Adaptive tech for trans and nonbinary people with dementia: from “safety” to selfhood

A lot of dementia tech is built around one question: How do we keep someone safe?

That matters. But for trans and nonbinary people living with dementia, there’s another question that can be even more urgent:

How do I stay myself - safely - as my memory changes?

Because “safe” isn’t only about falls, wandering, or missed medication. For many of us, safety also means:

• not being misgendered when we’re confused or distressed,
• not being forced into binary assumptions (names, titles, clothing, care routines),
• not having our identity treated as a “preference” that can be ignored when things get difficult,
• not having privacy stripped away in the name of monitoring.

Adaptive technologies can help. But only if we design them with the right priorities: dignity, consent, identity continuity, and practical day-to-day support—not surveillance with a smile.

What “adaptive” actually means (and why it matters)

Adaptive tech isn’t just “an app.” It’s technology that can learn, adjust, and respond as needs change—day by day, sometimes hour by hour. The best versions don’t infantilise. They scaffold.

Professor Arlene Astell has long pushed the field toward technologies that support connection and personhood, not just “task completion.” Her work with tools like CIRCA (Computer Interactive Reminiscence and Conversation Aid) shows how well-designed digital prompts and media can support conversation, cognition, and quality of life—especially when the content is meaningful to the person using it.

That same idea—meaningful, personalised content—is where trans/nonbinary inclusion becomes non-negotiable.

A practical, identity-safe “stack” of supportive tech

1) Cognitive stimulation that reflects your life (not a generic one)

Cognitive stimulation works best when it’s emotionally “sticky”: music, images, stories, and topics that light someone up.

For trans and nonbinary people, that content needs to include:

• correct name + pronouns (and “what to do if I forget”)
• affirming photos across time (pre-/post-transition if relevant, chosen by the person)
• chosen family, community spaces, Pride memories, and cultural anchors
• “glimmers” that calm the nervous system (sounds, songs, rituals)

This is where Astell’s approach is powerful: tech as a bridge into connection, not a test you can fail.

2) Step-by-step support for Activities of Daily Living (ADLs)

When dementia makes sequencing hard, the goal shouldn’t be “do it for you.” The goal is “help you do it your way.”

Adaptive prompting can support:

• washing and dressing (in a gender-affirming way)
• eating and hydration routines
• medication reminders
• “leaving the house” checklists (keys, phone, coat, bus pass, etc.)
• daily structure without rigid control

A great example of this direction is one of the Longitude Prize on Dementia finalists: AUTONOMOUS, which uses a smartwatch/phone/sensors approach to learn routines and deliver prompts (pictures/text/sounds/vibrations), escalating to a carer alert only when needed.

That “only when needed” part matters for LGBTQI+ folks who may have good reasons to fear constant monitoring.

3) Telehealth that reduces barriers (without erasing identity)

Telehealth can be a lifeline—especially when travel is hard, fatigue is high, or local services feel unsafe.

But telehealth needs to be more than a video call. The most useful systems:

• make appointments simple (one tap, big buttons, friendly interface)
• share what matters today (pain, sleep, mood, meds, agitation, appetite)
• include a pronoun/name banner that is always visible
• let the person choose who joins (trusted carer, partner, guardian, chosen family)

Some dementia-focused devices are intentionally built for “connection-first” simplicity. For example, another Longitude finalist, MemoryAid, is designed like a phone and focuses on easy prompts and easy video calling—removing barriers to staying in touch.

4) Safety tech that doesn’t default to surveillance

“Monitoring” is where good intentions can go bad fast.

One Longitude finalist, Supersense, explicitly leans into camera-free monitoring and pattern detection that can be shared to family via text/WhatsApp, aiming to reduce intrusive tech that ends up abandoned in a drawer.

And Theora 360 uses wearable sensing to predict/prevent falls rather than simply alert after harm has happened.

These are important directions—if they are paired with strong consent practices and clear choices about what data is collected, who sees it, and how long it’s kept.

5) Co-design that treats people with dementia as experts (not “participants”)

This is where Steve Milton and Innovations in Dementia have been consistently influential: meaningful involvement, accessibility, and real-world usability rather than shiny prototypes.

For trans/nonbinary people with dementia, co-design must also include:

• people who will say, plainly, “this feature could out me”
• people who can spot a subtle misgendering risk in interface language
• people who understand that “family contact” isn’t always safe contact

The design rules I want the field to adopt (starting now)

If we want adaptive tech that genuinely supports trans/nonbinary people with dementia, we need a shift in what counts as “innovation.”

Here are five non-negotiables:

1. Identity continuity is a clinical outcome.
   Misgendering isn’t a minor error; it can trigger distress, dysphoria, agitation, and withdrawal.
2. Consent must be designed in, not “handled later.”
   If someone’s capacity fluctuates, the system should support “consent check-ins,” not bypass them.
3. Privacy is not optional.
   Camera-free options, local processing where possible, and clear data controls should be the norm.
4. Prompts must be affirming.
   A dressing prompt that undermines someone’s gender expression isn’t support—it’s harm.
5. Tech should expand autonomy, not replace it.
   The goal is more life, not more compliance.

Where this is heading: the most exciting frontier

The Longitude Prize ecosystem is pushing toward tools that combine sensors, AI, and personalised support—while (at least in the best cases) paying attention to usability and acceptability. A winner is due to be announced in 2026, but the finalists already show where the field is going.

My hope is that the next leap forward is explicit: adaptive tech that can hold identity with care.

Not just “what’s the next step in the task,” but:

• “How do you want to be addressed today?”
• “Who is safe to contact?”
• “What helps you feel grounded?”
• “What parts of your story do you want close at hand?”

Because dementia doesn’t erase gender.
But systems can—unless we build better ones.

Written by Dáithí Clayton 

Submitted January 2026

Dáithí is an Irish-born, Flanders-based activist, researcher and writer living with dementia. As a trans and nonbinary person, they work internationally to challenge how dementia care, policy and research exclude LGBTQ+ people — particularly those whose identities do not fit traditional gender and family assumptions.

An Expert by Experience with the Dementia for Applied Dementia Studies, Dáithí collaborates with academics, clinicians and community organisations across Europe, the UK and beyond. Their work combines lived experience, research and creative practice, addressing identity, autonomy, sexuality, safeguarding and human rights in later life. 

Unapologetically queer and firmly person-led, Dáithí’s writing pushes dementia conversations beyond “care” alone — toward dignity, intimacy, agency and citizenship.