The last place you want to be when you're sick . . .

is in a hospital. Hospitals are very dangerous places for several reasons. The most obvious is that there are a lot of debilitated people there with tubes going into their orifices, and often extra holes with extra tubes, that are full of all kinds of nasty bugs that eat antibiotics for breakfast, and then eat people for lunch.

But that's not the only reason. I'll pass briefly over the risk entailed by being in the clutches of doctors who are often overeager to do really radical stuff to you, although I happen to think that's quite dangerous. As Covinsky and colleagues discuss in JAMA, an extraordinarily high percentage of older folks who are hospitalized for one reason or another leave the hospital with brand new disabilities having nothing specifically to do with the original reason for hospitalization. Quite often, they never make it home again. Among the reasons:

Excessive confinement to bed. This can happen due to inappropriate bed rest orders, or because they are essentially tied to the bed by a urinary catheter or IV line. If you can walk, dress yourself, make it to the toilet, etc. when you enter the hospital, you should insist on keeping on doing it. When people who are already frail become inactive for even a couple of days, they often can't get their strength back.

Poor nutrition. Again, people may be placed on restrictive diets inappropriately, but they also may just find it very hard to eat the swill placed in front of them. And, as with the above, when you lose strength due to a bout of malnutrition, if you're getting on in years, it may be hard to get it back.

Falls. The hospital is an unfamiliar environment and believe it or not, regular hospital wards aren't necessarily set up so as to be safe for people prone to falling -- there's a lot of weird furniture on rollers, slippery floors, often the odd piece of paper or linen lying on the floor, not necessarily railings where they should be, etc.

Delirium. The environment is bizarre, noisy, chaotic. People may be drugged or sleep deprived. The result is often loss of contact with reality. Sometimes people never fully recover their cognitive chops.

So . . .

A) Try not to go there, and deal with issues on an outpatient basis if at all possible.

B) If you do have to go there, as I say, be feisty and a pain in the ass and insist on getting out of bed, getting dressed, getting yourself to the loo, keeping to your usual routine of newspapers and crosswords or whatever, as much as you possibly can. Eat. Don't take any crap.

C) The people who run hospitals need to learn how to do it better.

That is all.