The aim of this study was to investigate purpose in life in relation to psychological well-being, social relations, and physical and psychological symptoms among very old women (n = 120) and men (n = 69). Their purpose in life was evaluated using the Purpose in Life (PIL) scale. Women scored lower on this PIL scale than men (102 vs. 108 p = 0.013). Regression analysis was used to estimate influencing factors on the PIL score. Determinants for purpose in life did not differ between the men and women, except for musculoskeletal symptoms. Attitude toward own aging had the strongest relation to PIL scores for both men and women; to have family to talk to was also important, as were musculoskeletal symptoms, for women. Our study indicates that the very old people studied were feeling indecisive about their purpose in life and that feelings are linked with poorer psychological health. For this reason, the purpose in life must be discussed and taken into consideration in the care of the elderly. (Contains 2 tables.)