Loneliness is common among people approaching the last months or years of life due to serious illness or the end stages of chronic illness, and can significantly affect quality of life and other health outcomes. This chapter examines the unique experience of loneliness in this time period, including the epidemiology, risk factors, and health and social factors that may uniquely contribute to loneliness at the end of life. The chapter then provides an overview of strategies for alleviating loneliness unique to this life stage and future directions in research.