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Dr. Samir Sinha speaks with patient Leora Dowswell, as part of the geriatrics consultation service at Mount Sinai Hospital in Toronto on March 25, 2011.JENNIFER ROBERTS

Reining in Canada's health-care costs as the population ages is an issue that has been largely ignored during the federal election campaign. Instead of reform, party leaders suggest medical-student debt relief - hardly a fix when the sustainability of medicare is at stake.

In many provinces, health care consumes at least 40 per cent of total program spending. Seniors are the fastest-growing segment of the population, with 4.8 million people aged 65 and older, a figure expected to increase to 10.4 million in 2036.

Those facts alone should prompt party leaders to devise a plan for a health-care overhaul, but instead they cling to their old ways: high on transfer payments and low on vision.

The fixing of the $192-billion system should begin with the elderly. Canadians are living longer, and those who shaped this country face significant challenges in the coming years. At a minimum, they are owed a dignified end.

Consider this common scenario. A frail senior on multiple drugs for chronic conditions receives care that is not well managed, prompting a medical crisis that necessitates a hospital visit. The patient is hooked to machines of low benefit and prescribed medications that worsen cognitive function, growing so weak in bed that the only solution eventually becomes a nursing home.

With no nursing bed available, the patient is trapped in hospital, like thousands of other Canadians every day, spawning health-care chaos; the emergency department backs up and operations are cancelled. It amounts to poor, expensive, inefficient care.

The president of the Canadian Medical Association, Jeff Turnbull, says that at the Ottawa Hospital where he is the chief of staff, as many as 150 such patients a day await placement elsewhere. So far, he hasn't heard a comprehensive health-reform plan - just piecemeal initiatives.

Key to any health-reform plan would be more doctors to care for the elderly. Geriatricians are troubleshooters who spend time with patients, going over medications, dealing with memory problems and helping avert medical crises. There are only 238 of them, and experts say 500 more are needed.

Any new geriatricians would need a health-care system to work in - one that features house calls, home care and other supports for seniors. Without these changes, seniors will continue to languish in hospital beds and face the undignified ending they so wanted to avoid.