The end of life can have so many meanings for various cultures. Moments that lead to the end of life are of particular importance as during the process, longstanding effects as well as impressions on family and friends will continue after the patient’s death. Considering all of the factors that can correspond with end of life care, advanced practice nurses should reflect on how to best help patients and their families during this crucial time. While describing end of life care, it is important to distinguish that end of life care is not synonymous with palliative care. This chapter describes the goals, management of symptoms, and needs while providing palliative and end of life care for the elderly within the realm of mental health care. It discusses the ethical considerations of providing geriatric palliative care, and explains differences between end of life care and palliative care.