Background and objective:
Aging represents a relevant issue in Italy and it is strongly associated with the growth of noncommunicable diseases. Data from PASSI d’Argento (PdA) 2016-2021, an ongoing national surveillance system of Italian aged 65+, are used to detect the association between accessing health services and the WHO 25x25 strategies’ risk factors (at-risk alcohol consumption, sedentary behavior, current tobacco use, raised blood pressure, diabetes and obesity) with three health outcomes, hospitalization and comorbidity. The effect of Covid-19 emergency on accessing to health services were analyzed.

Methods:
Among the several health-related aspects, access to basic healthcare services and the avoidance to medical care during pandemic are investigated by PdA using a sample randomly selected from the local health unit (LHU) list of beneficiaries of health services, stratified by sex and age. The association between outcomes and behavioral risk factor is presented in terms of the adjusted prevalence ratio (aPR).

Results:
Elderly hospitalized at least once for 2+ days in the last year had greater risk to have difficulties in accessing health services, whereas the model included health conditions such as obesity (aPR = 1.95 95% CI 1.75-2.17), smoking (aPR = 1.95 95% CI 1.76-2.16), alcohol use (aPR = 1.93 95% CI 1.73-2.14), hypertension (aPR = 1.92 95% CI 1.73-2.13) and diabetes (aPR = 1.91 95% CI 1.73-2.12). During pandemic 40% of elderly have foregone a medical care. Being female (aPR 1.31 95% CI 1.04-1.67), having a high level of education (aPR 1.35 95% CI 1.02-1.79), and many economic difficulties (aPR 2.64 95% CI 1.74-4.02) were associated with higher avoidance due to service disruption.

Conclusion:
Living environment barriers which prevent access to care among elderly and delay of care during the pandemic may impact morbidity and health outcomes in the long term which are important to monitor with PdA surveillance system