Background <p>Chronic low back pain (LBP) impairs postural control and quality of life (QOL), yet findings on disability and postural sway in older women with LBP remain inconsistent.</p> Purpose <p>To investigate gender differences in postural sway during unilateral stance under varying visual conditions, and to examine relationships among sway parameters, disability, and QOL in older adults with LBP.</p> Methods <p>Seventy-seven community-dwelling adults with LBP (46 women, 31 men) completed three unilateral standing trials under eyes-open and eyes-closed conditions on a force platform. Outcome measures included anteroposterior (AP) and mediolateral (ML) sway ranges, the Oswestry Disability Index (ODI), Fall Efficacy Scale (FES), Tampa Scale of Kinesiophobia (TSK), and Short Form-36 (SF-36) QOL domains.</p> Results <p>A significant gender × direction × trial interaction (F = 4.47, <i>p</i> = 0.04) indicated that men and women adapted differently across repeated trials depending on sway direction. Under eyes-closed conditions, AP sway differed significantly across trials (<i>p</i> &lt; 0.05). Women exhibited smaller AP sway and no significant associations among ODI, emotional well-being, or other QOL domains, whereas men showed strong correlations among ODI, FES, TSK, and QOL measures.</p> Conclusion <p>Older women with LBP demonstrated reduced AP sway under visual deprivation, indicating a compensatory postural control strategy. As a result, balance strategies should emphasize enhancing fall efficacy, physical function, and pain management in women, while prioritizing emotional well-being and role-related QOL in men.</p>