Background: Medical assistance in dying (MAID) is a process that allows patients, who suffer from unbearable suffering that cannot be alleviated, to receive assistance from a medical practitioner in ending their life. Today, eleven countries have legalized (or partially legalized) MAID. Physical pain or symptoms are often described as the primary reason for MAID requests. However, in a recent quantitative systematic review, psychosocial suffering has also emerged as an important factor that leads patients toward MAID and some qualitative studies have examined the motivations behind these requests. Aim: The present study aims to review the qualitative literature on the psychosocial factors involved in the wish to die by MAID in older adults aged 60 and over, who represent the population most likely to use MAID to end their suffering. Method: A systematic search for qualitative studies was conducted using MEDLINE and PsycINFO databases. After removal of duplicates, 22 studies met the inclusion criteria and were analyzed using a qualitative evidence synthesis method. We used a reflexive thematic analysis approach for data extraction and synthesis. Results: Six themes were identified after data codification: 1) Meaninglessness; 2) Loss of connection; 3) Fear of the future; 4) Weariness of life; 5) Loss of autonomy; and 6) Self-determination. All were related to the central theme of existential suffering. Discussion: The present study indicates that older patients’ attitudes toward or requests for MAID may be driven by existential suffering and its various expressions. Perspective: Further research and intervention on the wish to die would benefit from considering existential aspects of MAID requests, allowing for a better understanding of patients’ realities and improving care options.