Why Dementia Behaviour Can Change in Residential Aged Care – and What Helps

The Coolibah Dementia Support Series

Author: Coolibah Care

A not-for-profit aged care provider based in Mandurah, Western Australia. 

This article is part of the Coolibah Dementia Support Series, created to support families navigating the emotional and practical challenges of dementia and residential aged care.

You noticed something different at your last visit.

Perhaps your loved one seemed more unsettled than usual. Perhaps they were quieter than you expected, or more restless. Perhaps they said something that didn’t make sense, or reacted in a way that caught you off guard.

And now you are sitting with a question that is hard to say out loud: is this because of where they are now?

It is one of the most common things families wonder about when a loved one with dementia moves into residential aged care. Behaviour can shift. Moods can change. Without understanding why, it can feel frightening, or like something has gone wrong.

In most cases, it hasn’t. What is happening is far more understandable than it might first appear.

In this article, we look at why behaviour changes are common in people living with dementia, particularly during and after significant transitions, and what families and care teams can do together to help. We also share some of the ways Coolibah Care approaches this, and where you can find further support.

Why Dementia and Change Are a Difficult Combination

Dementia affects the parts of the brain that help a person process, interpret, and adapt to the world around them. For someone living with dementia, change – even positive change – can feel disorienting and hard to navigate.

A new environment brings with it unfamiliar sounds, faces, smells, and routines. For a person whose brain is already working hard to make sense of the world, that additional layer of newness can be genuinely overwhelming. Behaviour, in this context, is often a way of expressing something that words may no longer reach.

This is not a reflection of the quality of care being provided but more a reflection of how dementia interacts with change. With time, consistency, and the right support, many people do find their way in a new environment. The transition period, while challenging, is usually temporary.

What Behaviour Changes Can Look Like

Behaviour changes in dementia look different for every person, and they can alterover time. Some of the more common things families notice include:

• Increased agitation or restlessness – a person may pace, call out, or seem unable to settle, particularly in the late afternoon or early evening.
• Withdrawal or quietness – some people respond to change by becoming less communicative or less engaged with activities they previously enjoyed.
• Repetitive questions or actions – asking the same question repeatedly, or performing the same task over and over, can be a response to anxiety or disorientation.
• Emotional responses that seem disproportionate – tears, frustration, or moments of distress that appear to come from nowhere may be an unmet need or a sensory trigger that may not be immediately obvious.

None of these responses mean that a loved one is unhappy permanently, or that the decision to move into residential aged care was wrong. They are often the brain’s way of signalling that something needs attention, and that is something a skilled dementia care team is trained to respond to.

The Role of Familiar Routine and Environment

One of the most effective ways to support someone with dementia through a transition is through consistency such as familiar routines, familiar objects, familiar faces.

Residential aged care teams with specialised dementia experience work to understand the patterns that have shaped a person’s life; when they typically wake, what they like to do in the mornings, what music they respond to, what their preferred foods are, whether they are a morning or an evening person. That knowledge, much of which comes directly from families, shapes how care is delivered day to day.

Personal belongings like photographs or a favourite piece of clothing can provide important sensory anchors. They signal ‘this is still my world’ in a way that words often cannot.

Families play a central role here. The information you hold about the person you love such as their history, their preferences, their lifetime of habits, is something no care team can access without you. Sharing it generously, and continuing to share it as you notice what helps, is one of the most valuable contributions a family can make.

When Behaviour Changes Are a Signal Worth Investigating

While many behaviour changes are a normal part of adjusting to a new environment, some warrant closer attention.

Pain is one of the most common and under recognised triggers for changed behaviour in people with dementia, particularly those who are no longer able to describe discomfort in words. A person who is suddenly more agitated or resistant to care may be in pain – and that is something the care team should assess.

Infection, particularly urinary tract infection, can cause rapid and significant behaviour changes in older people with dementia. A sudden shift in alertness, mood, or behaviour is always worth reporting to the care team promptly.

Medication interactions can also play a role, as can changes in sleep, hydration, or sensory wellbeing – hearing aids not working, glasses misplaced, or a room that is too hot or too cold.

If you notice a behaviour change that feels sudden, significant, or out of character, raise it with the care team. You know your loved one. That knowledge matters, and a good care team will take it seriously.

The physical triggers outlined above are consistent with guidance from Dementia Australia and Alzheimer’s WA. Links to both organisations are included in the Additional Resources section below.

What Families Can Do – and Why Your Presence Still Matters

One of the most common fears families carry is that, once a loved one moves into residential aged care, their own role diminishes. In reality, the opposite is often true, particularly for someone living with dementia.

Your presence provides something the care team cannot replicate – continuity. The sound of your voice, the familiarity of your face, a shared memory or a favourite piece of music or food – these things can reach a person even when so much else has changed.

Families who remain closely involved make a real difference to how their loved one experiences residential aged care. Dementia Australia describes this ongoing involvement as central to person-centred dementia care. You can read more at www.dementia.org.au.

It also helps to be patient with yourself. Watching someone you love go through this kind of transition is hard. Visits can sometimes be distressing. It is normal to sometimes leave feeling unsettled, or to wonder if things could be different. Talking to the care team about what you observed, or how you are feeling, is always a reasonable thing to do.

Working With the Care Team

Dementia care at its best is a collaboration between families and care professionals. Both bring something the other cannot fully provide.

The care team brings care and clinical expertise, 24-hour presence, and experience managing the kind of behaviour changes that families often find frightening. Families bring intimate knowledge of who this person is, what has shaped them, what brings them comfort, what they have loved across a lifetime.

Regular communication between families and care teams is the foundation of that collaboration. If you are unsure how to raise something, ask. If you are noticing something that concerns you, say so. The relationship works best when it is open in both directions.

If you are navigating a loved one’s first weeks in residential aged care and would like to understand what to expect during that settling-in period, our earlier blog What to Expect in the First 30 Days of Dementia Care looks at this in more detail.

Common Questions Families Ask About Dementia Behaviour Changes in Aged Care

How Coolibah Care Approaches Dementia Behaviours in Residential Aged Care

At Coolibah Care in Mandurah, our approach to dementia care is built on understanding the whole person, and not just managing behaviour. Our team works to identify what behaviour is communicating, to minimise triggers where possible, and to create an environment of consistency and calm where residents can find their footing.

Families are central to that process from the very beginning. If you would like to talk about what specialist dementia care at Coolibah Care looks like, or if you have questions about a loved one already in our care, our team is always happy to have that conversation. You can reach us at coolibah.org.au/contact-us, or explore the full Coolibah Dementia Support Series at coolibah.org.au/dementia-support-series.

Additional Resources

• Coolibah Care – Specialised Dementia Care: coolibah.org.au/residential-aged-care/specialised-care/
• The Coolibah Dementia Support Series – all blogs in the series: coolibah.org.au/dementia-support-series
• Dementia Australia – behaviour and dementia support resources: www.dementia.org.au
• My Aged Care – understanding residential aged care: www.myagedcare.gov.au
• Alzheimer’s WA – local support for families in Western Australia: www.alzheimerswa.org.au