Predicting suicidal vulnerability based on previous risk factors remains a challenge for mental health professionals, especially in specific subpopulations.

This study aimed to use structural equation modelling to assess which sociodemographic and clinical variables are most predictive and modulating of repeated self-injury or reattempts at suicide in older adults and the elderly with previous attempts.

We obtained digital data for 619 people (N = 342; 55.3% women), aged 50–96 years (mean 71.2 years, s.d. 3.65), who presented to the emergency department with a repeated self-injury or suicide attempt. Data were collected from several public and private hospitals in southern Spain.

There were different sociodemographic and clinical profiles between people who repeat self-injury and those who reattempt suicide. In addition, we show that outcome variables may directly or indirectly modulate these behaviours.

The study findings provide only a limited insight into suicidal vulnerability in older people, and there is an urgent need for specific care protocols for the prevention of repeated self-injury or reattempts at suicide that are adapted to the psychosocial characteristics of this age group. There is also a need to improve social and health alert actions for older adults and the elderly who present with suicide risk profiles, and the presence of mental health professionals in hospital emergency departments should be improved.