“Holocaust survivors are known to be at a higher risk of a variety of psychological conditions, such as post-traumatic stress disorder (PTSD) and depression, and some studies have found a correlation with early-onset dementia,” says Dr. Yotam Weiss, of the Department of Anaesthesiology & Intensive Care, Tel Aviv Medical Center, Tel Aviv, Israel, one of the study’s authors and a grandson of Holocaust survivors.

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“Research has also shown are in poorer health and have more medical conditions than others of the same age.

Postoperative Delirium: New Insights

“However, there is a lack of information on their perioperative cognitive trajectory – whether they are at higher risk of postoperative delirium – and whether they are more likely to suffer other adverse outcomes, such as falls while in a hospital or dying in the months after their operation.

“We have a duty to the survivors. We know that their number is declining every year, and it is our duty as a medical staff to assist them during hospitalization. Information like this can help us adjust their care accordingly.”

To find out more, Dr. Weiss and colleagues carried out a retrospective single-center cohort study. They analyzed data on patients who had elective (planned) surgery at Tel-Aviv Medical Center between January 2020 and July 2021.

The procedures covered ranged from cataracts, biopsies, hernia surgeries to hip replacements, cancer surgery, and thoracic and vascular procedures. Cardiac and emergency procedures and planned ICU admissions, and patients with diagnoses of dementia were excluded.

1,211 of the 2,222 elective surgical patients were born before 1945 and so may have experienced the Holocaust.

315 (26%) of the 1,211 were Holocaust survivors (HS) and 896 were non-Holocaust survivors (NHS). All were aged 75 years or above.

The HS were older than the NHS (average age of 82 years vs. 80 years) but there were no other differences between the two groups, including gender or the proportion having major surgery.

Cognitive status was evaluated at the pre-anesthesia clinic and delirium was assessed daily, from within one hour after they left the operating theatre to the second post-operative day.

No significant differences were found in rates of cognitive impairment (23% HS vs. 21% NHS) or in postoperative delirium (14% HS vs. 16% NHS).

However, when the results were adjusted to take into account known risk factors for postoperative delirium (such as age, cognitive impairment, type of surgery) the Holocaust survivors were 40% less likely to develop postoperative delirium than age-matched non-survivors.

The prevalence of cognitive impairment (1 in 5) and postoperative delirium (1 in 6) were consistent with other studies on this age group.

The researchers also compared rates of other adverse outcomes – falls in hospital, unplanned ICU admission, being discharged to a facility other than their home, having a stroke or heart attack within three months of their operation, death within a year of their operation.

Dr. Weiss says: “The increased rate of falls may indicate increased frailty in this population.”

The researchers conclude: “Among surgical patients born before 1945 living today in Israel, 1 in 4 are Holocaust survivors, 1 in 5 have undiagnosed cognitive impairment and 1 in 6 are at risk for postoperative delirium.

Mental Health of Holocaust Survivors

“In an aging world with a rising life expectancy, these numbers have enormous significance.”

Dr. Weiss says: “Given that Holocaust survivors are at increased risk of a range of physical and psychological conditions, we were surprised to find that they seem to have a lower risk of postoperative delirium.

“As a grandson to survivors, the first thing that came to mind was ‘resilience’ – the ability to adapt positively to adversity or to recover readily from adversity.

“While early studies of Holocaust survivors described ‘survivor syndrome’ and ‘concentration camp syndrome,’ which emphasized the negative mental aspects of their experiences, later psychological studies characterize the survivors as exhibiting survivorship and resilience.

“We can only assume that these traits exist in those that have survived the Holocaust and reached old age.

“This is, however, only a hypothesis, and testing for resilience pre-operatively in a follow-up study might shed further light on our finding and also expand our knowledge of delirium.”

Source: Eurekalert