Conversion cascades for sensory and oral capability in primary care and community settings

Healthy ageing programmes increasingly incorporate functional checks and intrinsic capacity pathways in primary care and community settings. Yet, programme success is still often judged by the number of people screened, a metric that captures reach but not whether older adults receive usable follow-up, remain engaged, or achieve meaningful benefit. In this Personal View, we propose a conversion cascade as a staged framework for assessing whether people with eligible need progress from case finding to assessment, actionable planning, linkage to recommended intervention, sustained use or participation in the intervention, and patient-valued functional gain. We define conversion governance as the routine use of these stage measures, denominators, reasons for non-conversion, equity stratifiers, balancing indicators, and capacity measures to guide pathway redesign, resourcing, and scale. We focus on sensory and oral capability because deficits in hearing, vision, or oral function can obstruct communication, comprehension, health-care navigation, eating, and participation across many other intrinsic capacity interventions. The framework is intended to distinguish avoidable attrition from appropriate non-conversion and to shift healthy ageing programmes from screening volume towards effective pathway coverage, equitable functional benefit, and real-world usability.