Life-Weariness, Wish to Die, Active Suicidal Ideation, and All-Cause Mortality in Population-Based Samples of Older Adults

•What is the primary question addressed by this study?Are different levels of passive and active suicidal ideation differently associated with all-cause mortality in older adults?•What is the main finding of this study?A wish to die, but neither life-weariness nor active suicidal ideation was associated with increased all-cause mortality.•What is the meaning of the finding?A wish to die may be a more important marker of mortality risk than other levels of suicidal ideation in older adults. To investigate potential differences in the strength of associations between different levels of passive and active suicidal ideation and all-cause mortality in older adults. Prospective cohort study. Population-based samples of older adults in Gothenburg, Sweden. Older adults aged 79 and above who participated in any wave of the Gothenburg H70 Birth Cohort Studies or the Prospective Population Study of Women between 1986 and 2015 (n = 2,438; 1,737 women, 701 men; mean age 86.6). Most intense level of passive or active suicidal ideation during the past month: life-weariness, wish to die, or active suicidal ideation. The outcome was all-cause mortality over 3 years. During follow-up, 672 participants (27.6%) died. After adjustments for sex, age, and year of examination, participants who reported a wish to die (HR 2.01; 95% CI 1.55–2.60) as the most intense level of ideation, but not participants who reported life-weariness (HR 1.40; 95% CI 0.88–2.21) or active suicidal ideation (HR 1.10; 95% CI 0.69–1.76) were at increased risk of all-cause mortality. Reporting a wish to die remained associated with mortality in a fully adjusted model, including somatic conditions, dementia, depression, and loneliness (HR 1.70; 95% CI 1.27–2.26). In older adults, reporting a wish to die appears to be more strongly associated with all-cause mortality than either life-weariness or active suicidal ideation