Freedom from symptoms is an important determinant of a good death, but little is known about symptom occurrence during the last year of life. In a prospective cohort study of 491 community-dwelling older persons, Chaudhry and coauthors assess symptoms leading to restrictions in daily activities every month in the year before death. They found that the monthly occurrence of restricting symptoms was fairly constant until 5 months prior to death, when it began to increase rapidly, reaching 57.2% in the month prior to death. In multivariable analysis, age younger than 85 years, multimorbidity, and proximity to time of death were significantly associated with the monthly occurrence of restricting symptoms, and participants who died of cancer had a higher monthly symptom occurrence compared with participants who died of sudden death. In an Invited Commentary, Ritchie proposes changes to common methods of research on symptom burden in older adults in order to improve care.