Background: The elderly population is increasing worldwide, reflecting success stories of public health and social-economic development. However, longevity affects the growing prevalence of chronic conditions and disabilities, creating requirements for more healthcare services to meet these population health demands. The WHO proposed the age-friendly primary healthcare centers to strengthen public health care (PHC) centers to meet the increasing needs of older clients. In Indonesia, the policy mandated health services for the elderly through the age-friendly PHC center program. However, there is a lack of research evaluating the impact of that program from the perspective of the elderly. This study investigated the differences in public health centers utilization, health status, and satisfaction with PHC centers and the possible associations between community-dwelling elderly in the age-friendly versus general PHC center service areas. Methods: A comparative cross-sectional study was conducted in Manado City, Indonesia, from March to October 2020. Two-stage cluster random sampling was applied. A total of 405 participants, aged ≥ 60 years, communicated in Bahasa Indonesia, lived in the community permanently, with PHC centers as a first-point contact, participated in this study, with a response rate of 89.6%. A self-developed questionnaire was administered, and the researchers obtained the information through face-to-face interviews at the participants’ homes. Chi-squared, Spearman’s rank, Mann-Whitney U, Kruskal-Wallis tests, hierarchical regression, and Hayes PROCESS were employed to analyze the data. Results: Of the 405 participants, there were slightly more males than females, with a mean age of 67.6 (SD = 6.51). Most of the elderly comprised an ethnic group of Minahasa, Christian, married, lived only with a spouse, and had a level of educational attainment corresponding to high school. Most of them were retired and had monthly incomes under the provincial average net income per month. More than half of participants reported having at least one chronic condition, and hypertension is the highest among the reported chronic conditions. The elderly in general PHC center areas engaged in higher PHC centers utilization and better health status. The elderly utilizing the age-friendly PHC center were more satisfied than those using the general PHC center. Functional status and chronic conditions appeared to be the strongest influencing factors related to PHC centers utilization and health status across PHC center areas. Furthermore, the elderly who used motorcycle taxis as a mode of transportation and PHC centers utilization were predictors of the satisfaction of elderly individuals with PHC centers. After adjusting for confounders, different PHC centers' moderation effect between PHC centers utilization and elderly satisfaction. Conclusion: Individual characteristics, PHC centers utilization, health status, and satisfaction with PHC centers have differed across PHC centers. The study findings support the importance of individual needs factors as the strongest predictor of PHC centers utilization, health status, and satisfaction with PHC centers. It was concluded that the elderly in the age-friendly PHC center service areas who had low used PHC centers in the previous four weeks were more satisfied with the PHC centers than those in the general PHC center service areas. The study findings showed a high level of satisfaction with PHC center among the elderly and highlighted the need to strengthen age-friendly PHC center services. The nurse should be agents of change, educators, and influencers to promote PHC centers' utilization and early detection of potentially irreversible conditions detrimental to the health of the elderly.

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