Analysis of risk factors of social frailty in older adults living with HIV/AIDS

As a predictor of mortality, accidental disability, depressive symptoms, and other adverse outcomes in the older population, social frailty has yet to receive attention among older adults living with HIV/AIDS. Therefore, this study, using Least Absolute Shrinkage and Selection Operator (LASSO) and Random Forest (RF), aims to analyze the current status and risk factors of social frailty in older adults living with HIV/AIDS and provides a basis for its prevention and reversal. From January to December 2024, a total of 335 older adults living with HIV/AIDS (≥ 50 years old) receiving outpatient treatment at a tertiary hospital in Zunyi, Guizhou, China, were selected using convenience sampling. Data were collected through a general information questionnaire (demographic and clinical disease), the HALFT scale for social frailty, the Geriatric Depression Scale-15 (GDS-15), the Barthel Index (BI), the Montreal Cognitive Assessment (MoCA), the Pittsburgh Sleep Quality Index (PSQI), and the Social Support Rating Scale (SSRS). Data processing and analysis were conducted using SPSS 29.0, Python 3.11, and R 4.3.1. Among the 335 older adults living with HIV/AIDS, 105 cases (31.34%) exhibited social frailty. LASSO regression was used for validation, and based on the lambda.min value (λ = 0.0127), 12 relevant variables with non-zero coefficients were selected from 26 variables. These 12 variables were then incorporated into the RF model, which identified that older adults living with HIV/AIDS with reduced activities of daily living (ADL), lack of exercise, cognitive impairment, depression, lower social support, older age, sleep disorders, low CD4⁺ lymphocyte counts, low per capita household income, complications, smoking history, and those enrolled in China's free antiretroviral therapy (ART) program faced a higher risk of social frailty. The top five risk factors in order of importance were ADL, exercise, cognitive impairment, depression, and social support. The incidence of social frailty is relatively high among older adults living with HIV/AIDS. The risk factors include ADL, exercise, cognitive impairment, depression, social support, age, sleep disorders, CD4⁺ lymphocyte count, per capita household income, complications, smoking history, and participation in China's free ART program. This highlights the importance of healthcare institutions and community healthcare workers addressing social frailty in older adults living with HIV/AIDS. Early identification of the risk factors can help prevent or reverse the onset and progression of social frailty, improving prognosis and quality of life. It also provides a theoretical foundation for developing targeted intervention measures.