Risk and protective factors for suicidality in older adults: an umbrella review and framework for multidimensional suicide risk assessment

Introduction Suicidality in older adults is a major public health concern influenced by psychiatric, psychological, physical, functional, social, and socioeconomic factors. However, the evidence remains fragmented, and protective factors have received substantially less attention than risk factors. Methods This umbrella review followed JBI methodology and was reported in accordance with the PRISMA 2020 statement. PubMed, Scopus, and Web of Science were searched from inception to 30 June 2026 for systematic reviews and/or meta-analyses examining risk or protective factors for suicidal ideation, suicidal behavior, suicide attempts, suicide death, or self-harm in adults aged 50 years or older. Methodological quality was assessed using the JBI Critical Appraisal Checklist. Overlap was evaluated using the corrected covered area. Results Eighteen systematic reviews were included, comprising 551 eligible primary-study occurrences and 423 unique publications. Depression and other mental disorders showed the strongest and most consistent associations with suicidality. Other substantial and recurrent risk indicators included loneliness, chronic pain, disability, and psychiatric comorbidities. Associations varied across suicidal ideation, suicide attempts, suicide death, and self-harm. Evidence regarding protective factors was less extensive. Purpose or meaning in life, resilience, psychological well-being, social support, connectedness, and sense of belonging were the most consistently reported protective factors. Conclusions Late-life suicidality is associated with interacting psychiatric, physical, functional, and social factors. Clinical practice may benefit from the use of brief, multifaceted screening tools in routine care to capture these co-occurring vulnerabilities. Ultimately, suicide risk assessment in older adults must move beyond a narrow disorder-based approach toward multidisciplinary models that seamlessly integrate mental health with physical and psychosocial indicators. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261458149 , identifier CRD420261458149.