Palliative care is no longer limited to patients with terminal cancer but now includes other diseases at terminal stage such as advanced Alzheimer disease. Accompanying the elderly at the end of life involves medical, psychological and social approaches. The expression of symptoms, and especially that of pain, can be atypical. Medical prescription should take into account both the change in drug metabolism and the more frequent occurrence of side effects in the elderly. Accompanying the patient at the end of life is an increasing part of care in geriatric institutions. Indispensable factors today are adapted personnel, training, specific support and social actualization.