[airspirit]

Another option may be the watercooling route. Slapping one of the external kits to your machine (such as the EXOS) may quiet things down significantly, allowing you to remove many of your fans altogether, and they are almost painless to install. Another option would be running one of the phase change kits such as the Prometia or Vapochill. In the Prommy you'd have to replace the stock fan with a quiet Panaflo or the equivalent, though that is pretty easy. The only problem with that is with arthritic hands it may be difficult to install the socket sealing materials, though I don't know how much dexterity you have left (my Grandma has arthritis really bad and can't even dial a phone ... I know how bad it can get!). That option would also quiet things down quite a bit due to being able to remove most of the fans.

High end air cooling is an art of diminishing returns: many times four fans do just as much as ten. Consider the idea that even if you stick with aircooling, you may not need all of the fans you're using. Try unplugging a few altogether and seeing what it does to your temps. Most people I've helped with high-end aircooling have had the best results with one 120mm fan over the CPU HSF, one 80mm fan exhausting in the lower front, one 80mm fan exhausting in the mid-rear, and one exhausting via the PSU, with all of the fans except for the HSF detuned to 7V. The only possible mod to this would be if they had a really hot GPU, in which case another detuned 80 would be blowing air in through the side over the graphics card. If done right with a good CPU HSF, the whole system can stay under 47dB.

That's just my .02, though.