For many baby boomers, World War II was the most significant event in our parents’ lives. Even if it seemed to be part of the faraway past, the war impacted our childhoods.

And for many Jewish baby bo-omers, despite our own assimilated lives relatively free from the anti-Semitism of earlier years, the Holocaust loomed above us, through the stories from our grandparents, family, friends and synagogues.

But now, 68 years after the end of the war, what does the Holocaust mean for baby boomers, our children and even grandchildren? As the number of survivors decreases and their voices become silent, how does today’s Jewish community relate to and care for the remaining survivors as they age?

The Conference on Jewish Material Claims against Germany, created after World War II to oversee restitution and reparations for for survivors, estimates that about 500,000 survivors are alive worldwide — 127,000 of them in the United States. More than 25 percent of the U.S. survivor population lives at or below the poverty level. This is especially significant because as Holocaust survivors age, their need for services — which they often cannot afford — increases.

Immediately after the war, there was no organized effort to provide psychological services for survivors, and the conspiracy of silence predominated. Even so, displaying tenacious resilience and adaptability, many survivors went on to rebuild their lives; most looked healthy from the outside, but their families knew of and felt their concealed suffering.

For many survivors, the progression of the lifecycle brings multiple issues to the surface. For example, retirement can create time to think about and process the past. But this can also reactivate and trigger symptoms of post traumatic stress disorder (PTSD), which makes coping more difficult for both the survivor and his or her family.

The atrocities of the Holocaust cannot be buried. Illness, loneliness, anniversaries, reunions, the death of loved ones, the use of psychotropic medications, hospitalization, and moving to an aging facility may all be triggers that cause reactivation of PTSD, increased anxiety, nightmares, or memory flashbacks.

One Israeli study showed that aging survivors are at a higher risk of PTSD than veterans and at higher risk of suicide than their peers. An Australian study describes the “late effects of the Holocaust” and shows that for survivors, the normal aging process is related to increased anxiety, reactivation of PTSD, and fear of the medical system. This study also notes that in addition to psychological changes, survivors are at increased risk for osteoporosis, cardiometabolic disease, cancer, vascular dementia, and severe dental problems.

Several studies have shown that Holocaust survivors may cope worse than other older adults after being diagnosed with a disease, and experience higher pain levels, more pain sites and higher depression scores. Weight loss, whether from an illness, depression, or lack of physical activity, can also be a trigger for survivors due to starvation during the war. When survivors experience dementia and declines in cognition, repressed traumatic memories may be released. This internal suffering sometimes manifests itself in disturbing behaviors, a phenomenon especially common in concentration camp survivors.

These studies demonstrate how survivors’ needs increase with age, even more than for many other older adults. This increasing need impacts medical systems, social service organizations and aging services, which may be unprepared or not have the necessary resources to meet the extensive needs of this population. Children, family members, caregivers and health professionals may not always understand changes in behavior or what is causing such extreme reactions, nor know how to respond.

As we age, we begin to review our lives, reminisce and rethink how we have acted. We look back in sentimental ways, often with a sense of nostalgia, about both good and bad times and what our lives have meant to us and to others. For Holocaust survivors, this looking back can be extremely difficult, and reactivate feelings of suffering as well as those questions to which there are no suitable answers.

As a community, we need to create opportunities for survivors to reconcile, resolve and grieve in order to arrive at a healthy psychological place in old age. We can empower survivors by creating meaningful engagement opportunities, such as educating our community and the next generations, and making sure their physical needs for care are adequately met.

Finding a profound personal meaning of survival not only helps to resolve past trauma and replace guilt, but it also passes on a legacy of “Never Again.” The Jewish community is obligated to remember not just those who were killed, but to care for those members of our community who still carry memories of the Holocaust with them into the final days of their lives.

Rob Tufel, MSW, MPH, is the outgoing director of Adult Services at Jewish Family and Children’s Services of the East Bay. This column was co-written with Rita Clancy, LCSW, program manager of JFCS/East Bay Holocaust Survivor Services.

JFCS/East Bay will be offering a short-term educational support group in the fall for children of Holocaust survivors dealing with changes related to aging. For more information, contact Rita Clancy at [email protected] or call  (510) 704-7480, ext. 257.