OBJECTIVES: We examined the association of acute hospitalization use by the elderly with psychiatric morbidity and social equity in healthcare access, taking into account other predisposing, need and enabling factors, in Singapore. METHODS: Population-based data from national representative sample (N=1092) of older adults aged ³60 in Singapore were used to identify subjects ³one acute hospitalization in 12 months prior to interview (N=136). The associations of acute hospitalization with socio-economic, medical and psychiatric morbidity, health, functional status and behavioral variables were evaluated in multivariate models with adjusted odds ratio (OR). RESULTS: Hospitalization use was independently associated with ¢being retired or unemployed′ (OR,3.15;95%cl,1.30-7.63),³2 medical conditions (OR,2.88;95%cl,1.66-4.99), SF-12 PCS scores of physical health status (middle tertile, OR,0.39;95%cl,0.23-0.66; highest tertile,OR,0.37;95%cl,0.20-0.67; versus lowest tertile), regular visiting of primary healthcare provider (OR,1.92;95%cl,1.10-3.36), and co-morbid psychiatric disorder (OR,2.76;95%cl,1.20-6.33). Proxy social equity indicators of healthcare access including self-reported financial limitation to pay for needed healthcare were not associated with hospitalization use. CONCLUSIONS: Acute hospitalization use by the elderly was related to psychiatric morbidity, and apparently un-related to potential social inequity in access to the health care system in Singapore. The complex relationships between psychiatric morbidity and medical and psychosocial factors and hospitalization in the elderly require further studies.