Background: The everyday lives of the elderly are significantly impacted by carpal tunnel syndrome. Exercise and mindfulness techniques are two non-pharmacological methods used to reduce symptoms of carpal tunnel syndrome. Aim: The present study aimed to evaluate the effect of hand exercise and mindfulness stress reduction intervention on the symptoms' severity of carpal tunnel syndrome among elderly patients. Design: A quasi-experimental research design. Sample: purposive sample of 90 elderly patients. Setting: This study was carried out at the physiotherapy and rehabilitation unit in Minia University Hospital, Egypt. Methods: Three tools were used for collecting data namely, A structured interviewing Questionnaire, Boston carpal tunnel syndrome Questionnaire, and Five facet mindfulness questionnaires Result: There was a high statistical improvement in symptoms severity, function status, and mindfulness condition on combined hand exercise and mindfulness stress reduction intervention group more than other groups. Conclusion: the combined hand exercise and mindfulness stress reduction intervention had more effect on reducing the symptoms severity among elderly people with carpal tunnel syndrome. Recommendation: Increase patient's awareness regarding the effectiveness of hand exercises and mindfulness techniques through effective teaching media such as videos, role play, and demonstration.