Let’s set the stage with a spoiler-free synopsis: the year is 1904 in Sicily, and Enzo — the titular protagonist — is a carusu working in the mines to pay off debts to Don Spadaro. Enzo and his friend, Gaetano, are just a few months from freedom when disaster strikes: the Federico crew has disappeared in the Deep Mines. Il Merlo, the mine boss, orders a rescue attempt, and it quickly leads them to the bodies and the cause—a catastrophic gas leak. As the mine collapses, Enzo escapes, but Gaetano and their hard-earned lira is lost.

In a fit of rage, Enzo attacks Il Merlo and escapes, only to fall into the hands of Don Torrisi, who offers him a place in his crime family for the price of his loyalty, and to bring down Don Spadaro’s mining empire. Thus begins Enzo’s journey across a breathtaking, dangerous landscape of Mafia: The Old Country.

Game Setup

On launch, Mafia: The Old Country does warns players about intense flashing lights and traumatic content; however, we feel a flashing light warning alone isn’t true accessibility. If developers are aware their game includes intense flashing scenes, why not add a setting to disable or reduce them? The game already provides options like screen brightness and HUD adjustment option before reaching the start screen, so adding this feature feels both reasonable and doable.

The Accessibility tab is available right from the start with Gameplay, Audio, Graphics, and Accessibility features available, but knowing which adjustments you’ll need requires some trial and error after playing. We came back to this screen after about fifteen minutes in once we had a better sense of how the default settings felt in-game. We also experimented with the difficulty options—Easy, Medium, and Hard, with Medium as the default. Even on Easy, the game still offers some challenges, but the main difference is that you receive extra loot. On Hard, not only do the enemies hit harder, but there’s less loot.

Visual Accessibility

Dear readers, Mafia: The Old Country is stunning — mountains fading into hazy skies, ornate villas, marble statues worthy of Michaelangelo — but the beauty comes at a cost. Currently, the visual accessibility options are limited to screen brightness and motion blur adjustments. We hoped these would be enough for what the game offers, but unfortunately, they fall short, even for a non-disabled player.

Here’s the truth: within the first twenty minutes of gameplay, a gas-leak escape sequence in the mine created an overwhelming visual overload. Swirling purple smoke, pillars bursting into flame, claustrophobic tunnels, and constant swaying camera movement combined into a literal disorienting storm. The limited accessibility settings simply aren’t sufficient to counteract what’s happening on-screen. Illuminated surfaces are distorted by heat waves and gas VFX while ultra-dim lighting leaves players without a clear grounding point for their character. While visually immersive, this effect is nausea-inducing and severe enough to trigger motion sickness that forced us to turn off the game.

A simple toggle for camera shake or an intensity slider for visual effects would go a long way. But in it’s current state we can’t, in good faith, recommend Mafia: The Old Country for players sensitive to motion sickness. That said, there are some positives, like colorblind mode for the U, which we genuinely appreciate. It didn’t need to be included, and to be honest, we were pleasantly surprised to see it at all.

Mobility Accessibility

Mobility is handled far better than visual accessibility! The game supports both keyboard and controller input, remappable controls, adjustable haptics, inverted axes, and multiple aim assist options! Our favorite feature is the Sprint Toggle, because trust us, you’ll want to dash to every corner of Sicily to soak in the scenery… or when things get hairy and you need to make a quick escape on horseback!

The Aim Assist can function as either a dot on the screen, or as a full target lock-on, giving players flexibility in how they want their mafia shootouts to play out. It’s helpful when facing large groups of enemies during the night where visibility is hard!

Alongside Sprint Toggle and Aim Assist , we also appreciated how there was an option to bypass button-mashing for suffocation sequences—which are on a timer! We tested the default suffocation sequences a few times, but the fatigue set in quickly after just a handful of takedowns, so the foresight to include this accessibility feature was very welcome. That said, the biggest mobility gap is the lack of alternatives to button-holds. In Mafia: The Old Country, nearly every interaction, stealth takedown, and object collecting, and general actions, require holding down a button, which is something Hangar 13 should address in future updates. A simple toggle or the option to change these to single taps would go a long way in making the game more accessible.

Auditory Accessibility

The voice acting is out of this world! It’s rich, authentic, and steeped in Sicilian flavor. The cast is stacked and well casted, with nearly every actor of Italian origin, which pays a wonderful homage to the game’s settings and roots. It’s genuinely exciting to see a modern title casting authentically for its world. And even better, the subtitle options are robust with customization for size, color, and background.

Unfortunately, there’s no closed captioning for environmental sound cues, and stealth missions suffer because of it. Enzo’s “see-through” skill helps reveal enemies through walls during these missions, but it can’t warn you of threats from behind, something hearing players can detect from footsteps. While stealth missions can be retried indefinitely with no penalty, repeatedly getting caught by surprise due to missing these auditory cues is frustrating, especially when you felt you were doing well or progressed further than before.

Cognitive Accessibility

This is where Mafia: The Old Country shines. While previous categories were rough, the cognitive accessibility options impressed us with how optional and flexible they are, giving players freedom to decide how much information they want. At any time, you can revisit tutorials through the Options menu, or dive into a detailed glossary to track notes, characters, and quest objectives. The Collection and Journal sections are especially rewarding for players who love deeper lore about the places they’ve visited or characters they’ve met. Sometimes surprising facts are tucked away in these notes — but rest assured, none of it is essential. You won’t miss out on anything major by skipping them, so there’s no pressure to study everything. Play your way!

We also liked how the quest objectives appear directly on the HUD (which you can adjust in the Settings menu!) with a persistent marker and proximity meter to your destination. In a world as large as Mafia: The Old Country, little touches like this go a long way for cognitive accessibility. Even better, there’s penalty for detouring or switching quests mid-journey. Sometimes its just as satisfying to hop on your horse and meander through the countryside.

Another great thing was fight controls reminders remain visible in the corner throughout combat, easing pressure on the player to memorize inputs. And best of all, flexible difficulty settings, infinite mission retries, and chapter replays make it easy to revisit story beats or practice tricky encounters whether you want to charge headfirst into a mob with nothing but a knife and a dream, or gallop peacefully through the mountain passes, the game supports your playstyle.

Mental Health

The game’s opening act, an escape from a gas-filled mine, sets the tone immediately: this is an intense world where danger lurks around every corner. Violence is a constant in Mafia: The Old Country, which won’t surprise long-time fans of the series. But for newcomers, consider this a warning: the story is gritty, heavy, and unflinching, steeped in deception, betrayal, and brutality. It’s rated M for a reason. While cutscenes can be skipped, the blood and violence are unavoidable.

A Long Road Ahead For Accessibility

Our final verdict is disappointing. Mafia: The Old Country is a beautiful story worth experiencing, but stumbles on accessibility. Visual accessibility is limited, and essential features like button-hold toggles are missing. These gaps matter because they can be the difference between someone continuing to play, or putting the game down for good. Deaf and hard-of-hearing players may struggle without environmental sound cues; players with epilepsy may be forced to return the game due to intense flashing; and in our case, severe motion sickness meant shutting it off entirely.

Still, we believe the issues are fixable. With focused updates, Hangar 13 could turn this into an accessibility success story. But until then, we recommend caution, especially for players sensitive to motion effects.

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