A TV and radio ad campaign for the Alzheimer's Society received 235 complaints from viewers. The campaign is hard-hitting and emotive, but the ASA ultimately concluded that it was not in breach of the BCAP Code.
Three TV ads and a radio ad for Alzheimer's Society, seen and heard in March and April 2024:
a. The first TV ad featured a man talking at his mum's wake and said, "Mum first died on the 12th of May 2019 when she couldn't work out how to prepare her legendary roast anymore. The style icon of the Covington estate. Mum died as a fashionista the day she couldn't get dressed into her colourful outfits. Some of the outfits we will all be glad to see the back of. She died as the queen of Christmas when she refused to have dinner with the family. She died again when she asked me, her son, what my name was. She died as dad's rock after 52 years of marriage the day she looked straight through him. On the 10th of March 2024 mum died a final time, surrounded by her family." A voice-over then said, "With dementia, you don't just die once. You die again and again and again. Which is why at Alzheimer's Society we'll be with you again and again and again."
The ad switched between scenes of home videos of his mum when she was younger enjoying time with friends, at Christmas and preparing a meal, and scenes of when she was older, including being supported by her son and a carer.
b. The second TV ad was a shortened version of ad (a). It also included the voice-over that stated, "With dementia, you don't just die once. You die again and again and again. Which is why at Alzheimer's Society we'll be with you again and again and again."
c. The third TV ad was a further shortened version of ad (a). It also included the voice-over that stated, "With dementia, you don't just die once. You die again and again and again. Which is why at Alzheimer's Society we'll be with you again and again and again."
d. The radio ad said, "Mum first died when she couldn't work out how to prepare her legendary roast. Mum died again when she asked me what my name was. On the 10th of March 2024 mum died a final time, surrounded by her family." Another voice said, "With dementia, you don't just die once. You die again and again and again. Which is why at Alzheimer's Society we'll be with you again and again and again."
Complaints
235 complainants contacted the ASA as they believed the ads were excessively distressing, offensive and irresponsible.
Alzheimer's Society response
Alzheimer's Society said that they were conscious from the outset that a campaign about the realities of dementia would be sensitive and potentially challenging for some audiences, and that they approached all aspects of the campaign with due care. The core message of the ads was truthful, powerful and vitally important to convey. The history of their cause had demonstrated that it did not serve those with dementia to shy away from highlighting the tough reality they faced, however difficult it might have been to do so.
The script itself was authored by someone who had personal experience of dementia, specifically they had lost their father to dementia 18 months previously, for whom 'the long goodbye' rang true. They also consulted extensively with experts during the development of the campaign, including by running focus groups with a broad representative sample of all audience groups, collaborating with Alzheimer's Society networks, sourcing scenarios represented in the ads from their networks, expert consultations and internal knowledge. The ads were approved by Clearcast and Radiocentre, with the agreement not to schedule the TV ads in media that could be viewed by children.
The objectives of the 'The Long Goodbye' campaign, which the ads were a part of, was to raise public awareness that dementia was the leading cause of death in the UK and to deliver more support to carers. Public understanding of dementia's seriousness and scale lagged behind conditions like cancer and heart disease. Only one in 10 knew that dementia was the biggest killer in the UK and fewer than half realised it was a terminal illness. This compounded the suffering faced by millions of people every year, and made it easier for leaders across politics, health and social care to avoid addressing the huge challenges posed by dementia. Alzheimer's Society was the UK's biggest dementia charity, but not enough people used their services to help them navigate the life-changing challenges of dementia. In order to achieve those objectives, they needed to bring dementia out of the shadows and show people that they understood what they were going through and be honest about the brutal truths that lay behind it. Dementia was a terminal illness and currently there was no cure for it; it robbed those who suffered from it of their memories and personality traits. They believed that if they sugar coated those facts, as much dementia discourse had previously done, the consequences would be ever more damaging. More people going through dementia would feel isolated, sidelined and stigmatised, and that their devastating experiences were the exception, not the rule. They would assume that charities and organisations like Alzheimer's Society could not support them. Unless they showed dementia as it really was, dementia would never become the priority it needed to be, and it would go on destroying lives. They were not seeking to exploit the experiences of those living with dementia to raise money; they were seeking to improve the care and services to which those receiving a diagnosis would have access to and encouraged them to seek that care.
The most common fears around dementia were not just the loss of one's character and cognition over time, but the loss of one's friends and family – a lonely end of life. Unlike many campaigns for older people's charities, these ads celebrated a very full life and showed a person actively loved and supported to the very end by their friends and family. This was specifically designed to draw attention to the person 'behind' the dementia and to avoid reductive stereotypes that focused solely on the 'patient', defining them by their dementia. The portrayal offered a positive alternative to the perception that, too often, friends and family withdrew from the person with dementia, leaving many to spend the end of their lives largely alone. They purposefully chose not to show that and to instead emphasise the importance and possibility of love and support, including from Alzheimer's Society, until the very end.
The ads were an honest depiction of the defining tragedy of dementia as a degenerative disease; namely, the way it gradually eroded the precious character traits of loved ones, which created the sensation of an extended, premature grieving process. There was nothing new or extreme in the ads. They drew on a well-established framing of dementia's unique cruelty, as loved ones mourned the steady loss of the person they knew. Academics and medical professionals called this 'anticipatory grief'. According to Healthcare Improvement Scotland's National Clinical Guidance, anticipatory grief for informal carers of people with dementia started long before the physical death of their dependent, and that carers experienced multiple losses. It was one of the many reasons why carers and those living with dementia may have felt guilty and embarrassed, and stopped themselves seeking support. They did not want to say they were already grieving for a living friend or loved one. The ads specifically sought to highlight and normalise that difficult reality, and make more people realise that anticipatory grief, and the personal tragedies it surrounded, was no reason to feel ashamed. They made clear in the ads that the protagonist's (Anna's) son, and the voice-over, were speaking metaphorically, and that Anna had not literally died 'again, again and again' by showing her alive and cared for throughout the ads before her actual death. Post-campaign analysis confirmed that an overwhelming majority of people interpreted the ads in that way.
In popular culture, anticipatory grief was called 'The Long Goodbye'. There were many other examples that used anticipatory grief as a lens for shedding light on dementia, and many of those referred to 'The Long Goodbye'. They provided a list of examples which included news stories, health pages, TV programmes, a novel, a memoir, and a speech to Alzheimer's Research UK.
Media coverage of the campaign had been ten times more positive than negative. Of the online comments, 80% had positively engaged with the campaign, with an overwhelming number of carers, especially those who had lost loved ones to dementia, expressing relief and gratitude that they had finally seen their reality articulated. Post-campaign analysis, which involved a survey of a representative sample of the population, suggested that three out of four people who saw the ads would contact Alzheimer's Society if they were worried about memory issues – an increase of 8% on their previous campaign. Some of the key objections raised by complainants regarding the language, meaning and offensiveness were confined to a very small segment of the population. Nonetheless, they took all perspectives seriously, and would continue to gather a range of evidence to evaluate the effectiveness and impact of the ads and learn from it. They provided a copy of the methodology and results of the post-campaign analysis that they had carried out so far. They also provided testimonials from two experts in dementia who were supportive of the ads and their aims.
Clearcast, responding in relation to ads (a) – (c), said that whilst they understood the ads could have been upsetting, they did not believe they were irresponsible or exploitative. They were very powerful and emotive which was due to the seriousness and importance of the subject. They showed a person who was surrounded by their family and was clearly very loved. They were never presented as a burden and while it was sad, they showed moments of true care.
When approving the ads, they took into consideration that the Alzheimer's Society was an authority on the matter and that they not only provided support for people caring and living with Alzheimer's, but they also invested in research into the disease.
Radiocentre, responding in relation to ad (d), said that given the urgent need families had for support, they felt that a reasonably robust approach was justifiable. The ad was to the point, but they felt that it was adequately restrained and sensitively done. Radio broadcasters followed the scheduling care advice they issued. They endorsed the points raised by Alzheimer's Society.
ASA's ruling
The BCAP Code stated that ads must be prepared with a sense of responsibility to their audience and society. Additionally, they must not cause serious or widespread offence, nor distress the audience without justifiable reason.
The ASA considered that whilst the portrayal of the progression of dementia in the ads was an accurate reflection of one family's experience which represented the gradual loss of a person with dementia which many felt, it was nonetheless emotive. It was likely to resonate strongly with those who had dementia themselves and those who had someone close to them with dementia. Additionally, the ads, and particularly the references to death, could cause a significant emotional impact with a wider audience.
The ASA said that, whilst there were many different types of dementia, they were all progressive and involved symptoms including, amongst others, memory problems and changes in emotions that worsened over time. They considered that viewers and listeners of the ads would interpret the references to the woman dying when she was no longer able to do the things she had previously been able to do as meaning that she had lost aspects of her character and was no longer the same person that she used to be. They would not interpret it literally.
The ASA considered that the audiences would understand that the overall message of the ads was to raise awareness of dementia and the support that Alzheimer's Society provided to those caring for people with dementia. They acknowledged the subject matter could be difficult for members of the wider public to watch and hear, but they considered the context of the overall message, as raising awareness and promoting support, was likely to be understood in the context of an important cause.
Some complainants were particularly concerned about the impact the ads might have on those who were recently diagnosed with dementia, particularly early-onset disease. The ASA understood that there was evidence those groups were at an increased risk of suicide, and therefore providing adequate support to those recently diagnosed was therefore particularly important. The ASA acknowledged that the ads, and particularly the references to dying "again and again and again" were likely to cause potentially significant distress to some people with Alzheimer's, particularly to those who had recently been diagnosed. However, they considered that the ads presented an accurate and sensitively delivered portrayal of the reality of the disease. They said that, importantly, the ad emphasised immediately following the reference to dying "again and again and again" that Alzheimer's Society provided support to those with dementia and those caring for people with dementia at all stages. Overall, they concluded that any distress caused was justified by the messages conveyed as part of the campaign.
The ASA therefore concluded that the ads were not irresponsible, did not cause serious or widespread offence, and did not cause unjustifiable distress.