title: Coping and emotional distress during acute hospitalization in older persons with earlier trauma: the case of Holocaust survivors.
abstract: BACKGROUND
  Older persons with earlier trauma are often more vulnerable to stresses of old age.
  
  
  OBJECTIVE
  To examine the levels of emotional distress in relation to cognitive appraisal of acute hospitalization and coping strategies in Holocaust survivors compared with an age- and education-matched group of elderly persons without Holocaust experience.
  
  
  METHODS
  This is a cross-sectional study of 63 Holocaust survivors, 65 years and older, hospitalized for an acute illness, and 57 age-, education- and hospital unit-matched people without Holocaust experience. Participants completed appraisal and coping strategies (COPE) questionnaires, and the brief symptoms inventory (BSI-18).
  
  
  RESULTS
  Holocaust survivors reported higher levels of emotional distress, appraised the hospitalization higher as a threat and lower as a challenge, and used more emotion-focused and less problem-focused or support-seeking coping strategies than the comparison group. Study variables explained 65% of the variance of emotional distress; significant predictors of emotional distress in the final regression model were not having a partner and more use of emotion-focused coping. The latter mediated the relation of group variable and challenge appraisal to emotional distress.
  
  
  CONCLUSIONS
  Health professionals must be aware of the potential impact of the hospital environment on the survivors of Holocaust as well as survivors of other trauma. Being sensitive to their specific needs may reduce the negative impact of hospitalization.
authors.affiliation: School of Social Work, University of Haifa, Haifa 31905, Israel.
authors.forename: Lee
authors.initials: L
authors.lastname: Kimron
authors.forename: Miri
authors.initials: M
authors.lastname: Cohen
mesh_terms: D000208:Acute Disease; D000223:Adaptation, Psychological; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003156:Community Mental Health Services; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D017767:Holocaust / Q000523:psychology*; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D011594:Psychometrics; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013997:Time Factors