Background:Italyis particularly concerned by population ageing. The costs for society are substantial. In this context a national, representative surveillance system, Passi D'Argento (PDA), was implemented in 2009 to monitor "active aging" and health status in people aged over 64 and to develop preventive health programs to reduce frailty. Methods/Design: PDA recruited a representative sample of 24,129 individuals (March 2012-January 2013) aged over 64 who were interviewed by trained staff using a standardized questionnaire. The PDA collects information about participation in society and employment, independent living, health conditions, safety and living environment. Indicator values are used to obtain population health profiles and to compare different LHUs’ profiles within the same region or between different regions. Discussion: The PDA surveillance system proved to be feasible and to be a powerful and innovative local and national tool for monitoring health status, frailty inItaly’s elderly population and the essential levels of care currently provided to the elderly.