The Jerusalem Institute of Aging Research, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Department of Geriatric Rehabilitation and the Center for Palliative Care, Hadassah Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
J Am Geriatr Soc. 2023 Oct;71(10):3199-3207. doi: 10.1111/jgs.18485. Epub 2023 Jun 26.
Holocaust 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.
The 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.
At 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).
Seventy 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.
现今在世的大屠杀幸存者（HS）构成了一个独特且正在消失的群体，他们在 70 多年前经历了系统性的种族灭绝。在 70 岁之前，大量研究已经证实了他们的健康状况不佳。我们假设，这种远程创伤的经历仍然会对 85-95 岁之间的健康、功能状态和生存产生负面影响。
耶路撒冷纵向研究（1990-2022 年）跟踪了耶路撒冷出生于 1920-1921 年的代表性居民样本，在 85、90 和 95 岁时进行了家访评估，包括医疗、社会、功能和认知状况以及死亡率数据。受试者分为：（1）HS-集中营幸存者（HS-C）：曾在奴隶劳动营、集中营或死亡营中幸存；（2）HS-暴露幸存者（HS-E）：曾在纳粹占领欧洲期间幸存；（3）对照组：欧洲血统，二战期间在欧洲以外地区。我们确定了危险比（HR），并调整了性别、孤独感、经济困难、身体活动、ADL 依赖、慢性缺血性心脏病、癌症、认知障碍、慢性关节疼痛和自我评估的健康状况。
在 85 岁（n=496）、90 岁（n=524）和 95 岁（n=383）时，HS-C 与 HS-E 与对照组的频率分别为 28%/22%/50%、19%/19%/62%和 20%/22%/58%。没有观察到一致的显著发病率差异。85-90 岁和 90-95 岁之间的死亡率分别为 34.9%、38%和 32.0%和 43.4%、47.3%和 43.7%，生存率无显著差异（对数秩检验 p=0.63，p=0.81）。HS-C 和 HS-E 在 85-90 岁（HR 0.87，95%CI 0.54-1.39；HR 1.14，95%CI 0.73-1.78）和 90-95 岁（HR 0.72，95%CI 0.39-1.32；HR 1.38，95%CI 0.85-2.23）期间的 5 年死亡率调整 HR 均无统计学意义。
在经历了大屠杀的创伤和苦难 70 年后，幸存者在整个成年期一直伴随着他们的健康、功能、发病率和死亡率的显著受损，现在已经不再观察到了。事实上，超过 85 岁的幸存者可能代表了一个独特的有韧性的人群，他们的适应逆境的能力伴随着他们的一生。
