Purpose: The purpose of this study was to compare health management and leisure activities of the Korean and Japanese elderly. Methods: This study used a cross-sectional descriptive research design. A total of 149 Korean and 140 Japanese older adults living in two urban-rural composite areas participated in this research project. Data were collected using interviews with the participants. t-test and $x^2$ test were used to analyze the data. Results: Eighty eight point two percent of the Japanese perceived that their health status was good whereas 27.3% of the Koreans responded that their health status was poor. There were significant differences in types of leisure activities in art, intellectual, events, and volunteer activities between the two groups. A majority of the Japanese elderly replied that they spent some time and money for leisure activities; however, 20.2% and 27.2% of the Koreans reported that they did not spend time or money at all for leisure activities. Conclusion: The number of the Korean elderly participating leisure activities was significantly lower than Japanese participants. Developing nursing strategies using leisure programs would improve the quality of life of older adults and the quality of nursing care.