Leaving hospital after COVID-19: Managing cognitive and emotional difficulties

A guide for patients and relatives on the cognitive effects of recovering from COVID-19

When you have been unwell with COVID-19, it will have been a confusing and unsettling time.

This is likely to have been made worse by hospital noises, alarms and limited daylight along with disruption of your normal sleep-wake patterns. The masks and goggles or visors that staff wore may have made you feel disoriented or scared and you might have seen other patients who were unwell.

These experiences may lead to a range of emotions as well as changes to your memory and thinking.

What is cognition?

Cognition is a term used to describe our thinking and memory skills. It comprises our ability to remember things, use and understand language, attend to information and make decisions.

Symptoms

After leaving hospital you may experience problems with your cognitive function, particularly memory. These symptoms are usually nothing to worry about and will typically disappear over time, but could include the following:

• Going into a room and not knowing why you have gone in there
• Losing things
• Noticing that your thinking has slowed
• Immediately forgetting what someone has just said to you
• Finding it difficult to plan and organise as well as you used to
• Forgetting important tasks, for example forgetting a doctor’s appointment
• Finding it more difficult to make decisions

Causes of cognitive difficulties

There are usually several factors that can contribute to cognitive or memory problems after a period of physical ill-health. These may include:

• Fatigue
• Pain
• Low mood
• Anxiety
• Effects of medication
• Continuing physical health problems

When to seek further support

If your symptoms persist for more than three months and are interfering with your abilities to work or live your life independently, please speak to your GP or hospital doctor.

Emotional responses

After being critically unwell, you might experience a range of different emotions and periods of feeling stressed. This is normal and could be due to the illness, your time in hospital or the treatment used to help you get better.

How you might feel

You may find that your mood changes often and you might:

• Feel upset and tearful
• Always feel tired
• Be quick tempered and snappy
• Not have an appetite
• Have difficulty sleeping
• Worry about getting ill again
• Feel concerned about stigma

Additional symptoms

These may be triggered by a sound, smell or something you see. These symptoms usually disappear over time but could include the following:

• Intense, vivid dreams or nightmares that feel real
• Disturbing sudden vivid memories of events in the past (flashbacks)
• Avoiding anything that reminds you of being ill or feeling numb
• Feeling irritable, jumpy and easily startled
• Feeling more worried
• Feeling low in mood or having feelings of hopelessness

When to seek further support

If your symptoms persist for more than four to six weeks, please speak to your GP or self-refer to your local wellbeing service. In Cambridgeshire this is CPFT’s Psychological Wellbeing Service, also known as Improving Access to Psychological Treatment (IAPT).

CPFT Psychological Wellbeing Service website (opens in a new tab)

Telephone: 0300 300 0055

Self help

Sleep – aim for a regular sleep routine, avoid caffeine / screens before bed.

Relaxation – engage in activities that will promote calm, for example taking a bath or reading a book.

Stay connected – maintain social connections with friends and family.

Engage in pleasurable activities – do things you find enjoyable.

Feeling in control – focus on the things you have control over.

Feeling hopeful – talk to others about your experience but ensure this is balanced with the positives in your life.

Establish a routine at home and be organised – find a single place to put your keys, phone and diary, make a ‘to do’ list, set alarms as reminders.

Managing fatigue – avoid overexertion, rest when needed and alternate between more demanding thinking tasks and low energy activities.

Coping strategies – use coping strategies that have worked well for you in the past and avoid unhelpful strategies (caffeine, alcohol, drug use).

Self-care -

• stay active and take regular exercise with guidance from a doctor
• eat and drink healthily with small and regular meals / snacks
• get as much sunlight, nature and fresh air as possible

Wellbeing apps

Unmind – offers coping strategies

Headspace – meditation to improve wellbeing

Sleepio – to improve sleep

Daylight – ways to combat worry and anxiety