That's good you have run Disk First Aid, and that you have kept all your applications up to date. However, you also need to do disk cleanup/maintenance/repairs, from a software perspective. For disk cleanup, you can start doing some of it yourself. Some examples:
1. Get rid of prior versions of software. For example, I use the venerable program Onyx for disk cleanup (I'll talk more about it below). I keep the prior version in a folder I have entitled "Useful Software" (I have quite a few other programs there also). When a newer version comes out, I install and test it. As usual, it works. So, I proceed to save that new version to its appropriate folder, and get rid of the 2nd prior version. No sense cluttering up my drive (SSD in my case).
2. I use Outlook 2016 as my EMail client, and whenever I delete an EMail, I get rid of it permanently. There is a simple keyboard combination I use for this. Again, I don't want to clutter up my drive.
Now, as for some more disk cleanup, and disk maintenance/repairs, there are a number of excellent products out there, both free and commercial, that can help you with that. Myself I use the excellent freeware program Onyx, available from here:
https://www.titanium-software.fr/en/onyx.html
(Make sure you get the right version). Onyx has been around for quite some time, has had numerous excellent reviews, and is good at what it does. I also use the excellent program TechTool Pro for more extensive disk cleanup/maintenance/repairs. Here is a link that discusses TechTool Pro:
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https://www.micromat.com/products/techtool-pro
Like Onyx, it has been around for quite some time, works well, and is rock solid. I depend upon both Onyx and TechTool Pro.
Even with those products, one needs to follow a time line when to use them. Myself, I am doing "self" disk cleanup on a daily basis (actually numerous times each day). Also, I run Onyx, TechTool Pro, and SuperDuper! (for my backups) once a week, usually on Saturdays. I havre been following all that for so long, it is second nature to me. The result is that I rarely (if ever) have issues with my machines.
Additionally, if I want to completely get rid of an application, I use the excellent freeware program AppCleaner, available from here:
https://freemacsoft.net/appcleaner/
As you can see, besides getting rid of the application itself, it gets rid of just about all the other files associated with the app.
Finally, if you want to proceed with a clean installation of Sierra OS 10.12.6, again doing that with a Time Machine backup is OK< but definitely labor intensive (and time consuming). Myself, I use SuperDuper! for my backups, and doing a clean installation of the Mac OS is much smoother from a SuperDuper! backup (plus less time consuming). If you are interested in doing your backups that way, I can fill you in with some information.