This study aims to evaluate sociodemographic information, lifestyle, physical and mental health status, and otological symptoms factors associated with the accuracy of the Hearing Handicap Inventory for the Elderly Screening version (HHIE-S) in older people, which helps to increase the efficiency of hearing screening. Participants aged over 60 years who had not undergone professional hearing examinations were recruited from July 2023 to November 2024. The assessments consisted of age, sex, body mass index, living alone, education background, occupation, history of smoking, alcohol consumption, noise exposure, hypertension, diabetes, coronary heart disease, cerebrovascular disease, cognitive function, anxiety, depression, tinnitus and vertigo, along with HHIE-S and pure tone audiometry. The rate of total accuracy, total inaccuracy, false negative, and false positive were calculated, and factors associated with the false negatives and false positives of the HHIE-S were analyzed via multivariate logistic regression analysis. The results revealed that 773 participants (aged 60-93 years) were included, and the total inaccuracy rate of the HHIE-S was 33.11%. Among individuals with normal hearing, the false positive rate of the HHIE-S was 13.64%, while the false negative rate was 36.35% among individuals with hearing loss. Tinnitus (OR = 24.77, 95% CI 4.91-124.89) was the main factor contributing to false positives of HHIE-S. However, the significantly associated factors with false negatives of HHIE-S were living alone (OR = 1.96, 95% CI 1.21-3.17), smoking (OR = 1.83, 95% CI 1.23-2.70), cognitive decline (OR = 1.54, 95% CI 1.11-2.16), anxiety (OR = 1.51, 95% CI 1.02-2.22) and hypertension (OR = 0.65, 95% CI 0.46-0.91). Therefore, even when the HHIE-S ≤ 8 during hearing screening for the older people, there is still a possibility of hearing loss. Vigilance should be maintained associated factors such as living alone, smoking, cognitive decline and anxiety.© 2025. The Author(s).