Older adults with apathy have a high risk of falls and are prone to repeated falls . Few interventions could achieve satisfactory effects on improving apathy, although improved apathy is associated with a reduced risk of falls. Improving frailty may be a new method for reducing the risk of falls in older adults with apathy.

To investigate the mediating effect of frailty between apathy and risk of falls in older adults in the community, so as to provide a new idea for reducing the fall risk in this group.

A total of 212 community-dwelling older adults were selected to attend a survey by convenience sampling from November 2021 to March 2022, including 128 from Dongshan Community Health Center, Nanjing, and 84 from Qinghu Town, Donghai County, Lianyungang. A self-developed Demographic Information Questionnaire, the Fried Frailty Phenotype (FFP) , Geriatric Depression Scale (GDS-3) , Stopping Elderly Accidents, Deaths & Injuries Tool Kit (STEADI) were used to collect demographics, frailty prevalence, apathy prevalence, and risk of falls, respectively. The intermediary role of frailty in apathy and fall risk was analyzed.

One hundred and ninety-two cases (90.6%) who responded effectively to the survey were included for analysis. The average total STEADI score, average total GDS-3 score, and FFP score of the respondents were 2.0 (0, 4.0) , (1.6±0.9) , and 0 (0, 2.0) , respectively. Fifty-six (29.2%) and other 136 cases (70.8%) were assessed with and without fall risk, respectively. Spearman rank correlation analysis showed that apathy was positively correlated with frailty and fall risk, (r_s=0.303, 0.388, P<0.05) , and frailty was positively correlated with fall risk (r_s=0.424, P<0.05) . The analysis using intermediary Model 4 showed that apathy had a significant positive effect on fall risk (B=1.011, t=5.207, P<0.05) ; apathy significantly positively influenced frailty (B=0.324, t=3.800, P<0.05) ; frailty had a significant positive effect on fall risk (B=0.679, t=4.173, P<0.05) . Bootstrap test showed that the effect size of frailty in the path of "apathy→frailty→fall risk" was 0.22 〔95%CI (0.08, 0.40) 〕, indicating that frailty played a mediational role between apathy and risk of falls. Apathy could directly affect the fall risk, and could indirectly affect the fall risk through frailty. The total effect was 1.01, in which the size of direct effect was 0.79, the size of mediator effect was 0.22 (accounting for 21.78%) .

Frailty may be a mediator between apathy and fall risk in older adults in the community, and improving frailty is an important way to reduce risk of falling.

淡漠老年人跌倒风险高且易重复跌倒，改善淡漠虽有助于减少老年人的跌倒风险，但淡漠的干预效果不佳，而改善衰弱可为减少淡漠老年人跌倒风险提供新方法。

探讨衰弱在社区老年人淡漠与跌倒风险间的中介效应，为干预淡漠老年人跌倒提供新思路。

2021年11月至2022年3月采用便利抽样法抽取南京市和连云港市社区老年人共212例，其中南京市东山社区卫生服务中心128例，连云港市东海县青湖镇社区84例。采用一般资料调查表，衰弱评估量表（FFP，评估衰弱情况），老年人抑郁量表（GDS-3，评估淡漠），预防老年人意外、死亡、伤害工具包（STEADI，评估跌倒风险）进行问卷调查。分析衰弱在淡漠与跌倒风险中的中介作用。

共发放问卷212份，回收有效问卷192份，有效回收率为90.6%。192例社区老年人中跌倒风险总分为2.0（0，4.0）分，淡漠总分为（1.6±0.9）分，衰弱总分为0（0，2.0）分。无跌倒风险136例（70.8%），有跌倒风险56例（29.2%）。Spearman秩相关分析结果显示，淡漠与衰弱、跌倒风险呈正相关（r_s值分别为0.303、0.388，P<0.05）；衰弱与跌倒风险呈正相关（r_s=0.424，P<0.05）。Model 4中介模型结果显示，淡漠对跌倒风险的正向影响作用显著（B=1.011，t=5.207，P<0.05），淡漠对衰弱的正向影响作用显著（B=0.324，t=3.800，P<0.05），衰弱对跌倒风险的正向影响作用显著（B=0.679，t=4.173，P<0.05）。Bootstrap检验模型分析结果显示，"淡漠→衰弱→跌倒风险"路径中衰弱效应值0.22〔95%CI（0.08，0.40）〕，中介效应成立。淡漠可以直接影响跌倒风险以外，还可以间接通过衰弱影响跌倒风险。总效应为1.01，直接效应为0.79，中介效应为0.22，中介效应值占总效应的21.78%。

衰弱是社区老年人淡漠与跌倒风险之间的中介变量，改善老年人衰弱是减少淡漠老年人跌倒风险的重要途径。