Objective To explore the current status of health behaviors in elderly stroke patients and its correlation with symptom clusters, and to provide reference for healthcare professionals to carry out precise symptom management to improve the patients′ health behaviors.Methods From December 2023 to May 2024, 500 elderly stroke patients were conveniently selected for the study.The general information questionnaire, Stroke Patients′ Symptom Experience Scale （Stroke-SES） and Health Behavior Scale for Stroke Patients （HBS-SP） were used for the investigation.Results The total score of HBS-SP was (73.18±15.45).The top three prevalent symptoms were limb weakness （94.6%）, memory decline （93.0%）, and inability to maintain physical balance （89.8%）.Exploratory factor analysis identified three symptom clusters, which were physical activity-related symptom cluster, emotion-related symptom cluster, and cognitive impairment-fatigue symptom cluster,with a cumulative variance contribution rate of 70.210％.The total score of HBS-SP was negatively correlated with all three symptom clusters （all P＜0.05）.Stratified regression analyses revealed that the three symptom clusters could explain 43.5% of the total variance in health behaviors.Conclusion Elderly stroke patients have multiple symptom clusters, and the more severe the symptom clusters are, the lower the level of health behaviors are.It is recommended that clinical staff pay close attention to the occurrence of symptom clusters in patients, and formulate a scientific and precise symptom management strategy in order to enhance the level of health behaviors and improve the quality of life of the patients.