Objective To investigate the status quo of fear of falling in elderly stroke patients with pre-frailty and analyze its influencing factors. Methods A cross-sectional survey research method was adopted. From January 2021 to January 2025, 305 elderly patients with pre-frailty stage of stroke in the 904th Hospital of the Joint Support Force of the People's Liberation Army were selected using the convenience sampling method. The general data questionnaire, Fried frailty scale, Falls Efficacy Scale-International (FES-I), Berg balance scale and Barthel index were applied for evaluation. Stepwise multiple linear regression analysis was performed to analyze the related factors affecting patients' fear of falling. Results The total score of FES-I was (41.25±11.74) points, and the incidence rate of fear of falling was 75.74% (231/305). Age, recent history of falls, multiple drug use, use of walking aids, pain, balance function, family support level, Barthel index, concurrent underlying diseases and slow walking speed were the influencing factors of FES-I score (all P<0.05). Decreased balance function, low family support level, use of walking aids, slow walking speed, pain and recent history of falls were independent influencing factors (all P<0.05). Conclusion The fear of falling is at a high level in elderly patients with stroke and pre-frailty. Intervention measures should focus on balance function training, rational evaluation of medication, gait and muscle strength training, in order to reduce fear of falling and related risks.