BACKGROUND AND OBJECTIVES: Older adults often experience communication changes due to ageing and an increased prevalence of conditions affecting speech, language, cognition, and sensory functions. While individual health conditions and contextual factors (e.g., personal and environmental) are known to influence communication, limited research has examined how these factors interact. Our scoping review summarizes how health conditions, impairments, and contextual factors can interact to influence communication in residential and community aged care settings. RESEARCH DESIGN AND METHODS: Peer-reviewed articles published 2003-2023 were identified through searches of PubMed, PsycINFO, CINAHL, Scopus, and ProQuest. Using the International Classification of Functioning, Disability and Health as a framework, we extracted information about health conditions, impairments to body structures and functions, and personal and environmental factors reported to influence communication. Data were synthesised using thematic analysis. RESULTS: From 75 articles, we identified combinations of health conditions (e.g., dementia), impairments to body functions and structures (e.g., hearing impairment, personal (e.g., language, culture, gender) and environmental factors (e.g., relationships, health services, products/technology), reported to impact communication for older adults in aged care environments. Language and culture, and support and relationships, were both key facilitators and barriers to communication. DISCUSSION AND IMPLICATIONS: Older adults may experience complex and diverse communication support needs that result from multiple intersecting factors. Research to date has focused on communication in residential aged care, with few studies exploring community aged care services. Our findings will inform the development of resources for identifying and supporting communication needs of older adults who receive aged care services.