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Objectives: Loneliness is a public health issue impacting the health and well-being of older adults. This protocol focuses on understanding the psychological experiences of loneliness in later life to inform technology development as part of the 'Design for health ageing: a smart system to detect loneliness in older people' (DELONELINESS) study., Methods and Analysis: Data will be collected from semi-structured interviews with up to 60 people over the age of 65 on their experiences of loneliness and preferences for sensor-based technologies. The interviews will be audio-recorded, transcribed and analysed using a thematic codebook approach on NVivo software., Ethics and Dissemination: This study has received ethical approval by Research Ethics Committee's at King's College London (reference number: LRS/DP-21/22-33376) and the University of Sussex (reference number: ER/JH878/1). All participants will be required to provide informed consent. Results will be used to inform technology development within the DELONELINESS study and will be disseminated in peer-reviewed publications and conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification., Objective: To assess how frailty affects presenting COVID-19 symptoms in older adults., Design: Observational cohort study of hospitalised older patients and self-report data for community-based older adults., Setting: Admissions to St Thomas' Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application., Subjects: Hospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020., Methods: Multivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19., Results: Hospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath., Conclusions: This is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)