Menachem Ben-Ezra

Predictors of Mortality in the Old-Old in Israel: The Cross-Sectional and Longitudinal Aging Study

OBJECTIVES: To examine whether well‐known predictors of mortality change their predictive power over time, being reduced or even reversed in the old‐old.

Delineating Terminal Change in Subjective Well-Being and Subjective Health

The present study investigated whether several evaluative indicators of subjective well-being (SWB) and subjective health decline as death approaches and which of them shows a stronger decline. Using three-wave longitudinal data from deceased participants of the Cross-Sectional and Longitudinal Aging Study (N = 1,360; age range 75-94 at T1= Time 1), we found a stronger decline in most evaluative indicators when plotted by distance-to-death relative to distance from birth. After controlling for background characteristics and physical and cognitive functioning, death-related decline was still found for SWB but not for subjective health. Implications are discussed regarding the well-being paradox and the yet unclear mechanisms that link evaluative indicators to the dying process.

The effect of prolonged exposure to war stress on the comorbidity of PTSD and depression among hospital personnel

The relationship between exposure to war stress and to traumatic and depressive symptoms among hospital personnel is understudied. Hospital personnel who were exposed to frequent missile attacks and casualties of war, both military and civilians (n=106), were assessed for posttraumatic stress disorder (PTSD) symptoms and depression a month after the war between Lebanon and Israel erupted. Increased risk for PTSD symptoms was found to be highly associated with increased risk for depression. Logistic regression analysis showed that hospital personnel with increased risk for PTSD symptoms had a significantly elevated risk for depression in comparison to hospital personnel without increased risk for PTSD symptoms (odds ratio=18.86, 95%CI=4.08-87.07). These findings show that hospital personnel exposed to prolonged war stress exhibited higher levels of depression in comparison to previous single exposure researches. No profession differences were found in the levels of depression, but physicians were found to be less vulnerable than other hospital staff to develop PTSD symptoms. PTSD symptoms were significantly associated with depression. The results warrant further longitudinal study.

How subjective well-being and meaning in life interact in the hostile world?

Two studies examined the interaction between subjective well-being (SWB) and meaning in life (MIL) vis-à-vis self-perceptions of actual or potential threats to ones physical and mental integrity, hereby defined as the hostile-world scenario (HWS). Study 1 (N = 608) showed that the relationship between SWB and MIL strengthened as the HWS increased. Study 2 (Survey of Health, Ageing, and Retirement in Europe; SHARE-Israel; N = 1665) similarly showed that SWB and MIL were strongly linked as lifetime cumulative adversity, the ultimate realization of the HWS, increased. Study 2 further showed that when one construct (whether SWB or MIL) was low, the other construct acted as a moderator of the effect of cumulative adversity on functioning. In conclusion, although SWB and MIL are more strongly linked under adverse circumstances, they are likely to compensate for each other, perhaps due to their unique operations.

Do Holocaust survivors show increased vulnerability or resilience to post‐Holocaust cumulative adversity?

Prior trauma can hinder coping with additional adversity or inoculate against the effect of recurrent adversity. The present study further addressed this issue by examining whether a subsample of Holocaust survivors and comparison groups, drawn from the Israeli component of the Survey of Health, Ageing, and Retirement in Europe, were differentially affected by post-Holocaust cumulative adversity. Post-Holocaust cumulative adversity had a stronger effect on the lifetime depression of Holocaust survivors than on that of comparisons. However, comparisons were more negatively affected by post-Holocaust cumulative adversity when examining markers of physical and cognitive functioning. Our findings suggest that previous trauma can both sensitize and immunize, as Holocaust survivors show general resilience intertwined with specific vulnerability when confronted with additional cumulative adversity.

Transgenerational Effects of Trauma in Midlife: Evidence for Resilience and Vulnerability in Offspring of Holocaust Survivors

Despite abundant research on offspring of Holocaust survivors (OHS), it is relatively unknown how they function in middle age. Transgenerational effects of the Holocaust may be stronger among middle-aged OHS as they previously suffered from early inclement natal and postnatal environment and now face age-related decline. However, middle-aged OHS may successfully maintain the resilience they demonstrated at a younger age. This study performed a wide-spectrum functional assessment of middle-aged OHS and a comparison group (N = 364) drawn from the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel). OHS, and especially those with two survivor parents, reported a higher sense of well-being but more physical health problems than the comparison group. The discussion provides possible explanations for this mixed functional profile. (PsycINFO Database Record

For Better and for Worse: The Relationship between Future Expectations and Functioning in the Second Half of Life

OBJECTIVES To examine age group differences in the relationship between future expectations about standards of living and physical, mental, and cognitive functioning in the second half of life. METHOD Data from the Survey of Health, Ageing, and Retirement in Europe (N=27,687, mean age=64.44). RESULTS First, with increasing age, the expectation to improve (ETI) and the expectation to worsen (ETW) in standards of living became more independent of each other. Second, with increasing age, ETI was less strongly correlated with functioning whereas ETW was more strongly correlated with it. Third, with increasing age, the relationship between ETI and functioning was more strongly moderated by ETW, so that adaptive functioning was associated with expectations that no major change is to occur and with expectations for both growth and decline. DISCUSSION Late-life positive and negative expectancies are less interdependent than they are in younger age, probably due to their stronger interaction when associating with functioning. Expectancies interact either to reflect an attempt to preserve the functional status quo (low expectancy to improve and to decline) or may signal a highly complex mental organization (high expectancy to improve and to decline).

Formal Education Level Versus Self-Rated Literacy as Predictors of Cognitive Aging

OBJECTIVES To compare the prediction of cognitive functioning by formal education and self-rated literacy and the differences in prediction across younger and older cohorts. METHOD Data on 28,535 respondents were drawn from a cross-sectional representative sample of community-dwelling older individuals (≥50), participating in the Survey of Health, Ageing, and Retirement in Europe. Education level was classified according to the International Standard Classification of Education 1997 (ISCED-1997) self-rated literacy was determined by having respondents rate their reading and writing on 1-5 scales. Cognitive functioning was measured by verbal recall, word fluency, and arithmetic ability. RESULTS Structural equation modeling demonstrated that self-rated literacy was more strongly associated with cognitive functioning than was education level, with or without additional exogenous variables (age, sex, household income, medical conditions, activities of daily living, reading eyesight, and country). The association between education level and cognitive functioning was weaker in older than in younger age groups, whereas the association between self-rated literacy and cognitive functioning showed the opposite trend. DISCUSSION Self-rated literacy was found to be a better predictor of late-life cognitive functioning than was the level of formal education. The results have implications for studies of age-related differences in which education level is taken into account.

Psychiatric symptoms and psychosocial functioning among hospital personnel during the Gaza War: A repeated cross-sectional study

Abstract Studies of mental health among hospital personnel during armed conflict are scarce and usually include single time point investigations without a comparison group. The authors compared the psychiatric symptoms and psychosocial functioning of exposed and unexposed hospital personnel at two time points. The research was conducted during 2009 and included a survey of two random samples of hospital personnel (physicians and nurses), one collected during the Gaza War and the other 6months later. Each sample included hospital personnel who were exposed to war-related stress and others who were not (Study 1: n =67 and 74 for exposed and unexposed, respectively; Study 2: n =57 and 50 for exposed and unexposed, respectively). Levels of psychiatric symptoms and psychosocial functioning were measured. Compared to unexposed hospital personnel, exposed hospital personnel had a significantly higher level of post–traumatic symptoms during the Gaza War and 6months later. In addition, during the Gaza War, exposed hospital personnel had a significantly higher level of depressive symptoms. However, in the second study, depressive symptoms were similar to those found in the unexposed group. These findings may suggest that war-related stress is associated with post–traumatic symptoms among hospital personnel even 6months after exposure.

Hospital personnel reactions to Haiti's earthquake: a preliminary matching study.

To the Editor: On January 12, 2010, Haiti was struck by a magnitude 7.0 Mw earthquake. The results of the earthquake were severe, as about 230,000 people were killed and more than 300,000 were injured.1 The Israeli aid delegation arrived in Haiti on January 15, 2010, and established an advanced field hospital. The aid delegation medical wing consisted of 40 physicians and 24 nurses.2 During a 2-week period, they treated 1,110 patients, conducted 319 successful surgeries of various levels, and delivered 16 births.3 The impact of large-scale natural disasters on hospital personnel is unknown. Most studies on hospital personnel have been conducted in the context of armed conflict, war, or terror.4,5 Studies have shown that exposure to mutilated dead bodies of victims of violent death is a significant predictor of posttraumatic stress symptoms among rescue personnel.6 Moreover, symptoms of posttraumatic stress disorder (PTSD) are also associated with functional decline among physicians.7 The purpose of this preliminary study was to survey the reactions of hospital personnel to the sights in Haiti. On the basis of previous research,5–7 we hypothesized that the hospital personnel who were in Haiti would report a higher level of posttraumatic stress symptoms, lower life satisfaction, lower perceived coping, and lower self-rated health in comparison to the matched group of hospital personnel who were not in Haiti.