The association between apathy, decline in physical performance, and falls in older persons

  • Marieke J. HenstraEmail author
  • Didi Rhebergen
  • Max L. Stek
  • Karin M. A. Swart
  • Suzanne C. van Dijk
  • M. Carola Zillikens
  • Sadaf Oliai Araghi
  • Lisette C. M. G. M. de Groot
  • Natasja M. van Schoor
  • Nathalie van der Velde
Original Article



Symptoms of apathy are common in older persons. Negative effects on physical performance and fall risk are plausible, considering the pathophysiology of apathy. However, literature is scarce.


To longitudinally assess the association between apathy and (1) decline of physical performance and (2) the number of falls in older community-dwelling persons.


The ‘B vitamins for the PRevention Of Osteoporotic Fractures’ study provided data on 2919 older persons over a period of 2 years. Apathy was assessed using the Geriatric Depression Scale 3. A physical performance score (PPS) was calculated using three performance tests. Falls were registered prospectively. We calculated adjusted odds ratios (ORs), Incidence Rate Ratios (IRRs), and their 95% confidence intervals. Effect modification by age and gender was investigated. We also investigated mediation by baseline PPS for the association between apathy and the number of falls.


Apathy and decline of PPS were independently associated. After stratification, the effect only remained in men. Age was an effect modifier; higher ORs for decreasing age. Apathy was also independently associated with the number of falls. After stratification, women had higher IRRs than men. Age modified the association in the opposite direction: higher IRRs for increasing age. Baseline PPS was a mediator in the association.


The impact of apathy on physical performance and fall incidents varied with age and gender. Potentially, in older individuals with apathy, fall risk is preceded by a decline in physical performance. In clinical practice, identifying apathy in older persons might be useful to target mobility preserving interventions.


Apathy Fall risk factor Physical performance Older persons Community-dwelling 



Paul Lips, Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam, The Netherlands,


The B-PROOF study is supported and funded by The Netherlands Organization for Health Research and Development (ZonMw, Grant 6130.0031), the Hague; unrestricted grant from NZO (Dutch Dairy Association), Zoetermeer; Orthica, Almere; NCHA (Netherlands Consortium Healthy Ageing) Leiden/Rotterdam; Ministry of Economic Affairs, Agriculture and Innovation (project KB-15-004-003), the Hague; Wageningen University, Wageningen; VUmc, Amsterdam; Erasmus Medical Center, Rotterdam.

Compliance with ethical standards

Conflict of interest

The author declares that there is no competing interest.

Statement of human and animal rights

The study protocol was approved by the Wageningen University Medical Ethics Committee and the Medical Ethics committees of the two other participating centres gave approval for local feasibility.

Informed consent

All participating individuals gave written informed consent


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Marieke J. Henstra
    • 1
    • 2
    Email author
  • Didi Rhebergen
    • 3
  • Max L. Stek
    • 3
  • Karin M. A. Swart
    • 4
  • Suzanne C. van Dijk
    • 5
  • M. Carola Zillikens
    • 6
  • Sadaf Oliai Araghi
    • 7
  • Lisette C. M. G. M. de Groot
    • 8
  • Natasja M. van Schoor
    • 9
  • Nathalie van der Velde
    • 1
    • 2
  1. 1.Department of Internal Medicine, GeriatricsAcademic Medical CentreAmsterdamThe Netherlands
  2. 2.Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Department of Psychiatry, Amsterdam Public Health Research InstituteVU Medical CenterAmsterdamThe Netherlands
  4. 4.Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research InstituteVU University Medical CenterAmsterdamThe Netherlands
  5. 5.Department of Geriatric MedicineFranciscus Gasthuis & VlietlandSchiedamThe Netherlands
  6. 6.Department of Internal MedicineErasmus MCRotterdamThe Netherlands
  7. 7.Department of Internal MedicineErasmus University Medical CenterRotterdamThe Netherlands
  8. 8.Division of Human NutritionWageningen UniversityWageningenThe Netherlands
  9. 9.Department of Epidemiology and Biostatistics, Amsterdam Public Health Research InstituteVU University Medical CenterAmsterdamThe Netherlands

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