Professor Leon Flicker AO


Director Western Australian Centre for Health & Ageing

Winthrop Professor of Geriatric Medicine, University of Western Australia

Leon Flicker is the inaugural Professor of Geriatric Medicine at the University of Western Australia since 1998. He has established and is the director of a productive research unit aimed at cutting edge translational issues focusing on the health needs of older people culminating in 2006, the Western Australian Centre for Health and Ageing (WACHA). As well as these research activities, he has led the reorganization of undergraduate and postgraduate education in geriatric medicine in Western Australia. He remains a practicing geriatrician and is Head of the Inner City Geriatric Services. Over the last 20 years LF has been actively involved in clinical and population based research, and the dissemination and implementation of research findings directed at improving health in older people. Over the last 10 years, major interests have been the general health of older people, including bone and mineral metabolism, cognition, mobility and falls. Together with his colleagues he has demonstrated an association of between people in residential care with low vitamin D levels are associated with falls, and that vitamin D supplementation reduced their rate of falls by 30% even in those residents selected so as not to be severely vitamin D deficient. These studies have led to further studies examining other potential benefits of vitamin D. Other career highlights have included the demonstration that smoking is a risk factor for dementia and that older smokers, without overt evidence of cognitive decline, exhibit structural brain changes very similar to those people with early Alzheimer’s Disease. Another research highlight has included the demonstration of the widespread prevalence, in older people, of B12 deficiency, and elevated homocysteine levels, the association between higher levels of homocysteine and plasma levels of amyloid protein (Abeta40), and trial evidence that B vitamins decrease the levels of Abeta40. He has also pursued aspects of older men’s health utilizing the Health in Men’s Cohort. A particular focus of these studies has been the neglected area of men’s mental health, exploring the association between biological factors (e.g. CRP, testosterone), lifestyle factors against the outcomes of cognition and depression. He has also studied the health needs of older Indigenous Australians, which has included the validation of the Kimberley Indigenous Cognitive Assessment tool, which is currently utilized in Western Australia, the Northern Territory and far North Queensland. Using this tool, the first survey of dementia within Indigenous Australians has demonstrated a five fold increase in the rate of dementia in those aged over 45 years compared with non-Indigenous Australians. To date, he has published 139 peer reviewed articles. The impact of this research has been rising steadily, from 78 ISI citations in 2002 to 180 in 2006. Leon Flicker has chaired the Clinical Reference Group for the AHMAC Health Care of Older Australians Standing Committee for the last 5 years. He is a member of the National Ministerial Taskforce on Dementia, and the research and innovation subcommittee. He was a member of the Steering Committee of the Building Ageing Research Capacity Project and the Transition Care Taskforce. Through these activities Professor Flicker has had a major role in implementing his own and others research outcomes into clinical guidelines regarding functional decline, delirium, redesign of the hospital environment (the Aged Friendly Hospital) and many others. He is involved in the development of Osteoporosis Guidelines, for the Musculoskeletal Guidelines project for the Royal Australian College of General Practitioners. He assisted with a review of the potential health benefits and risks of folic acid intake for the Food Standards of Australia New Zealand, which partly resulted in the recommendation for mandatory folate supplementation. He has had numerous roles within the Australian and New Zealand Society for Geriatric Medicine (ANZSGM) and the Australian Association of Gerontology (AAG), both organizations dedicated to the promotion of scientific practice to the care and management of older people. He has assisted the NHMRC by being a discipline panel member for Gerontology and Geriatrics (2002-2004) (Deputy Chair 2004), Chair Discipline Panel for Nursing and Geriatrics 2006, and Member of NHMRC Grant Variation Sub-committee, Assigner Musculoskeletal and Geriatrics and Nursing Panels, GAG coordinator 2007. He is an Editor for The Cochrane Dementia and Cognitive Improvement Group, Geriatrics Editor for the Internal Medicine Journal and is on the Editorial Board of the Australasian Journal on Ageing. He has reviewed papers, often multiple, for 29 different journals over the last 5 years.

Recent publications

1. LoGiudice D, Smith K, Fenner S, Hyde Z, Atkinson D, Skeaf L, Malay R, Flicker L. Incidence and predictors of cognitive impairment and dementia in Aboriginal Australians:  A follow up study of 5 years Alzheimer's & Dementia 2016; 12:252-261

Our ground-breaking work, from 2008, demonstrated that Aboriginal people have dementia rates 5 times that of the Australian general population. This follow-up demonstrated stability of dementia diagnoses over time and a strong association between dementia and mortality.

2. Bischoff-Ferrari HA, Willett WC, Oray EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, Stähelin HB, Theiler R, Dawson-Hughes. A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention New England Journal of Medicine 2012; 367:40-9

Whilst in Melbourne LF commenced a RCT of vitamin D supplementation for older people in residential care and completed this study in WA. This evidence was used by American and British Geriatrics Societies to justify recommendations for vitamin D supplements to prevent falls in residential care in their Clinical Practice Guidelines. This work has been incorporated into this published Individual Patient Meta-Analysis and has already been cited 486 times.

3. Hill AM, McPhail SM, Waldron N Etherton-Beer C Ingram K, Flicker L, Bulsara M, Haines  TP. Reducing falls in rehabilitation hospital units using individualised patient and staff education: a pragmatic stepped-wedge cluster randomised controlled trial. Lancet 2015; 385(9987):2592-2599.

This stepped-wedge cluster randomized trial demonstrated that individualized staff and patient education can reduce falls in rehabilitation units.

4. Almeida OP, Garrido GJ, Beer C, Lautenschlager NT, Arnolda L, Flicker L. Cognitive and Brain Changes Associated with Ischemic Heart Disease and Heart Failure. European Heart Journal 2012; 33:1769-76. This observational study was one of the first to demonstrate the subtle but important changes associated with heart failure independent to white matter vascular changes in the brain, reinforcing the importance of physical health for brain function. 

5. Murphy K, O’Connor DA, Browning CJ, French SD, Michie S, Francis JJ, Russell GM, Workman B, Flicker L, Eccles MP, Green SE. Understanding diagnosis and management of dementia and guideline implementation in general practice: A qualitative study using the Theoretical Domains Framework. Implementation Science 2014 9:31 Cited 23 times

 

This study used a theoretically based approach to elucidate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice 


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