It probably won’t upset most elderly patients if they’re taken into a shower or a very small room, or put in a line, or exposed to a siren.

But if the patient is a Holocaust survivor, the shower might remind him or her of the gas chamber; the queues might recall Nazi selection; the siren might bring to mind a Nazi search in the ghetto for Jews.

The average Holocaust survivor, having lost family more than six decades ago, is lonely even when surrounded by children, grandchildren and great-grandchildren. And the feeling of loss is only intensified as survivors lose their health in old age. The need to treat survivors with special consideration and to have an awareness of their unique needs was stressed at the recent Jerusalem launching of a new Hebrew-language guide aimed at making doctors, psychologists and other professionals more attuned to their needs.

ESHEL, the organization owned by the American Jewish Joint Distribution Committee and dedicated to improving the lives of the elderly in Israel, launched the 256-page guide called “Treatment of Aging Holocaust Survivors.”

The original English-language volume, issued a few years ago by the Baycrest Geriatric Health Care System in Toronto (www.baycrest.org), was prepared by a team of experts led by hospital social worker Paula David. The text will appear free in a few months on an affiliated Web site.

The guide comes just in time to help the 256,000 Israeli Holocaust survivors who are still alive, but whose numbers are being reduced by dozens per day (survivors in the diaspora are estimated to number about three times that figure). Today’s Israeli survivors — out of about 600,000 who moved to Israel during the early years of the state — make up 36 percent of all Israelis over 65.

But finally, after many of them were unfairly treated with pity, dismay and even ridicule for being the lucky ones among Jews who allegedly went “like sheep to the slaughter,” in the past year survivors have been given reason to hold their heads high. Public campaigns to make survivors’ last years comfortable have led to higher allotments, Knesset discussions and even the establishment of a state investigation committee headed by a former Supreme Court justice on how they have been treated.

ESHEL director Yitzhak Brick, whose grandmother was murdered by the Nazis, said that over a third of all elderly residents are Holocaust survivors. While the government has decided to spend billions of shekels on this unique group, “there is still a long way to go.”

Ze’ev Faktor, a frail survivor who is chairman of the Committee for the Welfare of Israel’s Holocaust Survivors, says that as the Holocaust falls deeper into the past, the population’s awareness of it has become “more confused,” even though a state memorial day is held annually.

“Every year there are people who don’t stop what they’re doing and get out of their cars when the one-minute siren is sounded. For us, maybe the wounds of the past seem healed on the surface, but our pain remains and is surging.”

Professor Ariela Lowenstein, whose University of Haifa academic gerontology center is the only one in an Israel to teach about Holocaust trauma, said the Baycrest volume and its Hebrew translation are evidence-based manuals for professionals and paraprofessionals who work with survivors. As their parents were usually murdered, survivors who were children during the Holocaust have no models of being old. When they finish building their families and retire from their jobs, Holocaust memories they had nearly forgotten pop up again, she said.

Paula David, the social worker at Baycrest, said a growing number of survivors have been coming to the geriatric hospital.

“Sometimes they need unique care,” she said. “We aren’t experts; the

survivors keep teaching us, as they are the real and only experts.”

David and her team contacted doctors, nurses, dentists and social workers for tips on how they relate to survivors and how they treat them differently from other old people. Their suggestions, and others, were studied and tested for usefulness. Now the challenge is what will be done with the guide. She recommends that survivors’ relatives photocopy or print out pages and take them to their doctors, dentists and caregivers.

ESHEL has already launched special projects to help survivors and strengthen their connection with adolescents. Low-income seniors, many from the former Soviet Union, are invited to clubs and day centers with a European atmosphere that combine emotional treatment with social support.

“Treatment is less threatening when you get a hot cup of coffee and are encouraged to dance,” said ESHEL program director Maggie Gad.