Case scenarioIllustrative scenario
Case Scenario: Adapting Activities for a Resident Living With Macular Degeneration
A composite example: from “she’s lost interest” to a plan that fits her vision
Written for: Activity directors, Nursing leaders, Medical directors
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Illustrative scenario
This is a composite scenario, written to show how the evidence could be applied. It does not describe a real facility or real residents, and it reports no outcome data.
Key takeaways
- Withdrawal from reading-based activities can be a vision problem rather than a loss of interest. More than half of nursing home residents in one study had impaired vision.1
- Large print, strong contrast, matte paper and good lighting are the first adaptations.23
- Eye care decisions belong to the resident and their physician or eye care provider.
- Activities based on each resident’s assessment and preferences are a federal requirement, and adapting materials for vision is part of meeting it.4
The situation1 min
In brief: A former teacher stopped coming to word games, and staff assumed she had lost interest.
Mrs. R. (a composite) is 88, a retired schoolteacher with late-stage dry AMD in both eyes and mild cognitive changes. She used to lead the word games; for two months she has declined every invitation. Staff noted “loss of interest in activities.”
Looking again1 min
In brief: Her withdrawal began when the materials changed, and she said so.
The activity director noticed that Mrs. R. stopped coming in the same month a new activity calendar and word sheets arrived, printed in small type on glossy paper. Asked directly, Mrs. R. said, “I can’t see the words anymore, and I won’t sit there guessing.”
AMD takes central vision, the vision reading depends on.5 Readers with low vision need far more contrast than fully sighted readers3, and glossy paper adds glare.2
What changed1 min
In brief: Print, light, seating and format, plus a referral for her eye care.
- Her profile recorded her visual needs, so every packet now prints for them: the largest activity type (26 pt) in Atkinson Hyperlegible, with raised line weights on coloring pages.
- Matte copy paper replaced glossy stock.
- A task lamp without glare, and a seat with her back to the window.
- Spoken formats alongside print: she leads word games aloud, and staff read the day’s prompts to the group.
- Her nurse told her physician about the change, who arranged a review with her eye care provider and a low-vision assessment.
What to watch1 min
In brief: Attendance, time engaged, and what she says herself.
- Attendance at word-based activities, week by week.
- Minutes engaged, and whether she takes part or only watches.
- Her own view, asked directly every few weeks.
- Whether the print still works as her vision changes.
Lessons for the team1 min
In brief: Screen for vision in every activity assessment, and make large print the default.
Federal rules require activities based on each resident’s comprehensive assessment, care plan and preferences.4 A vision question belongs in every activity assessment, and large print belongs on every page by default (see Print for low vision).
What this means for your community
- Ask about vision whenever a resident withdraws from reading-based activities.
- Record visual needs in each resident profile, so materials print to suit them.
- Offer spoken and tactile formats alongside print.
- Refer eye care questions through the resident’s physician.
What this evidence does not show
- This is a composite scenario, and it reports no real outcomes.
- Adaptations that help one resident may not suit another.
- The scenario describes activity adaptations, not medical care.
References
- Owsley C, McGwin G Jr, Scilley K, et al. The visual status of older persons residing in nursing homes. Archives of Ophthalmology. 2007;125(7):925–930.
- American Printing House for the Blind. Large print guidelines. APH. Accessed September 30, 2026. https://www.aph.org/resources/large-print-guidelines/ View source (opens in a new tab)
- Rubin GS, Legge GE. Psychophysics of reading. VI. The role of contrast in low vision. Vision Research. 1989;29(1):79–91.
- 42 CFR § 483.24: Quality of life. Electronic Code of Federal Regulations. Accessed September 30, 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.24 View source (opens in a new tab)
- National Eye Institute. Age-related macular degeneration (AMD). National Institutes of Health. Accessed September 30, 2026. https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/age-related-macular-degeneration View source (opens in a new tab)
How to cite this page
Cognicopia. Case Scenario: Adapting Activities for a Resident Living With Macular Degeneration. Cognicopia Clinical Science & Research Center. Updated September 30, 2026. Accessed [date]. https://cognicopia.org/resources/research/case-macular-degeneration/
An educational summary for professionals, not medical advice. It reports each source’s findings as the source states them, and was reviewed against its sources on September 30, 2026. Cognicopia makes the tools this page mentions. Found an error? Tell us.