Objectives Attributions for attempting suicide were explored in older adults with and without serious physical illness. Methods An open‐ended question was used to explore attributions for attempting suicide in 101 hospitalized persons aged 70+. Serious physical illness was defined as a score of 3 or 4 on any of the 13 non‐psychiatric organ categories in the Cumulative Illness Rating Scale for Geriatrics. Results Roughly one‐third of hospitalized persons with (22/62) and without (12/39) serious physical illness attributed the suicide attempt to somatic distress. Among 70‐ to 79‐year‐olds, seriously physically ill patients were more likely than healthier patients to attribute their attempt to psychological pain (84% vs. 48%, p = 0.013). There were no significant differences in attributions in persons with and without serious health problems in the 80+ group. Conclusions The processes by which physical illness confers risk for attempted suicide in older adulthood may be age dependent. Interventions are needed to mitigate psychological pain in physically ill older patients, especially those in their seventies. Research is needed to understand how the psychological processes that influence the desire for suicide change across older adulthood. Copyright © 2015 John Wiley & Sons, Ltd.