Mandala coloring three times weekly for 12 weeks reduces anger and death anxiety in nursing home elders

This randomized controlled experimental study evaluated whether an art-based mandala intervention reduces anger and death anxiety in older adults residing in a nursing home. Eighty participants were allocated to an experimental group (n = 40) or a control group (n = 40).

The experimental group participated in mandala coloring three times a week for 12 weeks. Outcomes were assessed using a descriptive form, a death anxiety scale, and the State-Trait Anger Expression Inventory, allowing evaluation of overall anger as well as State Anger, Anger-In, Anger-Out, and Anger Control subdomains.

Post-intervention, the experimental group demonstrated significantly lower anger scores than the control group (p = 0.001), with statistically significant differences across State Anger, Anger-In, Anger-Out, and Anger Control (p < 0.01). Death anxiety scores also decreased significantly in the experimental group (p < 0.01). In regression analysis, anger levels accounted for 42.4% of the variance in death anxiety (p = 0.001), suggesting a tight link between the two constructs in this population.

Safety outcomes, adverse events, tolerability, and dropout data were not reported in the abstract, and effect sizes in absolute terms were not provided. The sample was drawn from a single nursing home context, which may limit generalizability, and no long-term follow-up beyond the 12-week intervention was described.

For clinicians caring for institutionalized older adults, these findings support mandala coloring as a low-cost, non-pharmacological activity that may ease anger and death-related distress. Results should be interpreted cautiously pending replication in larger, more diverse samples and with standardized reporting of tolerability and durability of effect.