Boca Raton, Fla. — As he approaches his 90th birthday, a retired physician here had expected to live out his final years with his wife and a comfortable savings gleaned from 20 years of investments with Bernard Madoff.

That dream was shattered with Madoff’s arrest two years ago for orchestrating a $50 billion Ponzi scheme; it was completely destroyed last week.

Irving Picard, the trustee seeking to recover money for victims of the disgraced financier, filed so-called “claw-back” suits against the elderly man and hundreds of other investors who had allegedly profited from Madoff’s crime.

“How are we supposed to pay this back?” asked the man, who asked that his name not be used, of the $1 million for which he is being sued. “We have just enough money to live on.”

While media attention has focused on the large companies, banks and individuals sued — as well as settlements reached with such charities as Hadassah, which last week agreed to pay back $45 million — little attention has been paid to the now-elderly Jews who began investing with Madoff years ago.

Adele Fox, 87, of Tamarac just north of Fort Lauderdale, said she invested “hundreds of thousands of dollars” with Madoff beginning in 1988 because “he had a great reputation.”

A former secretary at Aviation High School in Long Island City, Fox said that after seeing her savings with Madoff disappear two years ago, she has worried since that Picard was going to sue her for the “profits” she withdrew in the six years preceding Madoff’s arrest. On Monday she said she had not been sued and now just wanted to be “left alone.”

“I live on a small pension from New York City and Social Security,” Fox said. “I’m part of the Madoff survivors’ group, and the stories I hear are pathetic. Some victims have had to sell their houses and move in with their children. … It’s been terrible for all of us. I have ulcers and gastrointestinal problems because of all the strain I have been under. This has really done a job on my health — my blood pressure has skyrocketed over this.”

She emphasized that the money she withdrew from her Madoff account during the last six years was “my money, money I and my husband worked for all of our lives. We had put 17 percent of our paycheck into our retirement fund.”

Picard is demanding that investors pay back any “profits” they received between 2002 and 2008. Thus, if an investor invested $100,000 and in the final six years withdrew $200,000 from a portfolio that had increased to $500,000, they are being required to return $100,000.

Two years after the scandal broke, even those who do not have to worry about lawsuits are still adapting to their newly modest means. The case of Ronnie Sue Ambrosino is an example of a Madoff investor who withdrew less than she deposited over the years and is thus entitled to be paid by the Securities Investor Protection Corporation (SIPIC) for up to $500,000. Picard is suing to recover money from those who took more than they deposited in order to replenish the SIPIC account.

Ambrosino, 57, a “nice Jewish girl from Levittown, [L.I.],” said she and her husband had invested everything they had with Madoff.

“I was a saver and worked hard for over 30 years,” she said. “I had a little over a million dollars [invested with Madoff] and the account grew on average about 10 percent a year. When people were making 30 percent, we made 18 percent and I was happy. I don’t take risks. I felt my money was safe and that I had enough. Growing up in Levittown I never needed a lot of stuff.”

Four years ago, Ambrosino said she retired as a computer consultant “to live my dream in a motor home because I had my Madoff money. …We were homeless by choice, knowing that if we ever had a problem we had money that could take care of it.”

But after the events of two years ago, Ambrosino said her life will never be the same. She said she and her husband live in their motor home in Surprise, Ariz., 35 miles northwest of Phoenix, and survive on her husband’s small pension.

“Our lifestyle is simple but we don’t have the security we once had,” she lamented. “Everything we both gave our blood, sweat and tears for is gone.”

Because they had withdrawn little of the money they had invested with Madoff, they received some SIPIC insurance money and used it to buy a lot at the motor park that has been their home for the last two years. And they are now building with their own hands a home nearby “because I need that security — a roof over my head.”

Ilene Kent, outreach coordinator for the Network for Investor Action and Protection, a nonprofit group formed by former Madoff investors, said the fraud has hit the elderly especially hard.

“A couple in their early 70s in Boca Raton who thought they were in their golden years have had to return to work, opening an airport transportation business,” she said. “They were both in the legal field and now they don’t know if they can stay in their house.”

Fox said those “who have been clawed back are suffering terribly. I hope there will be no other suicides. When I heard about Mark Madoff’s suicide [last Saturday], I became hysterical crying. He has children, and if he wasn’t guilty [of his father’s crime] it shows you the pressure he was under. This is a terrible mess; so many people have been hurt by this.”

Several miles north of Tamarac in Haverhill, the Alpert Jewish Family & Children’s Services operates a residential program for disabled adults. Ten years ago, a 30-year-old woman with severe autism and partial blindness was admitted to the group home after her parents set up a trust fund with Madoff that would ensure her care for the rest of her life.

“Two years ago, the family was wiped out” in the Madoff scandal, said Neil Newstein, the organization’s executive director. “We got some state funding [for her care], but it was a shadow of what was needed — $3,500 a month while it cost $6,000 a month to keep her in the group home. She’s doing very well, but we have to find $2,500 a month to cover the shortage, and we just got a letter from the state saying it will be cutting reimbursements by 2.5 percent. That’s more money we have to get donations for, and we expect other budget cuts as well. … We tell people in New York not to move to Florida if they need any subsidized services at all.”

Asked how her parents are doing, Newstein said it was not clear whether they would be sued by Pickard and are “at wits end. We can’t guarantee they can keep their child here forever. They lost a fair amount of their savings, and a year ago they moved into a smaller home. They are both retired. The mother has had serious health problems in the last two years — and the stress from this hasn’t helped.”

He added that Madoff’s scam also cost his organization two annual significant gifts from private foundations — one for $100,000 and the other for $50,000.

“Palm Beach County is full of people who have been hurt,” Newstein said. “The anger at the Palm Beach Country Club you could cut with a knife.”

Palm Beach has been described as “ground zero” of the Madoff fraud. The 72-year-old Madoff, now serving a 150-year prison sentence for his crime, owned an 8,700-square-foot mansion north of town — one of his three homes — and preyed on fellow members of the Palm Beach Country Club to invest in his scheme.

Audrey Freshman, a New Yorker who coordinates an emotional support group for Madoff investors, said investors who were traumatized two years ago when Madoff’s scam was unmasked have been “re-traumatized” by Picard, his lawsuits and threats of lawsuits.

“It’s not over,” she said. “It’s just hanging on. If you weren’t totally wiped out by Madoff, you still may be.”

Freshman said an online survey she conducted a year ago of more than 150 Madoff victims found a “high degree of anxiety, depression and medical problems.”

“I found that 56 percent reported post-traumatic stress disorder,” she said. “This is very high. In the general population, only 6 to 10 percent of people have post-traumatic stress disorder — such as Holocaust survivors and people who had been in wars.”

Freshman said the waiting for a resolution of this fraud has been excruciating for many and that it is a long way from being over for those who have been sued.

“Picard has 120 days from the date of filing the suit to send a letter mandating mediation” to resolve the claim, Freshman said.

Kent said Picard has sued about 20 percent of the more than 5,000 direct accounts Madoff had. She said his actions are “punitive because he is suing for more than he needs” to repay the investors who lost money with Madoff.

Kent said his suits total more than $70 billion and that Picard has determined that SIPIC needs to satisfy claims totaling $5.8 billion.

She said she is also upset with the way Picard determined who would be covered by SIPIC.

“SIPIC was set up to protect innocent investors,” she said. “It was supposed to protect the final account statement,” not just the deposits.

Madoff investors are now challenging Picard’s handling of this case in the courts.

For the elderly living with little money left from their Madoff investment, the pain will only get worse, Freshman said.

They could hire a lawyer to help them file a hardship application, “or they can wait for him [Picard] to come, and sit and be traumatized for the next few months waiting for the axe to fall,” she pointed out.

On his website, Picard says that he would not pursue claims “against customers with known hardships.”

“Through applications voluntarily submitted by customers to the Hardship Program, the trustee has been able to work with a substantial number of customers to confirm their hardship status and to forego the pursuit of” a lawsuit, the website says.

Looking at an online list of those who have been sued in New York, Florida, California and elsewhere, Freshman said, reminds her of “walking through a Jewish cemetery — 36 pages of Jewish money wiped out and him [Picard] coming after them. He is also filing against estates that were passed down to beneficiaries. So if parents left money, he is going after it.”