Introduction: Elderly individuals residing in rural areas of Tamil Nadu, India, encounter distinctive mental health challenges such as heightened stress, social isolation, and limited healthcare access. Mindfulness, a practice with historical roots in meditation and awareness, has been recognized for its potential to enhance mental well-being. However, its effectiveness in rural settings, particularly among the elderly, has not been thoroughly investigated. Aim: This study aims to assess the impact of an 8-week mindfulness-based program on the mental health of elderly residents in rural Salem, Tamil Nadu. It specifically evaluates changes in dispositional mindfulness and stress levels and explores participants' qualitative feedback on the intervention. Materials and methods: The study utilized a mixed-methods approach, featuring a quasi-experimental design with pre-test and post-test control groups. A total of 300 elderly participants from 20 rural old age homes were included, with 150 participants assigned to the experimental group and 150 to the control group. The experimental group participated in an 8-week mindfulness-based stress reduction (MBSR) program, while the control group maintained their usual activities. Data collection involved pre-intervention (T1), post-intervention (T2), and follow-up (T3) assessments using the Five Facet Mindfulness Questionnaire (FFMQ) and the Perceived Stress Scale (PSS). Qualitative insights were obtained through semi-structured interviews. Results: Analysis revealed that the experimental group experienced a significant increase in mindfulness scores, with average FFMQ scores improving by 25 from pre- to post-intervention, compared to a 5 increase in the control group. Stress levels, as measured by the PSS, decreased by 30 in the mindfulness group, while the control group reported only a 5 reduction. These differences were statistically significant, with p-values < 0.01. Qualitative feedback from participants highlighted several positive outcomes, including improved emotional regulation, enhanced feelings of well-being, and increased social engagement. Participants also reported a greater sense of connectedness and reduced feelings of loneliness. Conclusion: The mindfulness-based intervention effectively enhanced mental well-being among elderly individuals in rural Salem, demonstrating significant reductions in stress and improvements in mindfulness. These results indicate that mindfulness practices can be a valuable tool for addressing mental health challenges in rural elderly populations, offering a promising approach for similar settings. © 2025 Elsevier B.V., All rights reserved.