Mental health and aging in Israel: emerging and longstanding successes and challenges

Israel is a country of marvel and contrasts. Despite repeated wars and ongoing terror, Israeli men live longer than almost all others (i.e. M = 81.23 years; Taub Center, 2016) and Israeli women on average live 3.21 years longer still (World Population Review, 2019). Universal healthcare in Israel is supported by progressive income tax rates up to 47% (and 17% VAT on purchases). Nonetheless, Israelis consistently report that they are among the happiest on earth (#8 in Gallop World Poll; Levy, 2010). Yet these averages obscure the considerable disparities that persist across communities (e.g. Arab vs. Jew; religious vs. secular; Tel Aviv vs. periphery).

This special section examines a range of topics specific to older adults in Israel but germane also to other countries facing ongoing security challenges, population aging, or high rates of foreign-born seniors (Central Bureau of Statistics, 2019b). We feature quantitative and qualitative studies that examine a range of topics and cross-section of communities. Bergman and Segel-Karpas (2020) directly compare older Jewish and Arab Israelis, suggesting significant differences between the two.

Roughly 21% of Israelis are Arabs, most are Muslim but this total also includes Christians and Druze. And within the Muslim majority there are distinct subgroups, notably the Negev Bedouin who constitute 1/3 of the population of southern Israel (Central Bureau of Statistics, 2019b). The Bedouin are a collection of semi-nomadic tribes in transition from a traditional, pastoral society in which marriage between cousins is the norm and polygamy remains common (Manor-Binyamini, 2011). Many continue to live in unrecognized semi-permanent communities with neither electricity nor plumbing. As reported in this issue by Bachner, Morad, Sroussi, and O’Rourke (2020), these and other social factors unique to Bedouin families in the Negev make cancer caregiving especially challenging. Yet many of the same determinants contribute to burden as previously reported with other populations in Israel and abroad (e.g. social support, depressive symptoms).

National or obligatory military service is one factor associated with extended life expectancy (Taub Center, 2016). In Israel, the citizen army in which all serve (traditionally 3 years for men, 2 years for women) has been integral to the defense and ethos of the state. Yet globally, military service has many long-term social and psychological effects. As described in this issue by Stein, Levin, Aloni, and Solomon (2020), decorated military veterans appear to experience less psychiatric distress irrespective of combat exposure. Yet decorated and non-decorated veterans report similar levels of loneliness in later life.

As described in the first of two qualitative studies, loneliness among older adults is a multifaceted construct, experienced differently by each based on individual life features (Cohen-Mansfield & Eisner, 2020). Older adults also differ in how they would alleviate loneliness, as do the various barriers maintaining their social isolation (e.g. cognitive limitations, rejection of others).

The second qualitative paper in this issue examines factors affecting the will to live among Jewish older adults (Zamir, Granek, & Carmel, 2020). Social cohesion based on shared history and values is one factor that defines societies like Israel with extended life expectancy. These authors also report that religiosity, financial security, social networks, and work/volunteerism also contribute to the will to live in later life.

A further unique feature of older adults in Israel is the large number of Holocaust survivors, many who came from the former Soviet Union after 1989 (Fridman, Bakermans-Kranenburg, Sagi-Schwartz, & Van IJzendoorn, 2011). In 2018 there were roughly 212,300 survivors in Israel; but by 2025, this number will drop to 26,200 (Central Bureau of Statistics, 2019a). Opportunities to study survivors and convey their stories diminish each year. Yet a sufficient body of research exists allowing for integrative reviews. In this issue, Zimmermann and Forstmeier (2020) examine the effects and functions of reminiscence on the well-being of Holocaust survivors. As noted by these authors, reminiscence and life review have both positive and negative effects on mental health. Yet most survivors appear to use reminiscence effectively to integrate traumatic memories as part of coherent life narratives.

The studies compiled for this special section highlight various factors and challenges affecting later life in Israel. Although the conditions of life are generally good, the majority of older adults in this country report that they feel lonely even if they have regular contact with others (Yaron, 2016). Reminiscence research suggests that this void may be particularly acute for those who experienced significant early life losses (e.g. families, neighbors, communities) and trauma related to military service. Significant challenges persist for many older adults in Israel, especially minority communities and those outside of Tel Aviv with more limited resources (e.g. Negev Bedouin). Conditions of life have improved greatly for older adults over recent decades. But more attention, study and resources are needed, especially with religious and other minority communities.

Prof. Norm O’Rourke, Ph.D.
Department of Public Health and
Multidisciplinary Centre for Research on Aging,
Ben-Gurion University of the Negev,
Be’er Sheva, Israel