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Istituto Superiore di Sanità
EpiCentro - Epidemiology for public health
Epidemiology for public health - ISS


Why these surveillance systems?

Increased life expectancy and a steadily ageing population are a success of modern science and medicine, but also a challenge for society as a whole as they are linked to the growing burden of chronic degenerative conditions.


Chronic non-communicable diseases can be prevented by addressing the relevant modifiable risk factors (smoking, alcohol use, sedentary lifestyles, low fruit and vegetable consumption, overweight) from an early age, through early diagnosis programmes (such as cancer screenings) and actions aimed at improving the conditions for active and healthy ageing, in line with WHO recommendations [1].


Since 2004, the Ministry of Health and its National Centre for Disease Prevention and Control (CCM), in collaboration with the Regions, have promoted the design, testing and implementation of population-based surveillance systems to collect information on population health and modifiable risk factors associated with the development of chronic diseases. The goal is to guide prevention activities at the local level, and regularly assess their effectiveness towards achieving the health objectives set out in the National and Regional Prevention Plans.


Two such surveillance systems, both coordinated by the Istituto Superiore di Sanità, are PASSI [2] and PASSI d’Argento [3], which focus on the adult population (18-69 year-olds) and the elderly (people aged 65 years and over), respectively.


Ten years after their establishment, the population-based surveillance systems of chronic diseases and associated lifestyles were included, as essential publicly-funded healthcare services (Livelli Essenziali di Assistenza – LEAs), in the list of public health and prevention activities [4]. PASSI and PASSI d’Argento were classified as surveillance systems of national significance [5].


What is PASSI D'Argento

PASSI d’Argento is a surveillance system focused on the elderly population (people aged 65 years and over) and, as such, complements the PASSI surveillance.


Like PASSI, PASSI d’Argento is a public health surveillance system that collects information on health and behavioural risk factors associated with the development and complications of chronic non-communicable diseases in the country’s resident population.


PASSI d’Argento also collects information on some conditions specific to people over 65 years for the purpose of describing quality of life and treatment and care needs in this age group, while bearing in mind the concept of “healthy and active ageing”, as defined by the WHO.


Indeed, PASSI d’Argento also “measures” the elderly’s contribution to society, through paid work or unpaid and voluntary activities to support their families and community (“the elderly as a resource”), which requires good physical health, independence, psychological and social well-being. Therefore, this system can provide useful data to plan health policy actions and interventions aimed at improving the quality of life of its target group and the conditions for healthy and active ageing.


First tested in 2009 and conducted as a cross-sectional surveillance in 2012, PASSI d’Argento was established as a continuous surveillance in 2016. Like PASSI, it is an internal tool of the National Health System, coordinated by the Istituto Superiore di Sanità and implemented by the Regions and LHUs, which can provide valuable data to guide prevention activities at the local level and assess their effectiveness over time.


PASSI d’Argento investigates several topics that allow outlining a profile of the over 65 population based on the three pillars of active ageing identified by WHO’s Active Ageing strategy: health, participation and security. Information regarding health and prevention includes: perceived health, satisfaction with life, health-related quality of life (unhealthy days), symptoms of depression (Patient Health Questionnaire-2) [6,7], chronic conditions and independence in performing basic and instrumental activities of daily living (ADLs and IADLs) [8,9], sensory impairments (e.g. sight, hearing, chewing), falls, use of medications, flu vaccination, behavioural risk factors  such as smoking, alcohol use, fruit/vegetable consumption, overweight or unintentional weight loss and physical activity (measured using the PASE instrument [10,11]).


Information regarding participation includes: any paid work done, support given to family members and the community and attendance at social events or training courses.


Finally, information on security includes: accessibility to social and healthcare services, quality of the living environment, safety and security at home and in the neighbourhood.


The availability of additional social and personal information makes it possible to identify and analyze social inequalities in the elderly population’s health, quality of life and care and protection needs.


Data are collected by the LHUs on a monthly basis, through telephone or face-to-face interviews with representative samples (by age and sex) of the over 65 population in their respective catchment areas. The interviews are conducted using a standardized questionnaire, which is administered by properly trained social and healthcare workers. The surveillance does not include institutionalized people, i.e. long-stay hospital patients or residents of nursing homes or residential care facilities.


The data collected by the LHUs are transferred online to a national database. A hierarchical approach is used to control access to such data by LHU and regional coordinators, according to their responsibilities.


Since 2016, about 14,000 interviews have been conducted each year. The response rate is above 85%, while the refusal rate is 11%.


Data refer to non-institutionalized adults aged 65 years and over, living in Italy and registered with a local health authority.



  1. WHO.ACTIVE AGEING: A POLICY FRAMEWORK  [last accessed: March 2020]
  2. Istituto Superiore di Sanità. PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) Surveillance System. Technical Coordination Group for the “PASSI Surveillance System” experimental project. 2007, ISTISAN Report 07/30, viii, 228 p.
  3. Contoli B, Carrieri P, Masocco M, et al. PASSI d’Argento (Silver Steps): the main features of the new nationwide surveillance system for the ageing Italian population, Italy 2013-2014. Ann Ist Super Sanita 2016 Oct-Dec;52(4):536-542.
  4. Prime Ministerial Decree of 12 January 2017 on essential publicly-funded healthcare services (Official Gazette, General Series, n. 65 of 18-03-2017 - Ordinary Supplement n. 15 – Public health and prevention - Programme F2)
  5. Prime Ministerial Decree of 3 March 2017 on Registries and Surveillance Systems (Official Gazette, General Series, n. 109 of 12-05-2017 – Annex A).
  6. Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res 2005;58(2):163–71.
  7. Thombs BD, Benedetti A, Kloda LA, Levis B, Nicolau I, Cuijpers P, et al. The diagnostic accuracy of the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-8 (PHQ-8), and Patient Health Questionnaire-9 (PHQ-9) for detecting major depression: protocol for a systematic review and individual patient data meta-analyses. Syst Rev 2014;3(1):124. 10.1186/2046-4053-3-124 


Publication date: 7 december 2021