjOR = 3.51; 95% CI: 1.01–12.12) and health not good (AdjOR = 0.10; 95% CI: 0.02–0.49) were predictors of vaccine uptake. In the qualitative interviews, four key influences on up-take for the 28 vaccinated participants were: prevention and protection, convenience, fear of death from COVID-19, and trust in the vaccine. Four key influences on refusal of vaccination in the eight unvaccinated participants were: rarely leaving the house, fear of vaccine side-effects, fear of death after getting the vaccine, and not enough information for decision-making. Conclusion: Intervention and campaigns addressing COVID-19 vaccination should employ strategies, including the widespread use of social and other popular media to increase older people’s perceived benefit of vaccination on their current and future health status, while decreasing perceived barriers to receiving the vaccine.