I found X7 and X9 shifters have more play before the shift ratchet comes into contact with the lever arm. X0 shifters are incredibly smooth, have zero play in them and have the lightest action of any shifter I’ve used, and I think I’ve used them all (Deore, SLX, XT, XTR, X4, X5, X7, X9, X0) they are a worthy investment, especially given your health concerns.
XT has a much lighter action than X9, but not as good as X0, so it may be worth swapping to those if you want to save a bit of cash – but given you’ll need a new rear mech to match, it’s debatable whether it’ll be cheaper to just go X0 – personally I’d get some secondhand X0s – they last an age, and are brilliant in mud.
The biggest factor will be cable friction, whether that be from mud or tight outers. I’d recommend the Shimano SP41 outers with some teflon coated inners – it again will reduce the effort required to shift. I’d also advocate giving your outers a squirt of gt85 after each ride to drive out any water or dirt and keep things running well.
IMO gripshift in the winter isn’t ideal – as when they get muddy and wet they become hard to use – and again this is my experience of using them for about a month in the winter, your experience may vary.
Good shifters are key – the rear mech doesn’t play a part – it moves the amount the shifter indexes it to – so don’t bother upgrading the rear mech from x7 or x9 to x0, you really wont notice the difference.