The effect of art-based mandala intervention on death anxiety and anger levels in elderly adults living in nursing homes: A randomized controlled study

• Art-Based Mandala Intervention reduces death anxiety in older adults. • Art-Based Mandala Intervention reduces anger levels in older adults . • Art-Based Mandala Intervention was feasible and acceptable. • The findings of this study inform and support the design of a definitive pragmatic randomized controlled trial in the future. This study aimed to investigate the effect of art-based mandala intervention on anger and death anxiety in older adults residing in a nursing home. A randomized controlled experimental study with 80 participants (experimental group n = 40; control group n = 40) was conducted. The experimental group participated in mandala coloring three times a week for 12 weeks. Data were collected using a descriptive form, a death anxiety scale, and the State-Trait Anger Expression Inventory. Post-mandala, the experimental group showed significantly lower anger scores compared to the control group ( p = 0.001). Statistically significant differences were found in State Anger, Anger-In, Anger-Out, and Anger Control ( p < 0.01). A significant decrease in death anxiety scores was observed in the experimental group ( p < 0.01). Anger levels explained 42.4% of the variance in death anxiety ( p = 0.001). Mandala coloring is an effective intervention for reducing anger and death anxiety in elderly nursing home residents.