Background <p>Hearing loss is highly prevalent among the older population, and elder self-neglect will become a prominent issue worldwide as the population ages. The purpose of this study was to examine if hearing loss is associated with self-neglect in old adults.</p> Method <p>Data are from the wave 3 (2494 participants) of the Ma’anshan Healthy Aging Cohort (MHAC) in China. Multiple linear regression models and structural equation models were adopted to examine the relationship between hearing loss, social support, depressive symptoms, and the self-neglect.</p> Results <p>The results showed that hearing loss, social support, depression, and self-neglect were significantly correlated (<i>P</i> &lt; 0.001). Hearing loss could not only have a direct positive impact on self-neglect older adults (<i>β</i> = 0.046; 95% CI, 0.036, 0.056), but also indirectly affect self-neglect through three pathways: an independent mediating effect of social support (<i>β</i> =  − 0.014; 95% CI, 009, 0.019), an independent mediating effect of depression (<i>β</i> = 0.029; 95% CI, 0.022, 0.037), and a chain mediating effect of social support and depression (<i>β</i> = 0.003; 95% CI, 0.002, 0.004).</p> Conclusion <p>Hearing loss is associated with self-neglect, in which social support and depressive symptoms partly mediate the association. The findings suggest that the measures such as preventing and controlling hearing loss are crucial for reducing the severity of self-neglect in older adults.</p>