Holocaust survivors : Health and longevity 70 years later

Background
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.

Methods
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.

Results
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).

Conclusions
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.

Key points

• Among Holocaust survivors age 85+, their remote exposure to extreme trauma during early life no longer had a negative impact upon physical health, morbidity, or mortality.
• It is likely that survivors of extreme trauma during early life, living beyond the age of 85+ represent a uniquely resilient population.

Why does this paper matter?
Among the uniquely resilient population of Holocaust survivors aged 85+, the remote trauma experienced over 50 years previously no longer served to negatively impact upon medical morbidity or longevity.