Reply to: When One Is Not Enough: Multi‐Program Needs in Older Adults at Risk of Cognitive Decline

We thank Maier and colleagues for their thoughtful commentary on our recent article examining the association between Supplemental Nutrition Assistance Program (SNAP) participation and trajectories of cognitive decline among older adults [1]. In our study, we found that SNAP participation was associated with slower cognitive decline, suggesting that food assistance programs may play an important role in supporting cognitive health among economically vulnerable older adults. At the same time, we observed heterogeneity in these associations across racial and ethnic groups, highlighting the possibility that structural and social determinants may shape how individuals experience the benefits of nutrition assistance programs. Maier et al. raise an important point that SNAP operates within a broader system of social and economic supports that may collectively influence health outcomes in later life. We agree that many older adults facing financial hardship experience multiple overlapping challenges, including housing insecurity, limited healthcare access, and difficulty affording utilities or medications [2-4]. These co-occurring stressors, which disproportionately affect racial and ethnic minority populations in the United States, may help explain the weaker associations observed among certain racial/ethnic groups in our study. It also explains that SNAP participation alone may not fully capture the cumulative impact of socioeconomic disadvantage. Our analysis focused specifically on SNAP participation using harmonized longitudinal aging cohort data, which provide detailed measures of cognitive trajectories but limited information on concurrent enrollment in other safety-net programs. This constraint reflects a broader limitation in epidemiologic studies [5, 6], where SNAP participation is often examined in isolation. Building on Maier et al.'s point, future research is warranted to incorporate more comprehensive measures of economic conditions and multi-program participation to better capture how the social supports influence cognitive aging. In this context, integrated enrollment initiatives, such as community-based benefits navigation programs highlighted by Maier et al., may offer important opportunities for both policy innovation and research. By assisting individuals in accessing multiple programs through a coordinated process, these models may help reduce administrative barriers for older adults seeking assistance. At the same time, such initiatives could generate richer data on enrollment timing, continuity, and combinations of benefits over time, enabling researchers to better examine how sustained or bundled participation across programs influences health outcomes. From a research perspective, evaluating combinations of safety-net programs represents a promising direction for future work. Participation in multiple programs addressing nutrition, housing, healthcare, and financial stability may provide synergistic benefits that help mitigate the long-term effects of socioeconomic disadvantage. This multi-domain perspective is consistent with evidence suggesting that cumulative and modifiable factors jointly contribute to cognitive reserve and aging [7]. However, relatively few studies have directly examined how combinations of social safety-net programs operate together to influence cognitive outcomes. Mechanistically, multi-domain supports may influence cognitive health through several interconnected pathways. Improved nutritional access may reduce cardiometabolic risk [8], while stable housing and financial resources may alleviate chronic stress. Both of them are linked to cognitive decline [9]. In addition, greater healthcare services accessibility may help the management of chronic conditions, such as hypertension and diabetes, which are well-established risk factors for cognitive impairment [10]. The combination of these comorbidities among socioeconomically disadvantaged populations further highlights the importance of addressing multiple domains simultaneously, rather than through single-program interventions alone. At the same time, our findings suggest that SNAP participation itself may help with promoting healthy aging. By improving access to food and reducing financial strain related to nutrition, SNAP may help address key risk factors for cognitive decline among older adults experiencing economic hardship. In conclusion, these considerations suggest that while multi-program participation may contribute to additional benefits, SNAP remains a critical and actionable intervention aimed at reducing disparities in cognitive aging. We appreciate Maier et al.'s thoughtful engagement with our work and their emphasis on expanding research beyond single-program analyses. Continued efforts to improve both access to safety-net programs and the data systems used to evaluate them will be essential for understanding how social policies shape cognitive health across the life course. L.D. drafted the manuscript. S.S. edited and critically reviewed the manuscript. All authors have approved the manuscript before submission. The authors have nothing to report. The authors declare no conflicts of interest. This publication is linked to a reply article by Maier et al. To view this article, visit https://doi.org/10.1111/jgs.70488.