Living conditions and life satisfaction before and after stroke were assessed in 80 patients with acute stroke (mean age 73 years). The results were compared with a general elderly population. Already prior to their stroke the patients had more health problems, lower functional ability, more passive leisure time and lower global life satisfaction. Low life satisfaction was associated with dependence in the activities of daily living (ADL). Economic resources, social network and psychiatric morbidity before stroke did not differ from the general elderly population. At 3 months of follow-up, almost half of the patients reported low life satisfaction, compared to only 2% in the national sample. Major depression and ADL dependence were associated with low life satisfaction after stroke. We conclude that much of the disability and handicap seen in stroke patients is present already before the stroke. Stroke-related deterioration of ADL performance, major depression and social disintegration after stroke interact to further reduce life satisfaction for the stroke victims and their families.