Presley's decline continued. A journalist recalled: "Elvis Presley had become a grotesque caricature of his sleek, energetic former self... he was barely able to pull himself through his abbreviated concerts." In Alexandria, Louisiana, the singer was on stage for less than an hour and "was impossible to understand." In Baton Rouge, Presley failed to appear. He was unable to get out of his hotel bed, and the rest of the tour was cancelled.
According to Guralnick, fans "were becoming increasingly voluble about their disappointment, but it all seemed to go right past Elvis, whose world was now confined almost entirely to his room and his [spiritualism] books." In Knoxville, Tennessee on May 20, "there was no longer any pretense of keeping up appearances... The idea was simply to get Elvis out on stage and keep him upright for the hour he was scheduled to perform." Thereafter, Presley struggled through every show. Despite his obvious problems, shows in Omaha, Nebraska and Rapid City, South Dakota were recorded for an album and a CBS-TV special: Elvis In Concert.
In Rapid City, "he was so nervous on stage that he could hardly talk... He was undoubtedly painfully aware of how he looked, and he knew that in his condition, he could not perform any significant movement A cousin, Billy Smith, recalled how Presley would sit in his room and chat, recounting things like his favourite Monty Python sketches and past japes, but "mostly there was a grim obsessiveness... a paranoia about people, germs... future events", that reminded Smith of Howard Hughes.
A book was published—the first exposé to detail Presley's years of drug misuse. Written with input from three of Presley's "Memphis Mafia", the book was the authors' revenge for them being sacked and a plea to get Presley to face up to reality. The singer "was devastated by the book. Here were his close friends who had written serious stuff that would affect his life. He felt betrayed."
Presley's final performance was in Indianapolis at the Market Square Arena, on June 26, 1977.
Another tour was scheduled to begin August 17, 1977, but at Graceland the day before, Presley was found on the floor of his bathroom by fiancée, Ginger Alden. According to the medical investigator, Presley had "stumbled or crawled several feet before he died." He was officially pronounced dead at 3:30 pm at the Baptist Memorial Hospital.
At his funeral, hundreds of thousands of fans, the press and celebrities line the streets and many hoped to see the open casket in Graceland. Among the mourners were Ann-Margret (who had remained close to Presley) and his ex-wife. U.S. President Jimmy Carter issued a statement.
Presley was buried at Forest Hill Cemetery, Memphis, next to his mother. After an attempt to steal the body, his—and his mother's—remains were reburied at Graceland in the Meditation Gardens.
Presley had developed many health problems, some of them chronic. Presley first took drugs in the army, taking amphetamines to stay awake, though there are claims that pills of some form were first given to him by Memphis DJ Dewey Phillips. In Elvis and Me, Priscilla Presley writes that by 1962, he was taking placidyls to combat severe insomnia in ever-increasing doses and later took Dexedrine to counter the sleeping pills' after-effects. She later saw "problems in Elvis' life, all magnified by taking prescribed drugs." Presley's physician, Dr. George C. Nichopoulos, has said: "[Elvis] felt that by getting [pills] from a doctor, he wasn't the common everyday junkie getting something off the street. He... thought that as far as medications and drugs went, there was something for everything."
According to Guralnick: "[D]rug use was heavily implicated... no one ruled out the possibility of anaphylactic shock brought on by the codeine pills...to which he was known to have had a mild allergy." In two lab reports filed two months later, each indicated "a strong belief that the primary cause of death was Polypharmacy," with one report "indicating the detection of fourteen drugs in Elvis' system, ten in significant quantity." It appears he died of Combined Drug Intoxication.
The medical profession has been seriously questioned. Medical Examiner Dr. Jerry Francisco had offered a cause of death while the autopsy was still being performed and before toxicology results were known. Dr. Francisco dubiously stated that cardiac arrhythmia was the cause of death, a condition that can only be determined in a living person—not post mortem. Many doctors had been flattered to be associated with Presley (or had been bribed with gifts) and supplied him with pills which simply fed his addictions. The singer allegedly spent at least $1 million per year on drugs and doctors' fees or inducements. Although Dr. Nichopoulos was exonerated with regard to Presley's death, "In the first eight months of 1977 alone, he had [prescribed] more than 10,000 doses of sedatives, amphetamines, and narcotics: all in Elvis' name. On January 20, 1980, the board found [against] him... but decided that he was not unethical [because he claimed he'd been trying to wean the singer off the drugs]." His license was suspended. In July 1995, it was permanently revoked after it was found he had improperly dispensed drugs to several patients.
In 1994, the autopsy into Presley's death was re-opened. Coroner Dr. Joseph Davis declared: "There is nothing in any of the data that supports a death from drugs [i.e. drug overdose]. In fact, everything points to a sudden, violent heart attack." However, there is little doubt that long-term drug misuse caused his premature death.