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Objectives: This study aims to enhance the understanding of longitudinal associations between two important facets of well-being in late life: social support and commitment to life and living (CTL). Methods: Structured home interviews were conducted with 824 Israelis ≥75 years of age, with three annual data collection timepoints. We hypothesized and tested a cross-lagged, longitudinal structural equation model (SEM) in which CTL and social support were assumed to predict each other over time, covarying for previously reported CTL and social support. Results: Social support has a positive, contemporaneous effect, predicting commitment to living at T1 and T3, while CTL predicts social support the following year (i.e., T1–T2 & T2–T3). Satisfaction with relationships significantly contributes to measurement of both latent constructs at each point of data collection. Discussion: Commitment to life and living and social support are intertwined phenomena. Whereas social support has a concomitant effect on CTL, the effect of CTL on social support emerges over time. This suggests that greater social support fosters greater CTL, leading older adults to nurture social networks and relationships; the effect of which is greater social support in the future. The implications of these results warrant further research over longer periods and across cultures.

Social support functions as an effective buffer against depression, especially among older adults with limited social networks. For the current study, we examined longitudinal bidirectional associations between social support and depression among those 75+ years of age. We recruited and followed a sample of Israeli adults 75+ years of age (N = 824; M = 80.84; range 75–96 years). Structured interviews were conducted in the homes of participants at three annual points of measurement. Participants reported depressive symptoms and emotional and instrumental support received from friends and family. We examined a cross-lagged, longitudinal structural equation model (SEM) in which social support and depressive symptoms predict each other over time, covarying for previously reported social support and depressive symptoms. We found that both depressive symptoms and social support are largely consistent in late life. Depressive symptoms and social support reported at baseline predict levels reported 1 and 2 years thereafter. Cross-over effects emerged over time. Depressive symptoms predicted lower social support in future, and social support at baseline predicted depressive symptoms 2 years later. These findings suggest that associations between depressive symptoms and social support are bidirectional in late life. Further research is needed to replicate findings in other cultures and over longer periods, ideally until end of life.

Our study aimed to enhance understanding of memory decline (MD) in old age by evaluating longitudinal effects of personal and national contributing factors. We used data collected by the Survey of Health, Ageing and Retirement in Europe (SHARE) from 12 European countries and Israel. Our sample included 11,930 retirees aged 50+, interviewed at baseline and four years later. MD was evaluated by the change in the number of recalled words from first to second interview. Except for gender, all of our explanatory variables had a significant unique effect on MD – age, education, type of occupation, European geographical region, early retirement, time elapsed from retirement, reason for retirement, active lifestyle, re-employment, health/function status, depressive symptoms, and decline in physical and mental health – over the four years of the study. Our findings indicate that MD can be postponed by national policies such as those which prolong years of education and participation in the workforce, and by social interventions directed to promote active lifestyles in late life, especially in Mediterranean and Eastern European nations.

The aim of this study was to assess the level of awareness of elderly primary caregivers of being at physical and mental health risk due to their caregiving role, as well as to examine the impact of sociodemographic characteristics, patient care characteristics, and situational variables on caregivers’ awareness. Data were collected by interview of a sample of primary caregivers aged 60+. A total of 202 primary caregivers responded positively, representing a response rate of 65% (202/311). We found a low–moderate level of awareness. The final multivariate regression analysis (F (12, 179) = 21.26, p < 0.000) revealed six variables, out of nearly 30, that are associated with a high percentage (59%) of the variability of caregivers’ awareness, namely caregiving burden, caregivers’ self-rated health, patient’s disease severity, caregiver gender, number of children, and familial relation to the patient. Action may be taken to raise caregivers’ awareness. Such interventions would possibly contribute to the quality of life and health of caregivers, enable the optimal treatment of the patient, and reduce the costs imposed on the health system and society in general.

Holocaust survivors could be especially vulnerable to the negative effects of the COVID-19 pandemic due to their early life traumas. Thus, the current study examines the effects of the pandemic on the mental health of Holocaust survivors in Israel, compared to adults who did not experience the Holocaust. We collected quantitative data from 305 adults aged 75+ (38% Holocaust survivors) in Israel during the COVID-19 pandemic. The results indicate that Holocaust survivors were worried to a greater extent from COVID-19 and reported greater depression which became worse during the pandemic. On the other hand, despite these differences, the two groups were similar in their will to live. In conclusion, Holocaust survivors seem to be more vulnerable to the COVID-19 pandemic, strengthening the vulnerability hypothesis, while also showing resilience in their will to live. Policy makers and practitioners should pay special attention to this particularly vulnerable population during these difficult times.

IntroductionThe COVID-19 pandemic places older adults at increased risk for hospitalization and mortality. It also involves social isolation and negative effects of limited mental, social and physical activity. Holocaust survivors could be especially vulnerable to such effects due to their early life traumas. Previous research suggests that in times of life crises, Holocaust survivors may be both most vulnerable (i.e., wear-and-tear hypothesis); yet they may also demonstrate resilience.ObjectivesThus, the current study examines the effects of the COVID-19 pandemic on the mental health and well-being of Holocaust survivors in Israel, compared to adults who did not experience the Holocaust.MethodsWe collected data from 305 older adults aged 75 and above in Israel during the COVID-19 pandemic. Of these, 114 were Holocaust survivors and 191 did not experience the Holocaust. Participants were asked about their worries of COVID-19 infections, will to live, loneliness and depression and how these changed during the COVID-19 pandemic.ResultsHolocaust survivors were worried to a greater extent from COVID-19 infection and from close others becoming infected, compared to older adults who did not experience the Holocaust. Moreover, survivors reported greater loneliness and depression overall and also reported that these measures became worse during the pandemic. On the other hand, despite these differences, the two groups were similar in their will to live.ConclusionsHolocaust survivors seem to be more vulnerable to the COVID-19 pandemic, strengthening the vulnerability hypothesis. Policy makers and practitioners should pay special attention to this particularly vulnerable population during these difficult times.DisclosureNo significant relationships.

Vision impairment is one of the most common disabilities among older adults, and it has a substantial impact on well-being. The present study constructs an integrative model to identify which variables derived from four dimensions of life (physical/functional, social, psychological and environmental) combined with sociodemographic variables explain the overall subjective well-being (SWB) visually impaired older adults living in the community.A total of 121 severe visually impaired persons, aged 60 and over (M = 77.4, range 60-95), participated in the study. Personal, face-to-face interviews were conducted with participants at social centers or at their homes. Research tools consisted of valid and reliable questionnaires.Five variables explained the older adults' variability in SWB: self-rated health, sense of meaning in life, functional independence in activity of daily living (ADL), sense of control of one's environment (Mastery) and the participant's age. The explained variance percentage was found to be high (61%). In contrast to expectations, social-environmental variables proved to be only of secondary significance in explaining SWB variability.Variables derived from the psychological dimension appear more significant than the social-environmental variables in explaining SWB among visually impaired older adults. These variables should be considered when developing intervention programs intended to increase SWB within this unique population group.

Objectives The purpose of the current study was to examine the longitudinal relationship between 2 central concepts in the study of subjective well-being in old age-self-perception of aging (SPA) and physical functioning, and to assess the mediating role of self-efficacy beliefs in this relationship. Methods Interviews were conducted in the home with 1,216 randomly selected persons aged 75+ years (T1) and repeated with 892 of them 2 years later (T2). We collected data on SPA, physical functioning, self-efficacy, self-rated health, and demographics. Using SEM techniques, we examined cross-lagged autoregressive relationships between SPA and physical functioning and between SPA and self-efficacy, and the mediating effect of self-efficacy. Results Findings indicated that it was SPA that affected physical functioning and self-efficacy and not vice versa, while controlling for age, gender, education, economic status and self-rated health. Evaluation of a mediation model showed that self-efficacy fully mediated the longitudinal relationship between SPA-T1 and physical functioning -T2. Discussion Our results indicated a psychological pathway by which SPA affected physical functioning through self-efficacy. SPA also affected self-efficacy, which in turn probably motivated people to use effective coping patterns for maintaining their physical functioning.

Life satisfaction is a core component of well-being. Across age groups, satisfaction with life was found to be integral to individual mental and physical health. Surprisingly, there appears to be little or no association between age and life satisfaction. Recent longitudinal research suggests that life satisfaction may even increase in late life. This is known as the paradox of well-being.To compare levels of life satisfaction reported by Israeli Holocaust survivors (HS) vis-à-vis other older Israelis and older Canadians.We interviewed 295 HS, 205 other older Israelis, and 335 older Canadians each of whom completed the Life Satisfaction Scale with items measuring both concurrent and retrospective aspects. Separate confirmatory factor analytic models were computed for each group.Overall, levels of life satisfaction were indistinguishable across groups. Both concurrent and retrospective items contributed significantly to measurement of a single latent construct. Yet differences between groups in the latent structure of response to certain scale items emerged.It may be that HS report high life satisfaction not despite, but because of, experiencing early life trauma, juxtaposing early years with the comparatively good conditions of their lives today.

Purpose Caregivers face severe difficulties in communicating openly with their terminally ill relatives about illness and death. Some studies suggest that females are more likely than males to hold such conversations. We compared level of open communication between male and female spouse-caregivers, and the contribution of personal and situational characteristics to the explanation of open communication level within each gender group. Methods The study design was correlational. We interviewed 77 spousal-primary caregivers of terminal cancer patients. Participants were recruited over a 10-month period from the home hospice unit of the central region of Israel's largest Health Maintenance Organization. The questionnaire included measures of open communication, along with caregiver's personal and situational characteristics. Results Female spouses reported higher levels of open communication about illness and death with their loved ones, compared to male spouses. Among males, duration of care and self-efficacy emerged as significant contributors to open communication level. Among females, self-efficacy and ethnic origin were found to be significant explanatory variables. Conclusions This study demonstrates the important role gender plays in level of open communication between spousal caregivers and terminal cancer patients, concerning their illness and approaching death. Self-efficacy, ethnic origin and duration of care are also significant factors explaining open communication of both male and female caregivers. These factors should be considered by nurses and other healthcare professionals when developing intervention programs to increase the level of open communication between family caregivers and their terminally ill relatives.

Objectives: The aim of this qualitative study was to explore factors that influence older persons' will to live (WTL).Methods: Twenty-five Israeli elders were interviewed about what weakens and/or strengthens their WTL. Elements of the grounded theory method guided the data collection and analysis.Results: Our analysis revealed that the elements that pertain to WTL could potentially both increase and decrease the WTL in elders. These factors included social networks, financial security, religious faith, working and volunteering, and honor versus ageism.Conclusions: Five factors represent different aspects of older persons' lives that influence the WTL. The first four themes including Social Networks, Religious Faith, Honor versus Ageism, and Working and Volunteering are consistent with the findings of the study of Blue Zones. Blue Zones are areas characterized by high life expectancy. Israel shares cultural characteristics with the Blue Zones, being a society with traditional collective characteristics stemming from the Jewish tradition. The last theme of financial security is related to the characteristics of Israel as a society in which the social gaps are large and many elderly are pushed to the social margins, and lack financial security. This study points to the unique cultural characteristics of Israel that affect the WTL among elderly Jews and proposes a hypothesis linking Israeli culture to the high life expectancy in Israel.

Literature indicates that family primary caregivers (FPC) to severely-ill patients are at high risk to incidence of physical and mental morbidity, especially if they are old themselves. The purpose of these studies was to examine the FPC’s awareness to their own health risks, and primary physicians’ awareness to the importance of locating, following and providing preventive treatment to FPC in their clinic. Participants included 202 FPC older spouses with average age 70.7 (SD=8.33), and 68% women, and primary physicians (N=201) with average age of 48.5 (SD=11.22) and 53.5% women. Among the FPC, awareness to the health risks of caregiving was higher the greater was the caregiving burden, the worse was their self-rated health, the severer was the patient’s disease, as well as the lower was the number of children and among women and spouses. Awareness to importance of medical surveillance was low. Among physicians, awareness to the risks of caregiving was highest among physicians who received their diploma in Israeli universities, and to specialists in family medicine. Their awareness was higher to the FPC’s susceptibility to mental risks rather than to physical risks. Physician’s awareness to the efficiency of medical surveillance of the FPC was high but their actual performance of it was low. This finding is in accordance with the FPC’s report about a low level of interest in their own health among their primary physicians. The importance of awareness to location, surveillance and preventive treatment of FPC should be promoted in medical education, and primary medical services.

Subjective well-being (SWB) has become an important concept in evaluating older adults' quality of life. The cognitive and emotional evaluations which are used to appraise it differ in structure, characteristics, and effects on life. The purpose of this study was to support hypotheses regarding expected Holocaust survivors-specific effects and cross-cultural differences on three indicators of SWB.We recruited samples of 50 male and female Israeli Holocaust survivors, other older Israelis, and older Canadians (N = 300) for allowing us to distinguish survivors-specific effects from cross-national differences. State anxiety, depressive symptoms, and life-satisfaction were compared across groups of men and women. Where univariate differences were detected, post hoc comparisons were computed to determine which of the groups significantly differed.In general, a higher level of SWB was found among Canadians in comparison to both comparative Israeli groups. Level of depressive symptoms was significantly higher among women survivors than in the other two groups. Both groups of Israeli women had higher scores on anxiety than Canadian Women; less apparent were differences across groups of men. Life-satisfaction did not differ among the groups.Our findings regarding depression support the survivor-specific effect hypothesis for women, and a national effect on anxiety, but not any effect on life-satisfaction. These findings suggest significant differences in impacts of traumatic life events on cognitive versus emotional indicators of SWB. This issue should be further investigated due to its practical implications in use of various measures of SWB with people who experienced traumatic events.

In old age, the will-to-live (WTL) is one of the most important indicators of subjective well-being (SWB). However, few studies to date have focused on WTL. In these studies, WTL has mainly been evaluated via indirect questions concerning factors that may influence peoples' WTL, or by measures directed to patients with specific diseases. The current study describes the development and psychometric properties of a new WTL scale.The five-item WTL scale was developed on the basis of previous qualitative and quantitative research, and was evaluated in a longitudinal study of a random sample of 868 adults, aged 75+.Confirmatory factor analytic (CFA) models were computed showing that each of the five items contributed significantly to measurement of a single WTL latent factor. Goodness-of-fit statistics were in ideal parameters for these CFA models at each point of data collection. Moreover, temporal analyses indicated that the relative contribution to measurement for each item was equivalent across time, attesting to reliability of measurement and the construct validity of WTL measurement. Concurrent validity was supported by significant positive correlations between WTL and life satisfaction, happiness, self-rated health, morale, self-rated aging, and, as expected, by inverse associations of WTL with depression and loneliness.The results of these analyses indicate that the WTL scale is a valid and reliable instrument. Considering the importance of the WTL concept in late life, and the psychometric properties of the WTL scale, we recommend it for use in research and practice related to older adults' SWB and end-of-life care.

Background In western societies, a shared decision-making model for doctor–patient relationships calling for open and collaborative communication is recommended. Research focuses mainly on the doctor's communication patterns, while research on patient communication patterns is rare. The purpose of this study was to develop a tool for evaluating patient's communication patterns – the Patient Communication Pattern Scale (PCPS). Methods Interviews based on structured questionnaires were conducted with 251 cancer patients. In addition to the 14-item PCPS, the questionnaire included questions regarding education, religiosity and desirability of control in general and over one's own health in particular, for validating the scale. Results The PCPS was found to be a valid and reliable tool for evaluating patients' communication patterns. Confirmatory factor analysis supported the PCPS designed structure of five facets: (1) Information, (2) Clarification, (3) Initiation, (4) Preferences and (5) Emotions. Conclusion The PCPS is a reliable scale for evaluating patient communication patterns. The use of this scale can assist in promoting related research and in developing interventions for enhancing open and collaborative doctor–patient communication.

Purpose of the Study: Existing researc h suggests that will-to-live (WTL) is an indicator of subjective well-being (SWB), and that similar personal variables including physical and mental health, quality-of-life, and sociodemographic characteristics influence elderly people’s WTL. The purpose of this qualitative study was to explore additional factors which influence older persons’ WTL. Design and Methods: T wenty-five elderly Israelis across the country were interviewed about what weakens and strengthens their WTL. The grounded theory method guided the data collection and analysis. Results: In addition to the previously repor ted aspects influencing WTL, analysis resulted in two new categories: nationalism and historical traumatic events. Negative influences of nationalism-related emotions on participants’ WTL included themes of disappointment with the state, with children leaving the state, and with existential insecurity. Among the positive influences on WTL, participants mentioned pride in the state and in its development, personal security, and hope for a peaceful future. Under the category of historical traumatic events, participants reported posttraumatic stress and war anxieties, as well as satisfaction and revenge in continued existence, and appreciation for life in Israel compared with life before immigrating to Israel. Implications: Our findings indicate that nationalism and feelings of per sonal involvement in national developments play an important role in the lives of elderly Israelis to the degree that they contribute to their SWB and motivation to continue living. Practitioners and family members can intentionally arouse and strengthen positive nationalistic feelings in the elderly as a way to maintain and promote SWB and WTL.

OBJECTIVES To assess the causal directions of interaction between depression and decline in will to live (WTL) over 2 years in community‐dwelling older adults. DESIGN Community‐based longitudinal study. SETTING Three large cities in Israel. PARTICIPANTS Individuals aged 75 and older (N=870). MEASUREMENTS We tested a cross‐lagged structural equation model in which WTL and depressive symptoms (DS) were tested as latent variables at each of three annual points of measurement. RESULTS Of the health and sociodemographic covariates examined, only self‐rated health predicted WTL and DS, and age predicted WTL. WTL predicted DS at each point of measurement. In addition to these cross‐sectional effects, WTL also predicted DS 12 months later at the second and third year. In other words, the direction of prediction was exclusively from WTL to DS, concomitantly and over time. CONCLUSION Our results indicate that WTL predicts DS rather than vice versa, suggesting that decline in WTL contributes and leads to depression at present and in future. Health strategies designed to promote WTL in older adults may help forestall depression. Moreover, psychotherapeutic interventions targeting WTL might be effective in the treatment of depression.

We used data collected in two waves of interviews (2009-T1 and 2013-T2) from the Survey of Health, Aging and Retirement in Europe (SHARE). We included 679 participants out of the Israeli sample (N=1645), who retired from work (early/on time/late), and completed T1 and T2-interviews. The memory score was calculated as the mean of 10 words recalled in two memory tests (immediate/delayed), ranging 0–20. Significant predictors of memory decline (MD) in a hierarchical regression analysis (Model-1) were: total words remembered at T1, T1-ADL, T1-depression, depression change, T1-age, and T1-education. Early retirement and work type, added to Model-2, were found significant predictors as well, increasing significantly the explained variance of MD (from R2=0.28 to R2=0.44). We conclude that early retirement and work type are significant predictors of MD even when controlling for socio-demographic characteristics, health/function status and changes in health/function. Appropriate interventions to reduce decline in cognitive capabilities should be developed.

International Longevity Centers (ILC-GA) are promoting healthy and active aging. Dementia is a severe and widespread health problem in Europe, with 6.4 Million patients. Two European health initiatives call to address the special needs of dementia patients, their families, and caregivers, while ensuring the sustainability of health and social security systems: The 2011 European Initiative which calls to see dementia a health priority and urges Member States to develop appropriate national plans, and the 2015 European Council’s conclusions on « Supporting people living with dementia: improving care policies and practices ». The role of prevention, health promotion, risk reduction and early detection, as well as the promotion of the rights of dementia people, and intensification of research are clearly stated in these initiatives.

Existing research indicates that early life trauma increases the likelihood of depression in later life. This includes children who survived the Nazi Holocaust living in Israel today. For this study, we set out to examine whether early life trauma affects both levels of depression symptomatology and the relative prominence of certain facets of depression as compared to other older adults in Israel and Canada.For this study we recruited 295 Holocaust survivors (HS), 205 other Israelis and 335 older Canadians each of whom completed Radloff's (1977) Center for Epidemiological Studies - Depression Scale (CES-D). The CES-D measures four distinct factors: Depressive affect, absence of well-being, somatic symptoms, and interpersonal rejection. Israeli and Canadian comparison participants were screened to ensure they had not experienced early life trauma.As anticipated, levels of depressive symptoms reported by HS were significantly greater than other Israelis and older Canadians. Moreover, the latent structure of depression as measured by the CES-D differs for HS. Depressive affect and the absence of well-being appear to distinguish depression among HS. Somatic symptoms do not differ, however, and interpersonal rejection seems less germane to depression as experienced by HS compared to both comparison samples.Findings support our assertion that early life trauma affects not only levels of depressive symptoms but also that these survivors of genocide experience depression differently than other Israelis and older Canadians. We discuss the implications of early life trauma for mental health in later life.

Aim: Numerous studies document that caregivers face severe difficulties in communicating openly with their loved ones about both illness and death. This study compares the communication level of male and female caregivers, and examines the contribution of different caregiver characteristics and situational variables to the explanation of communication level within both male and female groups. Methods: 77 spouses--who were primary caregivers of terminal cancer patients-comprised of 29 males and 48 females, participated in the study. The questionnaire included measures of caregiver communication, caregiver characteristics (i.e. age, ethnic origin, gender, education level, and self-efficacy), and situational variables (i.e. duration and intensity of care). Results: Female spouses communicated more with their loved ones about the illness and death compared to their male counterparts. Among males, ethnic origin (?=0.50, p

One of the main challenges of aging societies is maintaining quality of life despite inevitable changes that occur in the lives of elderly people. This study examined the contribution of coping resources and coping patterns to successful aging among elderly persons following a decline in health and function. Data were collected from 262 elderly Israelis during two home interviews carried out at an interval of 12 months. Successful aging was assessed using a number of measures of subjective well-being. Predictive variables included change in health/functioning, coping resources, and coping patterns (proactive and reactive). Hierarchical regression analyses showed that the coping resources self-efficacy and social support and the proactive coping pattern of concrete planning positively predicted successful aging, while the proactive coping pattern deciding on preferences had a negative influence. These results indicate that elderly people have the ability to shape their quality of life in the presence of decline in health and functioning by using appropriate coping resources and coping patterns. Controlled interventions are recommended to help older people acquire and maintain effective resources and coping skills, thus further promoting their successful aging process.

The SHALOM questionnaire is based on a multidimensional perception of spirituality. This study examines the psychometric properties and factorial structure of the Hebrew version of Fisher's SHALOM questionnaire.The study included 341 participants. Tools included the SHALOM questionnaire and measures for evaluation of well-being. The factorial structure of the SHALOM was evaluated using exploratory factor analysis (EFA). Concurrent validity was also tested.EFA supported the four-dimensional structure of the questionnaire. Internal consistency of the four dimensions ranges from adequate to excellent (0.72α0.96). Concurrent validity was supported by the positive associations between SHALOM and indices of life satisfaction, will to live, and participant's health perception and by negative association with depressive symptoms and fear of dying.These findings suggest that responses to the Hebrew version of the SHALOM questionnaire are valid and reliable, and can be used as an efficient tool for evaluation of spiritual well-being.

Objectives.Recently, a model of reminiscence and well-being has emerged in which reminiscence functions predict both the mental and physical health of middle-aged and older adults. Yet this model has thus far been verified only with North American, Western European, and Australian participants. This study was undertaken to compare the latent structure of responses between Canadian and Israeli older adults to ascertain if 8 distinct reminiscence functions map onto 3 second-order factors which, in turn, contribute significantly to measurement of an overarching reminiscence latent construct. METHODS: For this study, 336 English Canadian and 206 Jewish Israeli adults more than 50 years of age provided responses for this study via an Internet website constructed specifically for this study. RESULTS: Our findings demonstrate the psychometric equivalence as well as various cross-cultural differences in the relative strength of association between latent constructs (boredom reduction, bitterness revival, identity, and the overall contribution of self-negative functions to overall reminiscence).Discussion.We discuss various historical and geo-political factors that may account for these differences. For instance, repeated war, ongoing terror, and regional instability make living and aging in Israel distinct from Canada. This model of reminiscence functions would appear sufficiently sensitive to capture cross-national differences. Language: en

Previous research suggests that caregivers and terminally ill patients face substantial difficulties discussing illness and death. Existing research, however, has focused primarily on the experience of patients. The current study compared responses as well as the relative strength of association between mortality comunication, fear of death, and psychological distress (i.e., depressive symptomatology, emotional exhaustion) among secular and religiously observant family caregivers of terminally ill cancer patients. A total of 236 participants were recruited over 18 months within the first year of caregiver bereavement. Retrospectively reported mortality communication was statistically greater among secular caregivers; in contrast, both fear of death and depressive symptoms were greater among the religiously observant. Path analyses subsequently revealed notable differences between groups. Among secular caregivers, a significant inverse relationship between mortality communication and the two indices of caregiver distress emerged. In contrast, the association between mortality communication and psychological distress among the religious was moderated by these caregivers' fear of death. The results of this study suggest that fear of death is a significant predictor of psychological distress among religiously observant caregivers of terminal cancer patients (i.e., fear of their own death as elicited by the caregiving role). Fostering morality communication between secular caregivers and patients would appear to be one means of reducing the likelihood of clinically significant psychological distress. This may be insufficient among religiously observant caregivers, however, for whom fear of death may first need to be redressed.

To examine differences in health and functional status and in utilization of health services between holocaust survivors and their counterparts; and (b) to investigate if holocaust survivor status is a significant predictor of health status, functional status, and utilization of health services. The study included 1255 respondents of whom 272 were holocaust survivors. Interviews were conducted face-to-face at the respondents' homes. Participants were asked about their health (self-rated health and comorbidity) and functional (ADL and IADL) status, utilization of inpatient and outpatient health care services, age, gender, education, marital status, length of residence in Israel, and if they were holocaust survivors. Holocaust survivors, who were frailer and more chronically ill compared to their counterparts, visited their family physician and the nurse at the health care clinic more often than their counterparts did, and received more homecare services. Yet, there were no differences between them in the utilization of other health care services such as visits to specialists, emergency department, and hospitalizations. Holocaust survivors are more homebound due to more morbidity and functional limitations and therefore receive more health home care services that offset the utilization of other health services.

Day care centers are one of the core community-based services for frail older persons. The purpose of the study is to examine differences in characteristics of users and nonusers of day care centers among frail older people and factors that explain service utilization. Personal interviews are conducted with 333 respondents, of whom 81 were users. Based on the behavioral model of Andersen, the results show that both groups significantly differed in most predisposing (age, marital status), enabling (having a homecare worker), and need (IADL [instrumental activities of daily living]) factors. The findings lend support to Andersen’s behavioral model and suggest that further research is needed to assess underutilization of day care centers. Implications for research, policy, and practice are discussed.

Terminally ill cancer patients and their caregivers experience significant difficulties discussing illness and impending death (herein defined as mortality communication). The current study compares response levels as well as patterns of association between mortality communication and psychological distress among caregivers of home hospice and hospital inpatients. For this study, 231 family caregivers were recruited within a year of bereavement from the south and central health regions of Israel. Contrary to our initial hypothesis, retrospectively reported levels of mortality communication did not differ between groups; however, lower levels of depressive symptomatology were reported by home hospice caregivers. Separate path analytic models indicate statistically significant inverse associations between mortality communication and psychological distress (i.e. depressive symptomatology, emotional exhaustion). Invariance analyses indicate that the strength of association between variables did not differ between path models. The results of this study are discussed in terms of self-selection biases and possible confounds associated with retrospective reporting among bereaved caregivers.

In view of the developmental approach to sexual behavior, this article presents the stages of sexual behavior leading to coitus in four grades of high school students in Israel and the sociodemographic factors associated with initiating coitus. Analyses were based on data from the first national study dealing comprehensively with sexuality in 30 years. A self-administered questionnaire was completed by a random sample of 4,609 students of the General Educational (secular) system that included 68% of the Hebrew-speaking sector or 55% of all students in Israel. Our findings indicated a progressive set of stages of sexual behavior forming a Guttman scale, from kissing and petting over the clothes though petting under the clothes and genital touching to coitus. In comparison to results of a 1970 Israeli survey, we found an increase in practice in all Guttman scale stages of sexual behavior, as well as a diminished gap between genders. The gap fully disappeared in the three lower stages. Predictive variables of coitus initiation included gender, religiosity, immigration status, family structure, perceptions of academic achievements, and the proportion of peers practicing coitus. In addition to gender, perception of the proportion of peers that already practiced intercourse was the best predictor followed by grade, perception of academic achievement, and family structure. Marked differences were noticed between genders regarding associations with religiosity and immigration status. The discussion focused on comparisons to findings in other countries, the contribution of the findings to the understanding of Israeli adolescents' sexual behavior, and practical educational implications.

The aim of this study was to test a conceptual model designed to promote the understanding of factors influencing subjective well-being (SWB) in old age. Within this framework, we evaluated the relative influences on elderly Israelis' SWB of health and/or function, personal resources, coping behaviors (reactive and proactive), and changes in all of these factors over time.At baseline, 1216 randomly selected elderly persons (75+) were interviewed at home (T1) and 1019 one year later (T2). The conceptual model was evaluated by Structural Equation Modeling (SEM) analysis using AMOS 18.After one year, a relatively high percentage of participants reported decline in health/function (DHF) and in personal resources. The effects of the study variables on T2-SWB were evaluated by a SEM analysis, resulting in a satisfying fit: χPersonal resources and use of appropriate coping behaviors enable elderly people to control their well-being even in the presence of DHF. Evidence-based interventions can help older people to acquire and/or strengthen effective personal resources and coping patterns, thus, promoting their SWB.

In a previous study, the will-to-live (WTL) was presented as a parsimonious and easy to use indicator of well-being, perceived differently by men and women. This study evaluates the role of WTL in long-term survival of elderly men and women. In 1994, socio-demographic, psychosocial, and health characteristics were collected from a sample of 1,138 Israeli elderly persons (70+) by structured interviews. Data regarding survival were gathered 7.5 years later. Results indicated that WTL was significantly related to survival in univariate analyses. However, in multivariate Cox analyses, conducted separately on men and women, the will-to-live predicted survival only among women after adjusting for age, self-rated health (SRH) and psychosocial variables, so that the stronger the WTL, the higher the chances of survival for women. Age, WTL and SRH were the only statistically significant predictors of survival in women. Survival of men was predicted by age, daily functioning, SRH, working outside home or volunteering, and self-esteem. Our findings show that the WTL predicts long-term survival among elderly women, and therefore has a prognostic value. This strengthens its previously presented importance as a generalized indicator of well-being. These findings have practical implications for formal and informal caregivers.

Like other developed nations, Israel has rapidly aged. This demographic revolution has created new challenges for Israeli society. We describe the societal background, including the emerging societal needs, solutions, and problems, as well as the professional principles, which guided us in developing the first two Israeli academic programs in gerontology in Beer-Sheva and Haifa. We further discuss the structures of both programs and their accomplishments. Although both programs were guided by identical needs and principles, geared toward the same multidisciplinary target population, and are dynamic and responsive to the emerging needs and difficulties, they differ in structure. While Haifa's program is flexible, Beer-Sheva's program is structured and divided into three distinct programs, of which only one-the research track-is designed and tailored to the students' interest. The two programs have contributed to increasing interest and research in aging in Israel, enhancing professional cooperation within the universities and with the international scientific community, opening the labor market for the programs' graduates, creating fruitful collaborations with community services, and accelerating the improvement of elderly quality of care.