ObjectiveTo explore the relationships between fear of recurrence, family resilience, and health-promoting behaviors in elderly stroke patients and the pathways. MethodsThe convenience sampling method was used to select 250 elderly stroke patients as the research subjects. The survey was conducted using the Patient General Status Questionnaire, Health-Promoting Lifestyle Profile-Ⅱ (HPLP-II), Fear of Progression Questionnaire Short Form (FoP-Q-SF), and Shortened Chinese Version of the Family Resilience Assessment Scale (FRAS-C). The Model 4 and Bootstrap programs in the Process 3.3 plugin were used to analyze the mediation effect of family resilience between fear of recurrence and health-promoting behaviors. ResultsThe total score of HPLP-II was (105.00±14.14), the total score of FoP-Q-SF was (20.69±6.04), and the total score of FRAS-C was (102.57±16.48) in elderly stroke patients. In elderly stroke patients, fear of recurrence was negatively correlated with health-promoting behaviors and family resilience, and family resilience was positively correlated with health-promoting behaviors (all P＜0.05). Family resilience had a partial mediation effect between fear of recurrence and health-promoting behaviors, accounting for 27%. ConclusionThe level of health-promoting behaviors in elderly stroke patients is relevantly low, family resilience has a mediation effect between fear of recurrence and health-promoting behaviors, and fear of recurrence can not only directly affect the health-promoting behaviors of elderly stroke patients, but also indirectly affect the health-promoting behaviors of elderly stroke patients through family resilience.