In 2001, Pihos was diagnosed with Alzheimer's disease. In 2004, he was victimized by a con artist who acquired Pihos' lifetime collection of sports memorabilia in exchange for $30,000 in bogus checks. He spent his last years at the Grace Healthcare nursing home in Winston-Salem, North Carolina. He died there at age 87 in August 2011. His neurologist opined that Pihos' dementia was caused by blows to the head during his career as a football player. Pihos was buried at Bethel United Methodist Church Cemetery in Winston-Salem.