Objective Using the actor-partner interdependence mediation model to explore the relationship between illness perception, coping styles and FOP in middle-aged and elderly maintenance hemodialysis patients and spouses. Methods A total of 239 pairs of middle-aged and elderly maintenance hemodialysis patients and their spouses from three tertiary care hospitals were selected and surveyed using the Fear of Progression Questionnaire Short Form, the Simplified Coping Style Questionnaire, and the Brief Illness Perception Questionnaire. Results Middle-aged and elderly maintenance hemodialysis patients scored (38.48±8.50) points in FOP, and spouses scored (38.05±8.21) points. Patients′ FOP was positively correlated with their own and their spouses′ illness perceptions, and negative coping styles，while negatively correlated with positive coping styles (all P<0.05); spouses′ FOP was positively correlated with their own as well as patient′s illness perception and negative coping styles, while negatively correlated with positive coping styles (all P<0.05). In the actor-partner interdependence mediation model, both parties′ illness perceptions were directly predictive of their own FOP（both P＜0.05）; own illness perception affected own FOP through their own positive coping style（both P＜0.05）, patient′s illness perception positively predicted spouse′s FOP（P＜0.05）；both parties′ illness perception had an impact on the other partner′s FOP through the patient′s positive coping style（both P＜0.05）. Conclusion There were dyadic interactive effects of illness perception and coping styles on FOP in middle-aged and elderly maintenance hemodialysis patients and their spouses; patients′ positive coping mitigated the effect of both parties′ illness perception on the other party′s FOP. Clinical staff can develop interventions that enhance both partners′ positive coping styles ,in an effort to reduce both partners′ fear of disease progression.