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Weiss Y, Zarour S, Kiselevich Y, Abu Ghanim M, Hikry D, Sinai Brzezinski I, Zac L, Cohen B, Matot I. Preoperative cognitive impairment and postoperative delirium among Holocaust survivors who achieved longevity. J Am Geriatr Soc 2024; 72:1831-1838. [PMID: 38485466 DOI: 10.1111/jgs.18836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/28/2024] [Accepted: 02/05/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Holocaust survivors (HS) experience higher rates of physiological and psychological morbidities, increasing their vulnerability to perioperative complications. Limited information exists regarding their perioperative neurocognitive disorders. This study aimed to assess the rates of preoperative cognitive impairment, postoperative delirium, and other complications among HS aged 75+ undergoing elective surgery. METHODS This is a single-center retrospective cohort study that analyzed prospectively collected data. All surgical patients born before 1945 who underwent elective noncardiac surgery at a tertiary hospital in Israel during 2020-2021 were included. The HS group was identified through the hospital's information system. Preoperative cognitive impairment was assessed using the Mini-Cog test. Postoperative delirium was defined as a combined outcome, which included a positive 4A's-Test (4AT) result during the postanesthesia care unit stay up to the second postoperative day, a positive 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) test administered by the geriatric team, and identification through the medical records using the Chart-based Delirium Identification Instrument (CHART-DEL). We used multivariable regression to assess the risk factors for postoperative delirium. RESULTS Out of 1332 eligible patients, 422 (32%) were HS, while the others served as controls. Both groups had a similar rate of preoperative cognitive impairment (24%, p = 0.89) and postoperative delirium (16%, p = 0.95). HS exhibited a higher risk of the composite adverse events (24% vs. 20%, p = 0.05, aOR [95% CI] 1.3 [1.0-1.7]), driven mainly by falls during hospitalization (4% vs. 2%, p = 0.03, aOR 2.1 [1.1-4.1]). HS patients were more likely to be childless (33% vs. 11%, p = 0.001) and had higher rates of chronic antidepressant and benzodiazepine use. CONCLUSIONS HS achieving longevity do not face increased risks of preoperative cognitive impairment and postoperative delirium. However, special care is still warranted due to their elevated rate of other complications during hospitalization.
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Affiliation(s)
- Yotam Weiss
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Zarour
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Yossef Kiselevich
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Maher Abu Ghanim
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Hikry
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Isaac Sinai Brzezinski
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Lilach Zac
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Cohen
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA
| | - Idit Matot
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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Magano J, Fraiz-Brea JA, Ângela Leite. Dark tourism, the holocaust, and well-being: A systematic review. Heliyon 2023; 9:e13064. [PMID: 36711286 PMCID: PMC9873685 DOI: 10.1016/j.heliyon.2023.e13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Dark tourists experience negative and positive feelings in Holocaust places, suggesting emotional ambivalence. The research question of this study is, "is feeling well-being, as a consequence of dark tourism, a way of banalizing the horror?". The purpose of this study is threefold: to provide an updated systematic literature review (SLR) of dark tourism associated with Holocaust sites and visitors' well-being; to structure the findings into categories that provide a comprehensive overview of the topics; and to identify which topics are not well covered, thus suggesting knowledge gaps. Records to be included should be retrievable articles in peer-reviewed academic journals, books, and book chapters, all focused on the SLR's aims and the research question; other types of publications were outrightly excluded. The search was performed in Web of Science, Scopus, and Google Scholar databases with three keywords and combinations: "dark tourism", "Holocaust", and "well-being". Methodological decisions were based on the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. During the process, 144 documents were included, of which 126 were journal articles, 8 were books, and 10 were book chapters. The results point out a hierarchical structure with the main category (Dark tourism - Holocaust - Well-being) and three second-order categories (Dark tourism - Holocaust, Dark tourism - Well-being, and Holocaust - Well-being), from which different subcategories emerge: motivations for visiting places and guiding; ambivalent emotional experience that leads to the transformation of the self; and intergenerational trauma. The gaps identified were the trivialization of horror in Holocaust places; dark tourist profile; motivations and constraints behind visiting dark places; Holocaust survivors and their descendants' well-being; how dark tourism associated with the Holocaust positively or negatively impacts well-being. Major limitations included: lack of randomized allocation; lack of standard outcome definitions; and suboptimal comparison groups. Positive and negative impacts on the well-being of the Holocaust dark tourist were sought, as they are associated with the marketing and management, promotion, digital communication, guiding, or storytelling design of such locations.
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Affiliation(s)
- José Magano
- Research Center in Business and Economics (CICEE), Universidade Autónoma de Lisboa, Rua Sta. Marta 47, 5.° Andar, 1150-293 Lisboa, Portugal,Corresponding author.
| | - José António Fraiz-Brea
- Department of Business Organization, Business Administration and Tourism School, University of Vigo, 32004 Ourense, Spain
| | - Ângela Leite
- Center for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Portuguese Catholic University, Rua de Camões 60, 4710-362 Braga, Portugal
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