Influences of Nationalism and Historical Traumatic Events on the Will-to-live of Elderly Israelis

Purpose of the Study: Existing research 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: Twenty-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 reported 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 personal 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. Why Study Will-to-Live? The drive to continue living is one of the basic characteristics of all living beings. Among humans, the will-to-live (WTL) is the psychological expression of this existential phenomenon. Conceptually, the WTL can be described as being comprised of two intertwined facets: the natural instinct and the emotional-cognitive component. People have the ability to evaluate the intensity of both facets of their WTL (Carmel, 2011). The importance of the WTL to end-of-life care was documented in a study that sought to explain preferences of older adults for prolonging their lives in severe illness conditions by use of life-sustaining treatments (Carmel & Mutran, 1997). In this study, conducted in 1994 on a random sample

Why Study Will-to-Live?
The drive to continue living is one of the basic characteristics of all living beings. Among humans, the will-to-live (WTL) is the psychological expression of this existential phenomenon. Conceptually, the WTL can be described as being comprised of two intertwined facets: the natural instinct and the emotional-cognitive component. People have the ability to evaluate the intensity of both facets of their WTL (Carmel, 2011).
The importance of the WTL to end-of-life care was documented in a study that sought to explain preferences of older adults for prolonging their lives in severe illness conditions by use of life-sustaining treatments (Carmel & Mutran, 1997). In this study, conducted in 1994 on a random sample of 1,138 Israelis aged 70 and older, the WTL was found to be one of the best explanatory factors of elderly persons' preferences for medical treatment at the end of life.
In addition to its role in end-of-life care, WTL was found to be an important tool for evaluating older people's subjective well-being (SWB; Carmel, 2001Carmel, , 2011)-a general evaluation that people make about their lives (Shmotkin, 2005). This was based on strong correlations between the WTL and well-established indicators of SWB such as life-satisfaction, happiness, and depression (in the opposite direction). However, although WTL and life-satisfaction significantly correlate, WTL was found to have a moderating effect on the decline in life-satisfaction which is common with proximity to death (Carmel, Shrira, & Shmotkin, 2013). Moreover, although the influence of the WTL on survival has been widely expressed in poetry and literature only recently has this effect been scientifically evaluated in two long-term studies: Among older Israelis aged 70 and older, WTL was found to be a strong predictor of survival after 7.5 years of follow-up, mainly among women (Carmel, Baron-Epel, & Shemy, 2007). Similarly, a statistically significant effect of WTL on survival was reported in a 10-year Finnish study with participants aged 75 and older (Karppinen, Laakkonen, Strandberg, Tilvis, & Pitkälä, 2012). In both studies, the long-term effect of the WTL was assessed in multivariate analyses while controlling for other well-established predictors of mortality in older populations such as age, gender, comorbidities, and self-rated health. It should be noted that this significant influence of the WTL on survival was found in two very different countries, and in studies using somewhat different tools to evaluate WTL. The diagnostic and prognostic merits of the WTL for elderly people suggested the importance of researching its antecedents (George, 2012).

Determining Factors of the WTL
Determinants of the WTL have been assessed in a number of quantitative studies. In a series of Israeli studies on older adults (large representative samples of people aged 65+, 70+, and 75+), the WTL was found to be systematically weaker among women, and to decrease with age (Carmel, 2001(Carmel, , 2011. Results of multivariate analyses of cross-sectional data from the 1994 study showed that the best explanatory factors of the WTL were (in order of importance): self-esteem, fear-of-death, and life-satisfaction among women, and self-esteem, age, psychosomatic symptoms, living with a partner, and fear-of-death among men, while controlling for additional evaluations of health status, social support, religiosity, life events, past experience with a dying patient, and fear-of-dying. In both gender groups, self-assessed psychosocial indicators of well-being and fear-of-death were more strongly related to WTL than indicators of physical status (Carmel, 2001).
Associations between WTL and additional indicators of quality-of-life and SWB were reported in studies performed in other countries, on different populations and with different tools for evaluating WTL. Ellison (1969) found that among retired steel workers, a weak WTL was associated with poor health, loss of function, and social isolation. Studies on patients with advanced cancer reported significant correlations between WTL and life-satisfaction, happiness, anxiety, a sense of well-being, and physical symptoms (Beadle et al., 2004;Chochinov, Tataryn, Clinch, & Dudgeon, 1999). Chochinov and colleagues (2005) found that the most important factors in explaining WTL of terminally ill cancer patients were a sense of hopelessness, feelings of becoming a burden to others, being subject to violation of dignity and depression. The finding that depression is one of the aspects associated with WTL, and not an opposite facet of it was also supported in three Israeli studies (Carmel, 2011).
The valuation of life (VOL), developed by Lawton and colleagues (1999), is a conceptually related construct, which refers to the subjective perspective hypothesized to lead to a stronger wish to live. Using the VOL scale, Jopp, Rott, and Oswald (2008) found that VOL decreased with age, and that health and function explained twice as much variance in VOL compared to sociodemographic or social variables.
These quantitative analyses of determinants of the WTL and of similar concepts focused on evaluating the effects of personal characteristics, including demographic, psychosocial, mental, and physical health, and other indicators of quality-of-life. Although significant, these variables have not explained high percentages of the variance in people's WTL, raising speculation as to the additional factors that influence elderly people's WTL.
Since people are not only members of families, but also of larger social groups and societies, they live not only their personal lives, but also the life of their nation and their historical era. Thus, the social and political environment in which people live may have a strong influence on their lives, identities, and personalities. Moreover, according to social identity theory, feelings of social belongingness crystallize people's self and affect their self-worth (Tajfel & Turner, 1986). In line with these speculations, results of a recent international study showed that satisfaction with one's nation has a strong influence on people's satisfaction with their personal lives (Morrison, Tay, & Deiner, 2011). However, such influences on personal well-being are rarely reported in the literature. The influence of national satisfaction or dissatisfaction on people's SWB may be particularly strong in collectivist nations, and even more so in societies living under constant threat and undergoing significant historical events such as in Israel. We were thus interested to explore whether the Israeli social context would have an impact on older Israeli persons' WTL.

The Israeli Context
Israel is a historically unique state that was established after the Holocaust as a Jewish and democratic state with a strong socialistic orientation. It became the renewed homeland for the Jewish people, and immediately opened its gates to a massive wave of one million WWII refugees from Europe. This wave of immigrants was followed in the 1950s by waves of refugees from Arabic countries and in the late 1980s by another large wave from the former USSR. Many of these Jewish immigrants were escaping harsh life conditions including discrimination, violence, and terror in their countries of origin and saw Israel as a refuge, safe from further persecution. Thus, at the end of 2011, the majority of older Israelis, aged 65 and older (82%) were comprised of immigrants from other countries, with a significant percent (25%) of Holocaust survivors (Brodsky, Shnoor, & Be'er, 2012).
Since its first War of Independence in 1948, Israel has experienced numerous wars and periods of terrorism and missile attacks by its hostile neighbors. Elderly Israelis are thus either holocaust survivors and/or people who themselves participated as soldiers in the defense of their country. As Israeli citizens, they have repeatedly experienced threatening events and the severe effects of these events while raising their children, and later in life having children and grandchildren on active duty in the army. These experiences may cause many elderly Israelis to feel that they are under a constant threat to the basic existence of their country, themselves, and their families.
Given this unique national and social context and given the lack of qualitative inquiry into Israeli elders' perceptions of WTL, the aim of this exploratory study was to reveal additional factors to the personal factors already reported, which strengthen and/or weaken the WTL of older adults living in a relatively young country under constant existential threat.

Participants
In 2013, after obtaining ethics approval from the Research Ethics Board of the Ben-Gurion University of the Negev, we used the snowball technique to recruit participants. The first participants were recruited by a municipal social worker who obtained permission for the researcher to call in order to explain more about the study. Next, the interviewed participants provided telephone numbers of additional potential participants after receiving their permission to do it. We contacted by telephone 28 Israeli citizens, aged 75 and older (range 75-93), cognitively and physical competent to participate in an interview. After hearing about the study, 25 of them agreed to be interviewed. One person declined participation because her partner was feeling unwell, and two did not give an explanation for choosing not to participate. Participants resided in different areas of Israel including cities and kibbutzim (Table 1).

Procedure
The grounded theory method guided the study design and data collection. Accordingly, our theoretical/purposive sampling was based on the highest probability of representing the phenomena under inquiry (Charmaz, 2006). If the person agreed to participate, an interview time was set up at a location convenient to the participant. Informed consent and participants' agreement to the interview were reconfirmed at the beginning of each interview and audiorecorded. We used a semi-structured interview guide with questions designed to encourage the elders to discuss their feelings and experiences in depth. Questions pertained to both a subjective definition of WTL for the participant (e.g., "What is will-to-live for you?", "How would you define will-to-live for yourself?"), and aspects that strengthen or weaken this sense of WTL (e.g, "What strengthens your will-to-live?", "What weakens your will-to-live?" etc.). Our participants responded easily and willingly to these questions. Interviews ranged in length from 20 min to 2.5 hr. Interviews were then transcribed verbatim with all identifying information removed from the transcripts. A bilingual researcher, fluent in both Hebrew and English, translated the participants' quotations for the purpose of publication.

Data Analysis
The guiding principles of the grounded theory approach include simultaneous collection and analysis of data and the development of codes and themes grounded in the data (Braun & Clarke, 2006;Charmaz, 2006). The data were analyzed using line-by-line coding with codes and categories emerging from participants' narratives. Constant comparison was used to examine relationships within and across codes and categories. The final coding scheme was developed through ongoing discussions within the research team. Data collection stopped when the team determined that we had reached saturation. Atlas ti. software, a computer-assisted qualitative data management program, was used to code, store, and organize the data. After finalizing the coding scheme, the findings were arranged in relevant categories for data presentation.
Data for this study were pulled out from a larger qualitative dataset for examining factors that strengthen or weaken older adults' WTL. In this analysis, we focused on themes that emerged in relation to nationalism and the Jewish-Israeli specific context.

Definition of WTL
Participants found it difficult to define their WTL because they perceived the concept as self-explanatory. This caused them to intertwine their definitions with explanations of the personal and social conditions upon which WTL depends. Three interrelated aspects emerged in response to our request to define WTL: (a) an unconditional survival instinct, described by participants as a universal drive to live that is not dependent on external factors (i.e., economic conditions, wars, etc.), or internal factors (i.e., age, disease, etc.). For example, Deborah noted, "the WTL exists in all beings. We are born with this drive. …People who are living in the worst hellish conditions want to keep living" (age 90, widowed, holocaust survivor); (b) WTL as a function of people's social/spiritual obligations. Some participants described the WTL as a commitment or responsibility to keep living either for someone (i.e., an ill spouse that needs care), or for God. For example, Shmuel explained, "I am waiting for God to remember to take me, take my soul to him … but my wife needs my help and I have to keep living for her." (age 93, married); (c) WTL as a dynamic phenomenon, dependent on determinants of quality-of-life, and SWB, as well as on changes in them. On this, David explained, There is a WTL as long as you can enjoy your life. As long as you are not spending your time at doctors suffering from diseases, and as long as you feel good, you can enjoy your life. You are not lonely or alone and you have someone to share your happiness with… if you don't have these things, you don't have anything to live for and then your WTL goes down. (age 79, married, holocaust survivor).

Aspects Influencing WTL
In response to our open-ended questions about what strengthens and/or weakens their WTL, participants mentioned a variety of personal quality-of-life-related aspects that influenced their well-being. In addition, and although no specific questions were asked about any aspect, two major socioenvironmental domains emerged in our analysis: Nationalism and historical traumas. Nationalism themes that strengthened the WTL included pride in having been involved in the development of the country, having a sense of continuity and existential security, and hope for a peaceful future. Themes that weakened the WTL included disappointment with the state, disappointment with children leaving the country, and existential insecurity. Historical traumas included the Holocaust and wars in Israel. Under this category, the themes that strengthened WTL included revenge in surviving and living well, and appreciation of current life circumstances in comparison to life during the wars. The themes that related to weakening of the WTL included posttraumatic stress and war anxiety. In all cases, pseudonyms are used to describe participants.

Nationalism
Themes Strengthening WTL

Pride in the State
Israeli elders spoke about their identification with and relationship to the state of Israel and the sense of pride in their involvement in the development of the state and in its existence as a state, all of which play an important role in their lives and their WTL. Pride in the state was related to a number of factors including a sense of satisfaction and accomplishment at having been involved in the establishment of the state, and pride in the existential security it gave them in having a place to call their own. These positive feelings increased their sense of well-being. One participant described the state as being the "project of her life" (Rachel, age 80, divorced, holocaust survivor). On love and pride for the state, another elder noted "The state has great worth for me; it is what we expected and waited for, and this is the only thing we have to live for." (Michael, age 78, married). One of the participants reflected on the recent celebration of the establishment of the Kibbutz and how this event increased her sense of meaning, self-worth, and of accomplishment because of her involvement in the Kibbutz's development and subsequently, her desire to live.

Existential Security
On existential security and feelings of pride at having a 'motherland' to protect from humiliations and abuses, a participant explained, Now we have a mother, the country is our mother. We didn't have a mother then, that's why there were pogroms, even in Russia-everywhere. Now, no one can do us wrong, we have a mother and it's our country… I am a 4th generation Bulgarian. … There, I couldn't be friends with a "goy" [non-Jewish person], even though I studied in a non-Hebrew high school. They didn't let me study more because I was a Jew. It was really bad, but now after we came here and the war was over, I understood that we needed a country. Without a country… without a mother, it wasn't worth it. Everything we went through was worth it. Now, I'm in my own country and there are no more humiliations. (Ora, age 90, widowed, Holocaust survivor).

Sense of Continuity
Participants also spoke about the country giving them a satisfying sense of continuity. Continuity was described as a sense of belonging and an awareness of one's place in Israel as part of the historical legacy of Jewish people-feelings that contributed to participants' well-being. For example, one person explained, When did I feel the most alive? … when I stood on Mount Gerizim … I saw the view, I saw where my forefathers came from, and then I felt very alive. A historical feeling… I felt the historical connection between us and between Israel and our forefathers…. I felt that connection and I felt alive. Israel is alive and well and I am part of it. (David, age 79, married, Holocaust survivor)

Hope for a Peaceful Future
The majority of the elders in the study had lived through numerous events such as terror attacks and wars over their lifetimes. Thus, the desire to live and see how, and if, there would be peace in the country was one of the themes that emerged. For these people, hope for a peaceful future was tied up to the hope for a better future for their nation and for themselves, and this hope strengthened their WTL. One participant said, [I want to live] to see the development of the country, and most importantly if there will be peace. I think Israel is developing rapidly, but the peace is missing. I am holding on to this hope that I will live to see peace. (Leah,age 84,divorced) Themes Weakening WTL

Disappointment With State
The flip side of having pride in the state as a source of WTL was disappointment in the state. Some of our participants spoke at length about the various disappointments at what they saw transpiring around them in the country. These included disappointment in the growing emphasis on capitalism and individualism at the expense of the old socialistic values and collectivistic orientation; disappointment in the care of elders; and disappointment in the political decisions of the government that perpetuated conflict with Palestinians. On each of these themes, participants explained, Now you only have the pursuit of money… just chasing it, and there is no value. I feel disappointment. So do I really need to live 44 more years to see this country totally break down? (Miri, age 81, widowed) The issue of the occupation makes me extremely sad, makes things very hard for me. (Golda, 75, single)

Disappointment With Children Leaving the State
In addition to disappointment with the state that decreased participants' sense of well-being, some participants spoke about the distress they felt at the decrease in national pride they saw in their children who were thinking about leaving the country. As one participant explained, "It is important to me that my children will continue to live in Israel, but I don't think it will happen… and it disappoints me." (David, age 79, married, Holocaust survivor). Another woman noted her disappointment in her grandchildren who applied for European passports through her husband, originally a German citizen.
My grandchildren decided that they wanted German passports in order to be European citizens. I told them if you want to do this, you can. I don't have one. So they went ahead and got it. I'm not happy with it. This is not why my parents came here, why I lived all my life here. This is not why we are here in Israel, not why my husband worked for the foreign office, why we came back to this country. (Miri, age 81, widowed)

Existential Insecurity
Since the establishment of the state, Israelis have always lived with a sense of existential threat. This issue emerged when mentioning anxieties about the potential annihilation of Israel.
One participant noted, "It hurts me terribly. I am in a lot of pain when I think that something might happen to the state. It's terrible." (Rivka, age 75, single) Another participant similarly explained, "If we had the 'destruction of the third temple' [destruction of modern Israel], I would have no desire to continue living." (Joshua, 78, married)

Historical Traumatic Events: The Holocaust and Wars
Themes Strengthening WTL

Revenge in Living
Holocaust survivors who had immigrated to Israel over their lifetimes comprised 32% of the sample. One of the themes that emerged in relation to WTL for the survivors was a sense of revenge at having survived genocide and going on to thrive as parents, grandparents, and as citizens of the state of Israel. On this, one participant explained,

Appreciation for Present Life Compared With Life in the Past
In addition to pleasurable feelings of revenge and satisfaction at living and surviving, participants recounted that their WTL and sense of well-being were connected to their appreciation for their current life circumstances compared to conditions in the past. Reflecting on her childhood, Esther explained, I went through very difficult times in my life. So now I enjoy everything that I can. For example, then I didn't have food to eat; now I have food. All these years I have had food to eat, and I'm sure I will continue to have food to eat… I will never be hungry again like I was then. (90, widowed, Holocaust survivor) Another participant expressed his appreciation for Israel compared to where he had come from in the past and described moving to Israel as the day he "started to live." He noted, Only after we made Aliyah (immigrated to Israel), did we start to live. All of our kids are educated; every one of them has a Master's degree! I did something for them that my parents couldn't do for me. (Abraham,75,married) Themes Weakening WTL

Posttraumatic Stress
Many of the elders interviewed in this study had experienced all or almost all of the historical traumatic events of the Jewish people including WWII, wars and terror attacks in Israel. As such, a few spoke about the relationship between posttraumatic stress caused by these experiences and their WTL at the time of conflict and afterwards. One of the participants explained how the war and not age affected his WTL: After the 1973 war [Yom Kippur War], I was suffering from posttraumatic stress. And then I really didn't feel like living anymore. It was a stage in my life that wasn't related to old age, it was related to wars. (David, age 79, married, Holocaust survivor)

War Anxiety
In addition to the direct impact of fighting in the wars, some people described the ongoing impact of chronic wars and war-related events on their health and well-being. One participant noted, "I'm sick of hearing about death again. I don't always listen to the news, but I do read the newspaper, so I know, and I'm scared." (Esther, 90, widowed, Holocaust survivor). Another participant similarly spoke about this anxiety: It's worrisome. You worry for all of the soldiers and for all of your family. It's not that you don't want to live, but it definitely lowers your vitality. In the Gulf war it was horrible. All the running to the shelter… it definitely weakens it. (Rivka,75,single) Finally, another participant made the link between wars and health when he said, The wars harm your health… when you hear that something is wrong… that there is war, acts of terrorism, you worry. You call the kids and suddenly no one answers… this is one of the things that shorten your life. (Abraham, 75, married).

Discussion
The purpose of this qualitative study was to reveal aspects that strengthen and/or weaken the WTL of older adults in addition to the personal factors (demographic, psychosocial, health, quality-of-life) reported in previous studies on the WTL and similar concepts. Categorization of our participants' responses to direct open questions regarding the factors that strengthen and/or weaken their WTL resulted in two new socioenvironmental major domains: nationalism and traumatic national events.
Although these two domains can be conceptually differentiated, the responses of our participants illustrate how they are intertwined in different degrees of intensity in the personal lives of the studied cohort. For example, Holocaust survivors are unable to separate the influences of their patriotic feelings and gratitude to the state of Israel on their WTL from their past traumatic experiences as uprooted people finding refuge as free citizens in their homeland. Our participants' responses also demonstrate the interactive relationships between national developments and personal life. Their personal involvement as active participants in national developments following national traumas explains the expressed emotional attachment to the country and the influences (positive and/or negative) of national events on the participants' WTL. Thus, pride in the achievements of the state is interwoven with pride in personal accomplishments such as building the Kibbutz and/or the country, as well as protecting the state by participating in wars and/or attacks against it, all of which strengthen elders' WTL. On the other hand, existential threats to Israel such as repeated wars, terror attacks and lack of peace cause worry, sorrow and anxieties which weaken elderly Israelis' motivation to continue living.
The strong bond of many elderly Israelis to their nation, the identification with the state of Israel and feelings of personal involvement in its development, to the degree that they influence their WTL can be better understood when reflected on the background of their life histories. The cohort participating in this study lived during an unprecedented historically traumatic and heroic epoch for the Jewish people. On the personal and national levels, one mission followed the other, first surviving the Holocaust (for European Jews) and/or liberating the land from the British mandate (for those who lived in Palestine), next, fighting against seven Arab countries that declared war against the newly established state of Israel. During and after this very tough war, the small Israeli nation of about six hundred thousand people had to absorb about one million European war refugees who had waited since the end of WWII for the gates to open. After the Independence War and during the first decade of the state's existence, Israelis had to build their country while suffering constant terror attacks and severe economic restrictions in all domains of life including food supply. Thus, people who lived in Israel during its first decade became active participants in the building and defense of their renewed homeland.
Living through these historical events meant experiencing severe traumas as children or young adults, including losses of family, friends, home, community life, education, and more, on the one hand, while living to feel pride in the establishment and achievements of the new state, on the other hand. Many of our study participants were children, adolescents or young adults during the Holocaust who later began raising their families in Israel. A smaller number of elderly people were born in Israel, or immigrated to Israel before WWII. Sixty-six years later, the majority of elderly Israelis are still comprised of immigrants who left their countries of origin due to war, persecutions, discrimination, and/or ideological or religious incentives. To these people, Israel has become the "Motherland" and guardian of Jewish people, providing existential security, freedom and protection from humiliation and discrimination-for many of them it was a dream come true.
On the more personal level, our participants mentioned various positive and negative feelings upon which their WTL depends. For example, when asked to define WTL, David (age 79) mentioned ability to enjoy life, happiness, feeling good, and having reason to live for, as positively influencing WTL. Others mentioned finding value in life and pride in the family, while feeling lonely and being ill were mentioned as negatively influencing their sense of well-being and WTL. These results support the previously reported notion (Carmel, 2011) that WTL is an expression of general well-being and as such, another indicator of SWB.
The positive and/or negative influences of our participants' emotional attachment to the country on their sense of well-being and WTL are in line with findings of two recent quantitative worldwide studies: Morrison and colleagues (2011) found a relationship between national satisfaction and citizens' life satisfaction, and Reeskens and Wright (2011) reported an association between pride in being a citizen of a country and the life satisfaction of its people. These linear associations indicate that nationalistic positive emotions such as pride in one's country and its achievements positively influence SWB by giving participants a sense of satisfaction, meaning, and well-being, while negative nationalistic emotions, especially feelings of threat to the nation's existence, decrease SWB.
Our findings add to this relatively new field of knowledge by providing examples regarding the ways by which emotional attachment to a nation influences people's sense of satisfaction and meaning in life. One of the aspects of nationalism is identification with the country to the degree that people become involved in accomplishing the nations' goals, which gives people purpose and meaning in life. In our study this aspect was illustrated by some participants' expression of a sense of having a mission to support the continuous existence of the Jewish nation in its historical land. Other participants mentioned a feeling of personal fulfillment and self-worth due to direct involvement in the building of the new country. These expressed patriotic feelings have become an integral part of many elderly Israelis' personal identity and perceived self-worth ( Bar-On, 2008).
Our participants' ages and their expressed feelings about the positive influence of their contribution to the continuity of the Jewish people and the existence of their nation on their desire to live, also lends support to gerotranscendence theory. This theory posits that as people age, they go through a natural psychological shift from focusing on self-centered materialistic worldview and values to a transcendental view of life. This shift enables elderly people to maintain SWB despite their exposure to many difficult age-related losses (Tornstam, 2005).
Conveying personal contribution to the achievement of central national goals seemed to be important to our elderly participants. This may be explained as one of the ways for elderly people to preserve their social status. In Western societies, social status derives mainly from occupation and social position, and is central to people's perceived selfworth and SWB (Carmel, 1997;Steverink, 2001). Indeed, in a previous study of elderly people, self-esteem was reported to be the best explanatory factor of their WTL (Carmel, 2001). However, social status is among the first components to be lost after retirement, following which elderly people feel a need to substitute the status-related behavioral confirmation and affection they had received (Steverink, 2001). Contribution to the country's existence and achievements is another source of social status, especially in a country like Israel. This may explain why elderly Israelis feel the need to emphasize their role in Israel's accomplishments.
Nationalism and involvement in national development also strengthened participants' WTL by generating hope to live to witness progress and peace in their country. The participants' self-assessment of the influence of having hopes for a better future on their WTL supports Frankl's thesis (1972) that purpose in life and having hopes for a better future enabled prisoners to survive the Nazi concentration camps.
Our findings also illustrate negative influences of national involvement on elderly people's WTL. Living through distressing historical events and having strong patriotic feelings towards the state of Israel elucidate the importance that elderly people relate to the continuity of the state. Perceived threats to the mere existence of Israel thus become sources of anxiety. Three themes emerged from participants' responses regarding the continued existence of Israel, all of which weaken elders' WTL: an external existential threat such as wars and constant terror attacks, and two kinds of internal threats including emigration of the young generation from Israel, and erosion of the ideological nature of Israeli society. Many elderly Israelis have believed in and fought for the creation of a socialistic and collectivistic society; today however, they are witnessing a gradual deviation from those ideologies that were the cornerstones of their new homeland. The current shift towards more capitalistic and individualistic approaches leads to changes in many areas of public life. It thus appears that external and internal threats to the nation's physical and ideological existence raise feeling of disappointment, frustration and worry, which are negative expressions of SWB, to the degree that they weaken Israeli elderly's WTL.
The themes that emerged under the domain of historical traumatic events included war anxieties and feelings of constant stress due to the repeated wars and terror attacks. The first Gulf War was especially frightening to people because it aroused associations of the Nazi gas chambers (Solomon, 1995). Such events negatively influence the elderly's mental health, and WTL. Although they experienced a number of wars and many hostile attacks after the Holocaust, survivors repeatedly brought up their major trauma during WWII. On the positive side, they mentioned these traumatic events in order to emphasize the opportunities that were opened to them as Israeli citizens-to live freely, to build the country, and raise their families. All of these opportunities made them proud of their country and provided them with revenge against the Nazis, who wanted to eradicate them. Such feelings were reported to strengthen our participants' WTL, possibly because they grant meaning and purpose to their lives.

Study Limitations
Trustworthiness in this study was established by using the rigorous grounded theory method throughout the sampling, data collection, and analysis processes. Limitations of our study include recruitment and transferability. While we recruited as diverse a sample as possible of mentally and physically competent people, it is possible that elders with cognitive, psychological, or physical disabilities would elicit different responses about factors influencing their WTL. Moreover, while trustworthiness of the data analysis was ensured through weekly meetings between the coders and ongoing team discussions to clarify emerging themes, we did not member check with the participants. Finally, these findings are specific to elderly people living during the historical, political, and social reality of the Israeli context. As such, they may not be applicable to other cultures, but raise some interesting questions for further research: First, do elderly people who have experienced traumatic national life events including existential threats to their nation and themselves, develop stronger patriotic feelings toward their nation than elderly people who live a peaceful life in a safe country? Second, does the degree of influence of patriotic feelings on WTL vary in different countries? Finally, how prevalent is the impact of nationalism on WTL and on other indicators of SWB among people of different social groups (according to ethnic origin, socioeconomic and immigration status, etc.) within nations? Since research on the influence of nationalism on SWB to the degree that it affects people's WTL/SWB is in its early phase, studies on these subjects should be encouraged.

Conclusions and Practical Implications
Our findings indicate that nationalism and feelings of personal involvement in national developments play an important role in the lives of elderly Israelis to the degree that they influence their motivation to continue living. Responses of older adults to open questions about aspects that strengthen or weaken WTL exemplified positive and negative influences of nationalism-related emotions on their WTL.
Considering that loss of social status is one of the most difficult to bear in old age (Steverink, 2001), and that feelings of social belongingness affect people's self-worth (Tajfel & Turner, 1986), we suggest that our participants' perceived contribution to and involvement in the continued existence and flourishing of the country not only positively influence their WTL, but also boost their self-worth, that strongly correlates with the WTL. Therefore, this phase of self-worth should be preserved and reinforced. Positive national emotions can be aroused, maintained and strengthened by creating special opportunities in which attention and appreciation are expressed towards elderly people for their contribution to society. Such initiatives can be embedded in ceremonies held in the country during relevant memorial days and holidays. Positive patriotic emotions can also be aroused and strengthened in other ways including lectures, exhibitions, plays, movies, museum exhibits, historical sites, etc. Such interventions can be initiated by practitioners and/or family members on many social levels: the nation, communities, social clubs, assisted living facilities, and nursing homes.
In general, well-being of older people should be supported and enhanced by their societies. Our findings indicate that reinforcement of positive patriotic feelings can be considered as one of the ways to maintain and promote elderly persons' SWB, including WTL.

Funding
Funding of this research was made possible by The Minerva Center for the Interdisciplinary Study of the End of Life, Tel-Aviv University.