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88 2. Reduced kidney mass and volume, more significant in men than in women. 3. Thickening and compaction of the kidney capsule, an increase in the volume of paranephral tissue. 4. The development of hyalinosis of the capillary loops of the glomerulus (which is clearly manifested from the age of 40), in the future-the gradual death of renal nephrons. 5. Reduction of glomerular filtration (approximately 7% during each subse- quent decade of life after 40 years). 6. Decrease in the rate of physiological renewal of the tubal epithelium and vio- lation of the tubal activity: reduced maximum reabsorption of glucose, total acid excretion, free water clearance. 7. Arteriosclerosis of the kidney vessels, elastic hyperplasia of their intima. 8. Changes in the hemodynamics of the senile kidney as a whole: the renal blood flow is reduced by almost half, the effective renal plasma flow. 9. Atrophy of elements of the juxtaglomerular apparatus with rearrangement of its cells. 10. Weakening of the mechanisms of intracellular regulation of blood flow. 11. Atony of the urinary tract, which contributes to the occurrence of reflux (reverse flow of urine) at various levels. Features of care for elderly and senile patients When caring for elderly and senile patients, compliance with the norms of med- ical ethics and deontology is of particular importance. Often, a nurse becomes the only person close to a patient, especially a lonely one. Each patient needs an indi- vidual approach, taking into account the personal characteristics of the patient and his attitude to the disease. To establish contact, the nurse must speak in a calm, friendly voice, be sure to greet patients. If the patient is blind, you should introduce yourself daily when entering the ward in the morning. Patients should be treated with respect, by name and patronymic. It is unacceptable to call the patient familiarly «grandmother», «grandfather», etc. Geriatric patients often «withdraw into themselves», «listen» to their condi- tion, they become irritated, tearful. Preparation of the patient for various medical manipulations, the ability to listen, empathize and give advice are important fac- tors in successful treatment. However, the nurse alone, in addition to the doctor, should not give the patient or his relatives information about the nature and pos- sible outcome of his disease, discuss the results of research and treatment methods. The problem of insomnia. An old person needs 7–8 hours of sleep, and people with severe asthenia also need additional daytime sleep. Sleep is more important in the life of an elderly and old person than in the life of young people. The reserve capabilities of the nervous