Objectives <p>To examine the prevalence of kinesiophobia and factors associated with it in older patients after stroke, and to explore how historical context, social relationships, physical condition, and psychological factors collectively shape the experience of kinesiophobia in later life.</p> Design <p>A mixed-methods study incorporating a cross-sectional quantitative survey and qualitative semi-structured interviews.</p> Methods <p>Between January 2024 and June 2025, 307 patients aged ≥ 60 years in the subacute or chronic phase after stroke were recruited from a tertiary hospital in Wuxi, China. Patients with severe cognitive impairment, psychiatric disorders, or non-stroke-related mobility limitations were excluded. Participants completed structured questionnaires assessing physical function, psychological status, and illness adaptation. Quantitative data were analysed using descriptive statistics, correlation analyses, and binary logistic regression to identify factors associated with kinesiophobia. Following the survey, semi-structured interviews were conducted from July to September 2025 with 18 participants to explore their experiences from a life-course perspective.</p> Results <p>Among the 307 participants, the prevalence of kinesiophobia was 64.8% (199/307). Quantitative analysis identified muscle weakness, fear of falling, frailty, and anxiety as factors associated with a higher likelihood of kinesiophobia, while age ≥ 81 years, exercise self-efficacy, and illness acceptance were statistically associated with a lower likelihood of kinesiophobia. Qualitative analysis revealed four core themes: historical time and place, linked lives, timing in lives, and human agency, highlighting the interplay of early-life experiences, cultural values, family interactions, environmental barriers, and cognitive appraisal in the development of kinesiophobia.</p> Conclusion <p>Kinesiophobia in older patients after stroke is influenced by a combination of physical, psychological, social, and experiential factors. These findings may inform comprehensive nursing assessments to identify patients who may be at risk of kinesiophobia and to guide the development of individualised rehabilitation and home-care strategies that support safe exercise participation.</p> Impact <p>Kinesiophobia should be integrated into routine nursing assessments for older patients after stroke. Applying assessment findings to care planning and home-care guidance may help identify activity avoidance and inform strategies to support rehabilitation engagement.</p> Patient contribution <p>Patients participated in surveys and semi-structured interviews but were not involved in study design or data analysis.</p>