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

Da et al. make an important contribution by linking SNAP participation to trajectories of cognitive decline in older adults, offering timely evidence that nutrition assistance may confer neuroprotective benefit [1]. However, we believe there are additional limitations beyond those noted in the article that warrant discussion. Da et al. report heterogeneity by race and ethnicity, with weaker benefits observed among non-Hispanic Black and Hispanic participants [1]. These findings provide strengthening evidence that for non-white individuals, their current benefit enrollment may be insufficient to offset the broader constellation of unmet social and economic needs that disproportionately affect many older adults in these groups [2]. This reflects a more persistent research gap in the field of benefit assistance. Research demonstrates that households of color are more likely to experience food insecurity [3], and that even among SNAP enrollees, food insecurity persists at high rates, particularly among low-income households that include someone with a disability [4]. Studies further show that single benefit programs are often inadequate for high needs groups such as single-mother households [5] and that poorer, non-English-speaking families are less likely to be enrolled in multiple benefit programs [6]. These enrollment disparities mean that some groups may remain below critical economic thresholds despite SNAP participation, potentially explaining the persistent cognitive decline observed in certain populations in this study. The difficulty in examining concurrent enrollment in government programs alongside SNAP reflects the larger issue of limited availability of integrated datasets linking multi-program participation to health outcomes. In this context, evaluating SNAP in isolation may obscure how combined access to food, cash, health, housing, and utility supports together shape cognitive aging, and we believe future studies would benefit from the inclusion of a reported measure of food or economic security to improve comparability across groups. Additionally, we concur with the authors' call for policies that streamline SNAP enrollment and recertification, yet we emphasize that effective policy and research responses must also move beyond single-program solutions. The volatility of the benefits landscape has also made clear the need for interoperable, multi-program enrollment systems capable of adapting to changing eligibility requirements and program availability. In this space, community-based organizations focused on benefits enrollment can play a pivotal role in both improving older individuals' program access while also producing high-quality data for longitudinal health research [7]. One example of this approach comes from our work at Link Health, a Boston-based nonprofit organization where we have developed and studied an integrated enrollment model. This model embeds trained patient navigators within federally qualified health clinics and community centers and uses a simple five-question screener to simultaneously determine eligibility for nine different public benefit programs, including SNAP [8]. Through this model, Link Health screened 14,454 individuals and successfully enrolled over 3028 into benefit programs, amounting to more than $3.4 million in aid [9]. Integrated, community-based benefits navigation hubs can directly address the barriers Da et al. highlight while also strengthening the evidence base on benefits and cognitive aging. By supporting applications across multiple programs through a single, coordinated workflow, these hubs reduce administrative burden for older adults and other community members seeking assistance. They also create higher-quality longitudinal data by capturing program-specific enrollment dates, continuity, and multi-program participation over time, enabling researchers to test whether sustained, bundled participation across nutrition, cash, health, housing, and utility supports helps explain the racial and ethnic heterogeneity Da et al. observe in SNAP's cognitive benefits. Future studies should leverage data from these benefits navigation hubs to examine the health effects of sustained participation not only in SNAP, but also in combinations of safety-net programs, particularly among populations for whom SNAP alone may be less protective. In parallel, policymakers should consider embedding patient navigators in healthcare and community settings as a scalable approach that addresses both the enrollment barriers and the measurement limitations identified by Da et al. M.P.M., M.C.G. drafted the manuscript; M.P.M., M.C.G., and A.F.M. edited the manuscript and reviewed for critical content; all authors have read and approved the manuscript. All authors involved in the production of this work are listed and approved the manuscript prior to submission. All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. The authors have nothing to report. The authors have nothing to report. A.F.M. reports a relationship with Link Health that includes: consulting or advisory. Link Health is a branch of A Healthier Democracy, founded by A.F.M. where M.P.M. and M.C.G. are research fellows. This publication is linked to a related reply by Da and Song. To view this article, visit https://doi.org/10.1111/jgs.70489.