A cross-sectional study was carried out in the second semester of 2004 by means of a household survey with 292 elderly people in a Southern Brazilian city, selected by probabilistic sampling. The objectives were: to describe the use and geographic access of the elderly to primary healthcare (PHC) in Porto Alegre (RS), and to analyze the association between variables of interest to the study and access to PHC. Descriptive and bivariate analysis was used. The primary health care services were used by 49.7% of the respondents, motivated by their location, quality and "free service." The factors negatively associated with the use of PHC services were "level of education" and "perception of good health" and the variable related positively was "self-diagnosed chronic condition". The elderly exposed to frailty related with economic and health conditions were more likely to use PHC, showing signs of equity in the health system. On the other hand, it is necessary to broaden the coverage to the elderly that do not have access, as well as implement healthcare strategies to meet the heterogenous demands of this age group.