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Abstract Aging is a continuous set of time-dependent physiologic, biochemical, and molecular processes that generally mirrors chronological age, and could be theoretically used as biomarkers to assess biological age. In Egypt, people above 60 years were about 6.27% of the total population in 2006. There was 3.35% annual growth in the number of people above 60 years from the year 1996 to the year 2006. In 2016, their proportion reached 6.9%. To date, in Alexandria, Egypt, there have been no studies evaluating whether primary health care (PHC) services are sufficiently oriented towards the older population, particularly those with increas¬ing frailty. The aim of the current study was to assess how well the primary health care services in Alexandria meet the elderly needs. It addressed barriers to effective implementation and utilization of age-friendly primary health care services as perceived by service users and providers. To elucidate these aims, 250 elderly aged 60 years or older, as a convenient sample from 5 linked Family Health Care Centers/Units (FHC/Us) in Alexandria, were interviewed. Those patients with a terminal illness or those with severe dementia were excluded. Also, 45 PHC physicians and 5 managers were interviewed. Questionnaires and checklists were based on the WHO guidelines for age-friendly primary care covering 3 domains namely information, education and training, community-based health care management systems, and the physical environ¬ment. Questions and discussions were directed towards the following specific areas: transport to service facilities, clinic signage and facilities, the physical environment, such as adequate seating and space for waiting areas, the consultation process, clinic fees, community outreach services, the referral system, dissemination of health knowledge, medication management, standard of care for the elderly, feedback system, and communication skills of healthcare staff. An interviewing questionnaire was used for elderly and consisted of two parts: - Part 1: Baseline health assessment questionnaire: used to collect the following information: Personal and basic socio-demographic characteristics of service users, history and examination. - Part 2: Elderly Exit Interview: was based on “The Patient Satisfaction Questionnaire Short Form” (PSQ-18). Health facility Inventory: This consisted of two parts: − Part 1: A checklist for identifying different primary, secondary and tertiary (rehabilitative) preventive services provided for the elderly. − Part 2: Access and physical environmental audit observational checklist. The age of elderly in the five fam |