Objective To describe the clinical presentation and temporal variation in ambulance service cases involving patients aged 65 years or older (older adults) from residential aged care facilities and those who are community dwelling (CD). Methods This study used four years of electronic case records from Ambulance Victoria in Melbourne, Australia. Trigonometric regression was used to analyse demand patterns. Results Residential aged care facility cases included proportionally more falls and infection‐related problems and fewer circulatory‐related incidents than CD cases. Community dwelling demand patterns differed between weekdays and weekends and peaked late morning. Residential aged care facility cases peaked late morning, with a secondary peak early evening, but with no significant difference between days. Conclusions Older adult ambulance demand has distinct temporal patterns that differ by place of residence and are associated with different clinical presentations. These results provide a basis for informing ambulance planning and the identification of alternate health services.