Abstract:

Objective To explore the factors affecting social frailty in elderly patients with mild ischemic stroke and conduct interpretable analysis to provide references for the implementation of targeted intervention. Methods Using convenience sampling method，elderly mild ischemic stroke patients treated in a tertiary A hospital in Tangshan from September 2022 to August 2023 were selected as the survey subjects according to whether social weakness and no social weakness occurred 6 months after discharge. General Information Questionnaire，Chronic Illness Resources Survey，Family Care Index Questionnaire，Instrumental Activities of Daily Living Scale，Mini-Mental State Examination, International Physical Activity Questionnaire Short Form，and Social Frailty Scale were uesd to investigate. Univariate analysis，random forest-feature recurrence elimination screening variables were used to construct random forest models，and SHAP values were introduced for influencing factor analysis. Results A total of 818 elderly patients with mild ischemic stroke were included，and 110 patients were lost at 6 months，and 708 patients（86.55%） finally completed the survey. The prediction accuracy of random forest model was 0.828 and 0.807 in the training set and test set. The SHAP interpretability analysis results showed that impaired self-care ability，sedentary behavior，and the number of combined chronic diseases were positively associated with social weakness，ideal utilization of chronic disease resources，good family care and social weakness；the importance of characteristics was self-care ability，chronic disease resource utilization，family care，sedentary behavior，and combined chronic diseases. Conclusion The influencing factors of social frailty in elderly patients with mild ischemic stroke are complex，so medical staff should pay attention to the social function of elderly patients with mild ischemic stroke，and reduce the risk of social frailty by formulating personalized intervention measures.

Key words: Ischemic Stroke, Social Frailty, Random Forest, Questionnaire, Geriatric Nursing

摘要：

目的 探讨老年轻型缺血性脑卒中患者社会衰弱的影响因素并进行可解释性分析，为实施针对性干预提供参考。方法 采用便利抽样法，选取2022年9月—2023年8月在唐山市某三级甲等医院治疗的老年轻型缺血性脑卒中患者为调查对象，采用一般资料调查表、慢性病资源利用量表、家庭关怀度指数问卷、工具性日常生活能力量表、简易精神状态量表、国际体力活动问卷简表、社会衰弱量表进行调查。根据出院后6个月随访是否发生社会衰弱将调查对象分为社会衰弱组和无社会衰弱组。采用单因素分析、随机森林-特征递归消除筛选变量，构建随机森林模型，并引入SHAP可解释性分析进行影响因素分析。结果 共纳入818例老年轻型缺血性脑卒中患者，6个月时脱落110例，最终708例（86.55%）完成调查。随机森林模型预测准确率在训练集和测试集中分别为0.828和0.807，SHAP可解释性分析结果显示，自理能力受损、有久坐行为、合并慢性病数量多与社会衰弱呈正相关，慢性病资源利用理想、家庭关怀度良好与社会衰弱呈负相关；特征重要性由高到低依次为自理能力、慢性病资源利用、家庭关怀度、久坐行为、合并慢性病数量。结论 老年轻型缺血性脑卒中患者社会衰弱的影响因素复杂，医护人员应重视老年轻型缺血性脑卒中患者的社会功能，通过制订个性化干预措施，降低社会衰弱的发生风险。

关键词: 缺血性脑卒中, 社会衰弱, 随机森林, 问卷调查, 老年护理