Past history of prolonged traumatization and present health-related quality-of-life: Holocaust survivors before and after open-heart surgery

Past history of prolonged traumatization has been associated with reduced quality-of-life and difficulties of coping with major life-threatening conditions at an older age. In this article a prospective, case-comparison study was conducted in order to assess the association between Holocaust experience and quality-of-life of older patients before and after an open-heart surgery, and to examine factors associated with differences in quality-of-life. Sixty-four Holocaust survivors and 53 comparison patients who were not exposed to a major trauma were interviewed in the Department of Cardio-Thoracic Surgery at Hadassah University Hospital, Jerusalem, Israel before open-heart surgery, and 60 Holocaust survivors and 47 comparison patients were interviewed at 6 months. The interview included background data, mastery scale, and quality-of-life measured by the Nottingham Health Profile. Medical data were retrieved from the patients' charts. The Holocaust survivors reported greater problems than the comparison patients only in emotional reactions and pain components of quality-of-life at admission, and in emotional reactions and energy at follow-up. The improvement in quality-of-life over time was similar in both groups. In multivariate analyses of emotional reaction, the differences between the groups at admission remained statistically significant after controlling for education and medical status but disappeared when mastery was included. At follow-up, being a Holocaust survivor (OR = 2.56, 95% CI = 1.0-6.6), and having lower education and lower feelings of mastery were associated with higher levels of emotional reaction. The moderate differences indicate that older Holocaust survivors are not more vulnerable to problems in quality-of-life when confronted with this life-threatening medical condition. This may be further generalized to other ageing patients with past severe prolonged traumatization.