演講摘要Abstract

Nutritional, Exercise and Medical Cannabis Interventions for the Care of the Elderly Patient with Cancer  

The elderly cancer patient (ECP) population is a heterogeneous group, ranging from competent, active, and fit individuals to those who are frail and cognitively impaired.

A continuum exists from an increased vulnerability to stressors that results from the usual decreases in physiologic reserves (=aging) to the deregulation of multiple physiologic systems (=frailty). The ability or inability of carrying out activities of daily living is both a cause and an effect of frailty and may exacerbate the clinical manifestations of comorbidities. Cachexia is one of the most important comorbid conditions in ECPs, which can directly impair their quality of life, their ability to tolerate tumor-directed treatments, and their ability to respond to rehabilitation.  The comprehensive geriatric assessment identifies domains, assessed by a multidisciplinary team, that should be considered to guide appropriate oncological treatment decisions. 

This presentation will focus on the clinical and research practices available within the Cancer Rehabilitation Program and Medical Cannabis Program in Oncology, at the Cedars Cancer Center, McGill University Health Center. Optimization of both diet and physical activity may help patients improve their tolerance to oncological treatments and health-related quality of life. Beginning with definitions of frailty, sarcopenia, cachexia, and malnutrition, we will present the standardized screening, diagnostic, and interventional procedures to identify and treat these conditions in the ECP. Finally, we will present data on the safety and effectiveness of medical cannabis in reducing pain and concurrent medications in patients with cancer.

用於照護老年癌症患者的營養、運動和醫用大麻介入措施

老年癌症患者 (ECP) 族群是一個異質群體，既有有能力、活躍、健康的個體，也有虛弱和認知障礙的個體。

生理儲備通常減少（=老化）到多個生理系統失調（=虛弱）導致對壓力源的脆弱性增加，存在一個連續體。 進行日常生活活動的能力或無能力既是虛弱的原因，也是虛弱的結果，並且可能加劇合併症的臨床表現。 惡病質是 ECP 中最重要的合併症之一，它可以直接損害他們的生活品質、他們對腫瘤定向治療的耐受能力以及他們對康復的反應能力。 全面的老年病學評估確定了由多學科團隊評估的領域，應考慮這些領域來指導適當的腫瘤治療決策。

本演講將重點介紹麥吉爾大學健康中心雪松癌症中心的癌症復健計劃和腫瘤學醫用大麻計劃中可用的臨床和研究實踐。 優化飲食和身體活動可能有助於患者提高對腫瘤治療的耐受性和健康相關的生活品質。 從虛弱、肌少症、惡病質和營養不良的定義開始，我們將介紹標準化篩檢、診斷和介入程序，以在 ECP 中識別和治療這些病症。 最後，我們將提供有關醫用大麻在減輕癌症患者疼痛和併發藥物治療方面的安全性和有效性的數據。

Pharmaconutrition of Vitamin D for Osteoporosis in Older Adults

Because of vitamin D deficiency, cytokine storm, glucocorticoid therapy, hyperparathyroidism and long-term immobilization, critically ill patients are prone to bone hyper-resorption which further contributes to multiple complications and high mortality rates. Additionally, the survivors will have the higher risks of osteoporosis and fracture after hospital discharge. Along with increasing intestinal calcium absorption, active metabolites of vitamin D regulate directly the adaptive immunity to mitigate hyperinflammation, activate osteoblasts to inhibit steroid-induced bone resorption, depress parathyroid hormone (PTH) gene to constrain the high PTH level, and manage genes of IGF and Calmodulin in muscle cells to actuate fiber proliferation and contraction. Applications of vitamin D’s pharmaconutrition have been executed for more than 80 years, such as a therapeutic dose of 500,000 IU per day for vitamin D-resistant rickets. Therefore, the principal strategy for the prevention and treatment of osteoporotic fracture in the elderly contains a measurement of serum 25(OH)D among the high-risk populations and an effective increase in the serum 25(OH)D levels which is more than 60 ng/mL and constricts the high PTH level after mega-dosages of vitamin D supplementation.

維生素D的藥理性營養治療應用於年長者的骨鬆

重症患者因維生素D缺乏、細胞激素風暴、類固醇治療、副甲狀腺功能亢進及長期臥床，易發生高骨溶解，進而導致多重併發症及高死亡率；出院後，也有較高骨鬆及骨折的風險。除了促進腸道鈣質吸收，維生素D活性代謝物可直接調控適應性免疫系統以降低高發炎反應、活化造骨細胞以抑制類固醇誘導的蝕骨作用、抑制副甲狀腺基因以抑制高副甲狀腺素濃度、調控肌肉細胞的IGF及Calmodulin以促進肌纖維產生及收縮。維生素D的藥理性營養治療之臨床應用，已超過80年，例如每日50萬IU治療維生素D抗性佝僂症。因此，預防及治療年長者的骨鬆性骨折之首要策略是 : 檢測高危險群血中25(OH)D濃度，補充巨量維生素D以有效地提升血中25(OH)D數值≥60 ng/mL及抑制高副甲狀腺素濃度。

Use of Cannabis in Elderly Patients Care: Current Challenges and Practical Recommendations

The utilization of cannabis in elderly patient care is an emerging field that presents unique challenges and opportunities. As the global population ages and the legalization of cannabis becomes more widespread, there is a growing interest in its potential benefits for elderly patients, particularly in managing chronic pain, anxiety, insomnia, and other age-related conditions. From an epidemiologic perspective, the prevalence of cannabis use among the elderly has been steadily increasing over the past decade, reflecting broader societal trend and growing acceptance of cannabis as a therapeutic option. Despite this increase, one of the primary challenges is the lack of comprehensive clinical research specific to the elderly population. The majority of existing studies focus on younger cohorts, leading to a significant gap in understanding the safety, efficacy, and appropriate dosing for older adults. Additionally, elderly patients often have multiple comorbidities and are on various concomitant medications, increasing the risk of adverse drug-drug interactions. Despite the evidence gaps, from a practical standpoint, healthcare providers face the challenge of making informed decisions about the potential benefits and risks of cannabis use in elderly care. This includes recognizing contraindications and being able to provide informed guidance to patients and their families. Specific considerations include safety and efficacy (e.g., appropriate dosing and formulations), evaluating the potential interactions between cannabis and other medications commonly prescribed to the elderly, monitoring for adverse effects, particularly cognitive and cardiovascular effects. A recommended strategy to support informed clinical decisions is leveraging real-world healthcare data (so called big data) to identify high-risk subgroups based on comorbidities and concomitant medications, which is critical for defining personalized care plans. While cannabis holds promise for improving the quality of life in elderly patients, it is imperative to address the existing challenges through rigorous research, clear regulatory guidelines, and comprehensive education for both healthcare providers and patients. By doing so, we can harness the therapeutic potential of cannabis in a safe and effective manner, tailored to the unique needs of the elderly population.

The Pastoral Care Toward Terminally Ill Patients in the Light of Magisterial Document Samaritanus Bonus

The top cause of death in Taiwan for some decades is cancer. According to the Ministry of Health and Welfare of Taiwan, cancer affects the lives and health of Taiwanese people and causes more than fifty thousand deaths every year. In the face of such an impact, every institution, organization, and individual must find ways to deal effectively with these fatal illnesses. Confronted with the immense pain and suffering of countless patients, the Catholic Church recognizes the necessity of Catholic healthcare workers, chaplains, and ministers to support patients and their families in their hours of need. Consequently, besides offering theological responses for the avoidance of euthanasia, the Church has ceaselessly been providing a pastoral presence in the joint fight against patients’ pain, suffering, and fear of death. The Church has called on people of goodwill to stand together in protecting human life as well as to join in the efforts of serving and caring for terminally ill patients and their family members.

Therefore, based on recent Magisterial documents like the Samaritanus Bonus, this paper will discuss the role and the importance of pastoral care by the Church in helping patients and their family members cope with the challenges posed by cancer. This paper also intends to show how hospice care and palliative care involve the exercise of human and Christian virtues of love, hope, faith, and compassion. In doing this, as a good Samaritan, the Church never abandons sick people but rather reaffirms that euthanasia is a crime against human life and shows her support through Christian practices, prayers, and companionship that can help them, as well as their families, caregivers, and friends, to face death well.

臨終患者牧靈關懷以教會訓導《好撒瑪利亞人》文獻為基礎

幾十年來，癌症一直是台灣的首要死因。根據台灣衛生福利部的報告，癌症每年導致超過五萬人死亡，嚴重影響了本國人民的生活和健康。面對這些致命疾病，每個機構、組織和個人都必須找到有效的應對方法。天主教教會認為，在面對無數患者的巨大痛苦和折磨時，醫護人員、院牧和神職人員應在患者及其家人需要的時候提供支持與關懷。因此，除了提供神學回應以避免安樂死外，教會還不斷提供牧靈關懷，共同對抗病人的痛苦、苦難和對死亡的恐懼。教會呼籲每個人要團結一致，保護人的生命，並共同努力服務和照顧臨終患者及其家人。

基於最近的教會訓導如《好撒瑪利亞人》文獻，本文將討論教會在臨終患者及其家人中扮演的重要角色。本文還旨在展示臨終關懷和緩和治療如何運用基督宗教的信、望、愛及同理心等美德。教會如同好撒瑪利亞人一樣，從不拋棄病人，而是重申安樂死是對人類生命的犯罪，並通過信仰實踐、祈禱和陪伴來表達她的支持，以幫助臨終患者及其家人、照顧者和朋友更好地面對死亡。

From the service experience of St. Joseph’s Hospital and St. Joseph’s Social Welfare

Foundation, presenting the concept and practice of spiritual care in long-term care

institutions of the Church.

Is the holistic care of body, mind, society and soul emphasized by long-term care church institutions just an ideal? Or is it really possible to apply it to every elder being cared for? Father George Massin, the founding director of St. Joseph’s Hospital, mentioned in his will: “...May the social services of St. Joseph's Hospital help those who in need. In addition to physical care, don't neglect spiritual care, because people are a whole..." With medical services as the core, St. Joseph's Hospital had set up nursing homes and dementia care centers. It has also cooperated with churches in four different towns to establish long-term day-care and dementia locations. According to the ABC terms in long-term care 2.0 system, we had 2A , 4B, and 4C sites, and have direct contact with more than 200 elders in long-term care institutions every day. Colleagues from the hospital's Chaplaincy Department are responsible for the task of spiritual care. In order to provide spiritual care for the elderly in rural areas, they participated in the elementary and advanced training courses of Anselm Grun and Teacher Wu Xinru. After that, they began to design lesson plans suitable for rural areas and try to guide the elders to open their hearts, explore and express their spiritual needs, and help them to face the peaks of life and deal with emotions and belongings. The main content of my speech was to share the service experience of St. Joseph's Hospital and St. Joseph's Foundation in spiritual care in long-term care institutions. 

從若瑟醫院與若瑟基金會的服務經驗介紹教會長照機構靈性關懷之理念與實踐

教會長照機構所強調的身心社靈全人照顧,只是一個理想?或是真的可能實踐在每一個被照顧的長者身上?若瑟醫院創院院長松喬神父的遺囑提到「...願虎尾若瑟醫院的社會服務能幫助那些需要幫助的人,除身體的照顧之外,更不要忽略了靈性的照顧,因為人是一個整體...」。若瑟醫院以醫療服務為核心,設立護理之家、失智照護中心,外展結合了四個鄉鎮的教堂建立日間長照機構和失智據點,以長照 2.0 ABC 的說法,我們有 2A、4B、4C,每天直接接觸的長照機構長者超過 200

人。醫院院牧部的同仁負責靈性照顧的任務,為了做好鄉下地方長者的靈性關懷,他們參與了古倫神父和吳信如老師的初高階訓練課程,之後,開始認真設計適合鄉村的教案,嚐試引導長輩們打開心門,探索、表達靈性的需求,協助他們面對生命的高𡶶𡶶,處理情感和財物。演講的主要內容,是分享若瑟醫院與若瑟基金會在長照機構靈性關懷的服務經驗。

Practice the pastoral care of the church to give spiritual sustenance to the elderly terminally ill patients.

The Hsiao Ai Home for the Aged was founded in June 1972 as a caring and nursing home, adhering to Catholic humanistic ideas and the filial piety spirit of the Chinese people. “Be respectful to the elderly, respect God, and love others as if serving the master. Take care of the whole person and care for the entire process.” Our commitment to filial love is rooted in the fraternity of Jesus Christ and the spirit of traditional Chinese filial piety. We strive to provide a harmonious, comfortable, and safe place for elderly individuals who are helpless or in need of care. Our home supports the elderly in facing life's limitations, adding beautiful colors to their lives, and accompanying them on their final journey. We wish to ensure they can peacefully pass away without fear. This presentation focuses on Catholic liturgy and practical service for elderly individuals who trust in God, ensuring their later years are filled with vitality and hope.

In pastoral care and companionship with the elderly, we observe that their spiritual senses become more sensitive as they age, and their physical organs decline. Thus, in our accompany and care, we help the elderly to reflect on their lives while also discovering and experiencing God’s presence and love in their daily lives. In their tranquillity of daily life, we incorporate regular prayer, participation in Mass, Bible reading, and faith sharing. Through nourishing the Holy Word, their faith becomes more muscular, and they recognize the richness and sensitivity of their own lives.

Facing the passage of time, one realizes life's brevity. Transitioning from lamentation and resignation to embracing the gradual aging process, bravely accepting and confronting mortality, is a natural law. This presentation emphasizes that letting go of all past burdens, wholeheartedly trusting in God, and returning to Him. Thus, the primary purpose of caring for the elderly and the terminally ill is to help them discover the courage that comes from faith in their increasing frailty. This courage brings God's strength and the fruits of holiness, allowing them to understand the meaning of living and facing death.

陪著生命走向善終

財團法人台灣省私立孝愛仁之家 (以下簡稱本家)，成立於民國 61 年 6 月為一安養、養護機構，秉持天主教人文思想與中華民族之孝道精神所創辦。

「孝老猶敬天、愛人如侍主」，「全人照顧、全程關懷」，孝愛以耶穌基督博愛及中國傳統孝道精神，為無依或需要照顧的長者，提供一個和諧、舒適、安全的家，協助長者們面對人生的限度，為生命畫出美麗的色彩，陪伴長者們走人生最後的一程，得以安寧無懼地進入福地。本分享注重在天主教禮儀與實際服務信賴天主的長輩，在他們晚年生活，卻充滿活力和希望。

他們身體的器官衰退了，但他們靈性的感官，卻非常靈敏。接著牧靈的工作關愛關懷，陪伴讓長輩回顧生命，注意天主的旨意、體驗到天主的臨在與標記，在平凡的生活中，發現天主。接著陪伴過程讓長輩發現自己如此豐厚敏銳的生命，源於他們的信德的活動如每天念經、參與彌撒、讀經分享等。另陪伴讓長輩從無奈走向忍耐接受變老，不得不放下的過程，到死我們會放下一切，只對天主的依賴走向自由。照顧老人和臨終者的人，意味著要幫助這些人在日益增加的軟弱裡，發現因信賴而有的承擔，因承擔而有的天主的力量與聖善的果實，讓他們明白了活著的意義。