Caring for aging Holocaust Survivors – new manual for health-care providers

Baycrest is home to one of the largest groups of aging Holocaust Survivors in North America. With an average age in the high 80s, many survivors are now physically frail and suffering from dementias such as Alzheimer’s disease. The breakdown of their mental capacities has left them vulnerable to time disorientation and traumatic flashbacks of their experience in the death camps, or in desperate hiding, or watching relatives carted off to the gas chambers.

As survivors grow older and are confronted with the stresses and challenges of aging, they potentially face an exponential increase in vulnerability. In turn, their children also must cope both with their parents’ issues with death and dying as well as their own. Major illness, cognitive impairment and institutionalization will have a critical impact on any older adult and his/her family members, but for the Holocaust survivor there are additional elements.

The DSM-IV diagnosis of Post Traumatic Stress Disorder is based on six criteria, including re-experienced trauma and disturbing symptoms. The categories take into account that symptoms may remain latent for many years following the trauma, then suddenly awaken following a ‘trigger’ event. The sights, sounds and smells that most of us take for granted in our daily lives can trigger panic, stress and a flood of painful memories for Holocaust Survivors. The clomping of heavy winter boots down a hallway, the sight of a doctor in a white lab coat, the sound of a barking dog, the sight of people lining up in a cafeteria, or the word “shower”, can traumatize a Holocaust Survivor all over again. Aging, its related illnesses and inevitable death, may be laden with ‘triggers’ both for elderly survivors and their families.

As survivors advance in age and their health-care needs become more complex, they come into contact with hospitals, nursing homes and institutions for the aged. Relocation to these settings can potentially elicit difficult reactions associated with their early life exposure to extreme pain and loss. Even under the best conditions, institutional placement and the restrictions involved can be traumatic for survivors of the Holocaust. Such exposure may elicit feelings of being uprooted from familiar surroundings of home. It may be the strict schedules, loss of autonomy, medical health care or communal living that triggers the traumatic memories.

As survivors grow older and are confronted with new losses associated with both the decline in functioning due to their health or to the loss of friends and family due to natural death/aging, they may be reminded of their earlier tragedies. Yet even in the face of such challenges, these individuals tend to demonstrate incredible capabilities that preserve their ability to lead their lives with integrity.

Alzheimer’s Disease

Alzheimer’s disease is a devastating illness that wreaks havoc in any family. For survivors it is particularly painful. With the loss of short-term memory, they may forget their joy and pride in post-War accomplishments such as building new lives in new countries, raising and educating responsible and caring children and the adoration they lavish on grandchildren. Difficult long-term memories may intrude without control, and war trauma of years ago may become the reality of today.

The fact that many survivors are now institutionalized in long-term care facilities, such as Baycrest Centre, makes it critically important that health-care staff are made aware of their war-time history, vulnerability and special needs.

Now Baycrest has published Caring for Aging Holocaust Survivors: A Practice Manual. It’s believed to be the first comprehensive manual of its kind on how to provide the most sensitive care possible and enhance the quality of life for survivors of the Holocaust and other wars and genocides. The manual gives health-care providers contextual and practical information about how to handle challenging situations, such as screaming outbursts, physical aggression, or peculiar behaviors such as hoarding food for fear of starvation. Readers of this manual are reminded that the most effective way to respond to the needs of survivors is to learn about the range of experiences and trauma that they went through and then provide compassionate, sensitive and individualized care.

As we learn from the Survivors of the Holocaust and their families today, we will be in a better position to support all survivors of trauma tomorrow.