Holocaust survivors: Health and longevity 70 years later

Abstract

BackgroundHolocaust survivors (HS) alive today form a unique and disappearing population, whose exposure to systematic genocide occurred over 70 years ago. Negative health outcomes were widely documented prior to age 70. We examine the hypothesis that the experience of remote trauma continues to negatively affect health, functional status, and survival between the ages of 85–95.MethodsThe Jerusalem Longitudinal Study (1990–2022) followed a representative sample of Jerusalem residents born 1920–1921, at ages 85, 90 and 95. Home assessment included medical, social, functional, and cognitive status, and mortality data. Subjects were classified: (1) HS‐Camp (HS‐C): survived slave‐labor, concentration, or death camps; (2) HS‐Exposed (HS‐E): survived Nazi occupation of Europe; (3) Controls: European descent, outside Europe during WWII. We determined Hazards Ratios (HR), adjusting for gender, loneliness, financial difficulty, physical activity, ADL dependence, chronic ischemic heart disease, cancer, cognitive deficits, chronic joint pain, self‐rated health.ResultsAt ages 85 (n = 496), 90 (n = 524), and 95 (n = 383) the frequency of HS‐C versus HS‐E versus Controls was 28%/22%/50%, 19%/19%/62%, and 20%/22%/58%, respectively. No consistent significant morbidity differences were observed. Mortality between ages 85–90 and 90–95 years was 34.9% versus 38% versus 32.0%, and 43.4% versus 47.3% versus 43.7%, respectively, with no significant differences in survival rates (log rank p = 0.63, p = 0.81). Five‐year mortality adjusted HRs were insignificant for HS‐C and HS‐E between ages 85–90 (HR 0.87, 95% CI 0.54–1.39; HR 1.14, 95% CI 0.73–1.78) and ages 90–95 (HR 0.72, 95% CI 0.39–1.32; HR 1.38, 95% CI 0.85–2.23).ConclusionsSeventy years following their trauma and suffering during the Holocaust, the significant impairments of health, function, morbidity, and mortality which have accompanied survivors throughout their entire adult life, were no longer observed. Indeed, it is likely that survivors living >85 years old represent a uniquely resilient population of people, whose adaptation to adversity has accompanied them throughout their lives.

Aspects and dilemmas of euthanasia in modern times

“…30 The misuse of euthanasia as an excuse for the Holocaust was part of the Nazi policy of eugenics. 31 Latent suicides agree with the death penalty and euthanasia so that they don't have to kill themselves, because that brings stigma. 32 Euthanasia does not, but suicide carries a stigma, which means shame in front of society and for the family.…”

Preoperative cognitive impairment and postoperative delirium among Holocaust survivors who achieved longevity

“…25 As evidence regarding associations between surviving the Holocaust and poorer cognitive function is inconclusive, our primary conclusion of similar preoperative cognitive impairment rates is in agreement with some studies, yet contradicting others. 4,6,9,11,13 Notably, living in Israel has been suggested as a protective factor. 4,7,9 Postoperative delirium Interestingly, HS experienced similar rates of postoperative delirium when compared to the general population, despite the higher usage of chronic antidepressants and benzodiazepines, as well as a notable lack of offspring.…”

“…9,27 Moreover, older HS are often described as "resilient," demonstrating strength in both physical and cognitive domains, aiding recovery despite emotional vulnerability. 6,7,27,28…”

“…While HS were assumed to be more vulnerable to COVID-19, their COVID-related mortality did not increase. [3][4][5][6][7] However, long-lived HS often experience more depression, anxiety disorders, and post-traumatic stress disorder. [8][9][10] The Holocaust's impact on aging cognition remains unclear, with some studies suggesting no increased risk for cognitive impairment in older HS, while others report poorer cognitive function and a higher prevalence of dementia than the general population.…”

“…[8][9][10] The Holocaust's impact on aging cognition remains unclear, with some studies suggesting no increased risk for cognitive impairment in older HS, while others report poorer cognitive function and a higher prevalence of dementia than the general population. 6,[11][12][13] Although HS may demonstrate more risk factors for perioperative neurocognitive disorders, data on these disorders among HS are scarce. 14,15 We therefore aimed to compare the rates of preoperative cognitive impairment, postoperative delirium, and other postoperative adverse events in HS aged 75+ undergoing elective surgery with the general population in the same age group.…”