Over the last 200 years, where, when and how Americans die has changed dramatically. Throughout the 19th and early 20th centuries, most deaths occurred with little warning, typically due to short-term infectious diseases. In the contemporary United States, death typically happens to older adults following a long-term chronic illness. Most older adults die in institutions rather than at home, and many rely on life-extending medical technologies. For most older Americans, it is more useful and accurate to conceptualize the end of life as an anticipated and protracted process (i.e., dying) rather than a discrete and sudden event (i.e., death). In this article, I summarize historical and epidemiologic patterns of death and dying, and describe the implications of these patterns for two psychological processes: preparations for one’s own end of life; and psychological adjustment to the death of a loved one.